Reinforcing the links in the cold-chain
Turkmenistan’s partnership with the private sector sets innovative example for the region.
“Cold-chain infrastructure” is the term given to the complex network of processes, equipment and services used to transport and preserve vaccines in a controlled-temperature environment. The success of any vaccine programme in a country is dependent on the soundness and continuity of all the links in this chain.
The maintenance of the colossal cold-chain infrastructure required is a challenge for immunization workers in many parts of the CEE/CIS region. The outdated equipment, the lack of spare parts, the unclear designation of responsibilities and the shortage of funds at the sub-national level are clear causes of this issue. UNICEF field teams have witnessed numerous cases where medical staff had resorted to using their own resources to repair the vital refrigeration equipment in their outposts. These are examples of devotion to the immunization cause by health workers and despair in the face of the inefficiency of the system but this is far from the needed systematic solution to the problem.
Since 1996, UNICEF, jointly with other regional immunization partners such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), World Bank, GAVI Alliance, has supplied thousands of immunization posts with refrigeration equipment and has supported the establishment of cold-chain maintenance units at public health institutes in five countries within the region. The recent economic recovery has freed some necessary funds for boosting the primary health sector in countries but it has not necessarily brought an efficient solution to this problem. The maintenance and repair of cold-chain equipment is performed by health care workers even though these roles are clearly non-medical functions.
In 2006 Turkmenistan’s Ministry of Health made important steps to improve the management of the cold-chain system. The maintenance functions were “outsourced” to specialized institutions. The Health Ministry reached an agreement with the Turkmen Company “Turkmentorgremont” for the service and the maintenance of the immunization refrigeration equipment in Ashkhabad city, regardless of the origin of the equipment (locally purchased or UN-supplied). All provincial cold rooms were also encouraged to engage in similar service arrangements.
The transition of this maintenance function from the medical institutions to specialized and private institutions, has allowed the Ministry of Health to expect an increase in the quality of repair, an improvement in the maintenance and in the overall utilization of the equipment. All the costs of the repairs are to be covered by the Ministry of Health following the presentation of receipts certified by the health care facilities.
Similarly, an agreement with the “Turkmenistan meat and dairy products industry” was reached for the use of their cold store facility for the temporary storage of vaccines in the event of power cuts or if there is a need for the short-term storage of large quantities of vaccines such as during mass immunization campaigns.
The "outsourcing" of cold-chain functions to the private sector is an innovative practice in the region that UNICEF wishes to promote as a part of the overall emergency preparedness efforts in countries where gaps in the cold-chain capacity still exists.