Achieving sustainable, environmentally viable, solarized vaccine cold chain system and vaccination program-an effort to move towards clean and green energy-driven primary healthcare in Lebanon.

Introduction: Lebanon faces severe economic and energy crises, impacting its healthcare system, particularly vaccine storage. Traditional gas or kerosene-powered refrigerators often fail to maintain necessary temperatures for vaccine efficacy. This study explores transitioning to solar direct-drive (SDD) refrigerators to ensure reliable vaccine storage. Methods: A multi-phase methodology was employed, beginning with an inventory assessment of existing cold chain equipment. The implementation involved stepwise replacement of identified refrigerators across health facilities, including Primary Health Care Centers (PHCCs) and dispensaries. Feasibility, cost-effectiveness, and environmental impact were evaluated. Results: Findings indicate that solarization significantly reduces vaccine wastage, ensures stable temperatures, and cuts operational costs by decreasing dependence on non-renewable energy sources. Over 1,000 SDD units were installed across more than 800 health facilities. Additionally, PHCC solarization improved vaccine preservation and enhanced the resilience of health services overall. Discussion: The solarization initiative demonstrates the critical role of renewable energy in strengthening healthcare infrastructure, especially in crisis-hit regions. Solar-powered systems provide a reliable and sustainable solution for vaccine storage, reduce carbon footprints, and build public trust in the immunization system. Challenges included geographical and structural limitations, which were addressed through comprehensive planning and collaboration with local stakeholders. Solarization of Lebanon's vaccine cold chain and PHCCs marks a significant step towards sustainable and resilient healthcare infrastructure. The model offers a robust framework for other regions facing similar economic and energy challenges, highlighting the importance of renewable energy solutions in healthcare.

Immunization as an entry point for primary health care and beyond healthcare interventions-process and insights from an integrated approach in Lebanon.

Integrated healthcare systems are continually pitched as major contributors towards better distribution of health outcomes and enhanced well-being. Under emergency conditions, integrated healthcare services can guarantee better access to the target population. In recent years, several crises, i.e., economic collapse, the fuel crisis, the Beirut blast, a large refugee population, and the COVID-19 pandemic, in Lebanon have led to a major shift in the health-seeking behavior of the communities, with preventive services being downprioritized despite being available and curative healthcare services being sought out as late as possible. An extensive drop in immunization coverage and an overstretched public health system presents the risk of Vaccine-Preventable Disease outbreaks and urgent intervention is needed to bridge the immunity gap. The Ministry of Public Health, Lebanon, and UNICEF Lebanon successfully demonstrated the use of an immunization platform as an entry point to reach communities for service delivery, identification and referral, screening, awareness generation, and a host of other services that can be copied for other programs including but not limited to those for Maternal and Child health, nutrition, early childhood development, COVID-19, children with disabilities, social protection, education, health emergencies like cholera, etc., and these can provide bi-directional support to each other. UNICEF along with the MoPH (Ministry of Public Health) has been working towards reaching the most vulnerable population with a bouquet of services through existing immunization touchpoints for favorable healthcare outcomes.

Strengthening the immunization supply chain through EVM assessment: Comparing India's two successive national assessments.

Background: Effective immunization supply chain (iSC) is crucial for safe and timely transport of potent vaccines to the beneficiary. India's iSC, with a network of ~29,000 cold chain points (CCP), measures its quality standards using the World Health Organization-United Nations International Children's Emergency Fund (WHO-UNICEF) global tool on effective vaccine management (EVM). The two national EVM assessments (EVMA) were conducted in 2013 and 2018. This study helps to see the impact of policies and practices through EVMA in maintaining an efficient iSC for effective implementation of immunization program. Materials and Methods: We conducted a desk analysis using EVMA reports to summarize and compare the findings of the two studies. Cut-off of 80% was considered ideal for each category/criteria score. Results: Both EVMA 2013 and 2018 were conducted using Android-based global EVM tool, though across a wider sample of CCP. Maximum and minimum changes in scores were sub-national and lowest distribution (16% each) and national buffer stores (7%), respectively. Maximum and minimum improvements were seen in vaccine management (29%) and MIS and supportive functions (3%), respectively. The improvement was statistically significant for the overall scores (P = 0.02), primary (P = 0.01), subnational (P = 0.02), and lowest distribution stores (P = 0.03). Among the 36 recommendations of 2013 assessment, 78% and 22% were fully and partially implemented (or ongoing), respectively. Conclusion: Implementation of EVM recommendations has significantly led to improvement and continues to provide a benchmark for iSC and its processes. Follow-up assessments every 3-5 years can further help to evaluate iSC and ascertain the impact of recommendations.

Introducing rotavirus vaccine in the Universal Immunization Programme in India: From evidence to policy to implementation.

BACKGROUND: In 2016, India became one of the first countries in Asia to introduce an indigenously manufactured rotavirus vaccine. However, any new vaccine introduction needs to be meticulously planned to allow for strengthening of the existing immunization systems instead of burdening them. METHODS: The process of rotavirus vaccine introduction in India started with the establishment of National Rotavirus Surveillance Network in 2005 which generated relevant evidence to inform policy level decisions to introduce the vaccine. The preparatory activities started with assessment of health systems and closing any gaps. This was followed by development of vaccine specific training packages and cascade training for programme managers and health workers. The introduction was complemented with strong communications systems and media involvement to allow for good acceptability of the vaccine on the ground. Each step of introduction was led by the government and technically supported by development partners. RESULTS: India introduced rotavirus vaccine in a phased wise manner. In the first two phases the vaccine has been introduced in nine states of the country accounting for nearly 35% of the annual birth cohort of the country. From March 2016 to November 2017, approximately 13,260,000 rotavirus vaccine doses were administered in the country. The vaccine was well accepted by both the health workers and parents/caregivers. CONCLUSION: Rotavirus vaccine introduction in India is an excellent example of how government stewardship with well-defined roles for development partners can allow a new vaccine introduction to be used as a system strengthening activity.

How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India.

INTRODUCTION: Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. METHODS: We developed a computational simulation model of Bihar, India's routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. RESULTS: Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08. CONCLUSION: Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.