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Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance

Tuesday, 4th of April 2017

Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X16309410

Vaccine

Volume 35, Issue 17, 19 April 2017, Pages 2198–2202

 

Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance ^☆

• Pat Lennon^a, , , 
• Brian Atuhaire^b, , 
• Shahrzad Yavari^c, , 
• Vidya Sampath^d, , 
• Mercy Mvundura^a, , 
• Nithya Ramanathan^c, , 
• Joanie Robertson^a, 
• ^a PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
• ^b PATH, PO Box 7404, Kampala, Uganda
• ^c Nexleaf Analytics, 2356 Pelham Avenue, Los Angeles, CA 90064, USA
• ^d VillageReach, 2900 Eastlake Avenue East, Suite 230, Seattle, WA 98102, USA

Received 11 May 2016, Accepted 30 September 2016, Available online 30 March 2017

http://dx.doi.org/10.1016/j.vaccine.2016.09.068

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Open Access funded by Bill & Melinda Gates Foundation

Under a Creative Commons license

  Open Access

Highlights

• Eighty-six refrigerators were evaluated for non-performance in Mozambique and Uganda.

• Communicating equipment failures resulted in actions that addressed failures.

• Systematic monitoring, failure analysis, and reporting strengthen the cold chain.

Abstract

Vaccine cold chain equipment (CCE) in developing countries is often exposed to harsh environmental conditions, such as extreme temperatures and humidity, and is subject to many additional challenges, including intermittent power supply, insufficient maintenance capacity, and a scarcity of replacement parts. Together, these challenges lead to high failure rates for refrigerators, potentially damaging vaccines and adversely affecting immunization coverage. Providing a sustainable solution for improving CCE performance requires an understanding of the root causes of failure.

Project teams conducted small-scale studies to determine the root causes of CCE failure in selected locations in Uganda and Mozambique. The evaluations covered 59 failed refrigerators and freezers in Uganda and 27 refrigerators in Mozambique. In Uganda, the vast majority of failures were due to a cooling unit fault in one widely used refrigerator model. In Mozambique, 11 of the 27 problems were attributable to solar refrigerators with batteries that were unable to hold a charge, and another eight problems were associated with a need to adjust thermostat settings.

The studies showed that tracking and evaluation of equipment performance and failure can yield important, actionable information for a range of stakeholders, including local CCE technicians, the ministry of health, equipment manufacturers, and international partners such as the United Nations Children’s Fund, World Health Organization, and Gavi, the Vaccine Alliance. Collaborative efforts to systematically collect and communicate data on CCE performance and causes of failure will help to improve the efficiency and reach of immunization programs in low- and middle-income countries.