Strengthening the cold chain and access to immunization

Ms. Ramya Rajapakse (43) is a midwife attached to the office of the Medical Officer of Health (MOH), Galigamuwa – a small town about 70km northeast of Sri Lanka’s capital, Colombo. It is a busy day for her at the polyclinic at the MOH office where over 30 families had gathered.

The Galigamuwa MOH serves a population of around 80,000 and has 27 midwife divisions – geographical divisions that help manage community-level maternal and child healthcare. Midwives attached to the MOH oversee these divisions and serve as the community’s link to healthcare.

“I cover three midwife areas and have 350 families under my care. Today’s clinic is for all children under 5 years of age for regular health assessments and scheduled immunization,” Ramya explains.

“At the field level, as midwives, we keep track of the ages of the infants and young children and when they are due for their vaccines as per the national immunization guidelines, we remind the carers. There are clinics every Saturday and 2 weekdays every other week and the carers can bring their children accordingly.”

Once the child is over 5 years of age, their immunization schedule is supported at school level by the Public Health Inspectors (PHI) who are also attached to the MOH.

Sri Lanka boasts one of the best healthcare systems in the region with very strong immunization coverage for children and mothers and this polyclinic is a snapshot of how the 365 MOH offices located across the country continue to underpin the National Immunization Plan (NIP), that has been in effect since 1978, to ensure all children receive their vaccines on time.

Since 2013, UNICEF supported the strengthening of the NIP by equipping the existing cold chain with Ice-lined Refrigerators (ILR) – refrigerators with special ice-lining that help maintain the temperature at a safe level for vaccines even during electricity supply failure.

Additional support was provided in 2021 and 2022 by UNICEF to fill the cold-chain gaps with ILRs and Freeze-free vaccine carriers, ensuring quality vaccines reach a wider community The support also included log tags to enable monitoring of the ILR temperatures; emergency trays for all clinics ensuring they are equipped to handle any life-threatening effects of immunization; supply of water to field clinics that did not have access to the utility; and immunization registers for use in clinics.

“Our cold storage facility has now been upgraded to an ILR. This helps us store vaccines at the recommended temperature and maintain the potency of the vaccines,” Public Health Nursing Sister Anoma Peiris (51) explains the significance of this support, “the entire community depends on our clinics for their vaccines which are provided free of charge; regardless of their social status, ethnicity or religion, all families under the MOH purview bring their children to our field clinics for vaccines. Even though vaccines are available at privately run clinics, we have gained the public trust as a source for safe and effective vaccines.”

“The cold chain support we have received from UNICEF ensures our community continues to access high-quality vaccines. The support such as freeze-free vaccine carriers enables us to take our vaccines on longer distances to hard-to-reach areas without worrying about compromising the quality of the vaccines. Rukgahathenna is one such locality--about 25km away with minimal public transport for the community. Our team carries out a clinic there once a month to make sure the children and mothers receive their vaccines without delay.”

“This support will also be helpful for us to face any emergencies – both in terms of storage and transporting vaccines and ensuring accessibility to our community.”

Anoma continues to explain how the healthcare network of the MOH ensures all children receive their vaccines on time, “We educate the people about the importance of immunization. This is done when the midwives do their field visits and at these clinics. Therefore, all parents are eager to get their children immunized on time. The midwife reminds the parents when the children are due for inoculation. This system works very well and all children - girls and boys, receive their vaccines on time.

“Attention is required for children with special needs. These parents need assurance that its ok to immunize their children and they are also part of the immunization plan. We also ease accessibility for them by prioritizing them at the clinic.”

Rosy (29) and her husband are among the many parents who rely on the MOH for their children's healthcare and immunization. At the clinic today, their son, 18-month-old Abiner, who has received his DPT4 vaccines for protection against Diphtheria, Pertussis and Tetanus, is being soothed by the parents during the post-vaccine observation period. Rosy is a teacher and has taken time off from work to attend today’s clinic. “I got the reminder from the midwife that my child was due for his vaccines. I wanted to make sure he gets it on time,” Rosy explains.