Evaluating Mission-Critical Cold Chain

The performance of temperature-controlled supply chains ("cold chains") in frontier settings is complex, requiring electrification, engineered equipment, well trained and supported technicians, and efficient supply chain management, yet critical to delivering the world's most important and valuable health interventions. 

VACCINE COLD CHAIN

With the largest birth cohort in Africa, Nigeria's vaccine supply chain is responsible for several hundred millions of dollars worth of life-saving, temperature-sensitive vaccines for children and women. Functioning cold rooms, cold boxes, refrigerators, and carriers are essential for Nigeria to realize the promise of its investment in immunization.  

In 2014 we led the design of a national study in Nigeria to monitor continuous temperature and related supply chain data through 720 links, reflecting all supply chain tiers across all 36+1 states.

Analysis for Unicef and the National Primary Health Care Development Agency (NPHCDA) as since helped drive new technology and process investments across the country's cold chain.

Polio surveillance

Two stool samples must be collected from each suspected case of polio and kept between 2 and 8 degrees Celsius from the home or hospital to the polio reference laboratory. This reverse cold chain is critical to the accuracy of the surveillance and diagnosis. 

With support and direction from the US CDC, NPHCDA, WHO-Nigeria, Field Epidemiology & Lab Training Program (FELTP), and disease surveillance officers across five states, we developed and managed an evaluation of this reverse cold chain in one of the final three countries where wild poliovirus was still endemic.

This first-of-its-kind study provided insight into the field conditions affecting surveillance and several immediate ways in which to strengthen it now in practice in Nigeria. The initiative also yielded SOCCER, the System for Outreaching Cold Chain Evaluation & Research, a tool for rapidly measuring and analyzing last and first-mile cold chain performance in the furthest reaches of the field.