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Reinforcing links in the cold-chain to preserve vaccines in Turkmenistan

© UNICEF Turkmenistan/2006/Popovic
A toddler in Turkmenistan receives the measles vaccine from nurse Gulaylek Perdzikova at the policlinic in Abadan.

By Dragoslav Popovich

ABADAN, Turkmenistan, 16 March 2007 – The immunization programme in Turkmenistan is being overhauled, with responsibility for maintaining the ‘cold chain’ – which preserves vaccines and keeps them safe for children – shifting from the vaccinators themselves to maintenance professionals.

A combination of UNICEF-supported training for frontline health workers and the outsourcing of maintenance to dedicated companies will improve the longevity of life-saving vaccines and ultimately save more lives.

Previously, medical staff have resorted to their own devices to prevent the vaccines from spoiling.

Continuity is essential

“I remember during times of frequent electrical power cuts at the clinic,” explained nurse Gulaylek Perdzikova at the policlinic in Abadan, “I was so worried that the vaccines would be destroyed that I used to take them home and store them in my own kitchen fridge.”

‘Cold-chain infrastructure’ is the term for 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 is dependent on the soundness and continuity of all the links in this chain.

The required maintenance of the colossal cold-chain infrastructure is a challenge for immunization workers in many parts of Central and Eastern Europe and the Commonwealth of Independent States region. Outdated equipment, a lack of spare parts, the unclear designation of responsibilities and a shortage of funds are to blame.

Since 1996, UNICEF and its partners – including the World Health Organization, the US Centers for Disease Control and Prevention, the World Bank and the Global Alliance for Vaccines and Immunization – have supplied refrigeration equipment for thousands of immunization posts and supported the establishment of cold-chain maintenance units at public health institutes in five countries in the region.

Cold-chain maintenance outsourced

However, the challenges for health care workers like Ms. Perdzikova have not been entirely solved by the new equipment. The maintenance and repair of cold-chain equipment is frequently performed by health workers, even though these are clearly non-medical functions.

“Recently we got a new refrigerator in the clinic, which is very sophisticated compared to the old one we had,” said Ms. Perdzikova. “In the first months after it was installed here I used to call my cousin, an electrician, to ask him to check I was using it correctly.”

In 2006, Turkmenistan’s Ministry of Health took important steps to improve the management of the cold-chain system. The maintenance functions were outsourced to specialized professionals, and the ministry reached an agreement with the Turkmen company ‘Turkmentorgremont’ for the service and the maintenance of the immunization refrigeration equipment in Ashgabat.

All provincial cold rooms were also urged to engage in similar service arrangements, with the cost of repairs covered by the Ministry of Health.

Courses for health workers

“The storage of vaccines for this year’s measles-rubella immunization campaign will be a real test for this partnership,” said the Head of the Epidemiological Department at the Ministry of Health, Maral Aksakova, referring to an agreement with the Turkmenistan meat and dairy products industry.

That industry has offered a facility for the temporary storage of large quantities of vaccines when needed – such as during mass immunization campaigns or in case of power cuts.

“I am very confident that our health professionals have received a good quality medical education and are able to resolve any medical issue related to the vaccination of a child,” said Mr. Aksakova. “But we have to admit that training on the maintenance and handling of cold-chain equipment is not properly represented in the curriculum of our medical schools.

“With UNICEF’s support, we have organized numerous training courses for frontline health workers,” he added.

UNICEF is encouraging other countries with gaps in their cold-chain infrastructure to follow Turkmenistan’s innovative lead.



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