OM COACHING CENTRE PVT. LTD.

COLD CHAIN MANAGEMENT

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 It is a system of transporting, storing vaccine at recommended temperature from manufacture to the point of use.
 All vaccine can be stored at+20C to +80C (also diluents of BCG & Measles)
 Deep freezer vaccine (Below zero) = BCG, Measle & Polio.
 Cold compartment vaccine = Hep.B, DPT, TT (should not be frozen)
 Cold chain equipment:

 या सन भ डारण गदा कायम गनु पन ताप म

या सन के य ादे िशक या सन टोर ज ला या सन सव या सन वा य

या सन ( ३ दे ख ४.५ म हना ) या सन टोर वतरण के संथा
टोर ( ६ टोर ( १.२५ सं वागत
दे ख ११ दे ख २.२५ खोप
म हना ) म हना ) लिनक
पोिलयो -१५°से दे ख -२५°से या सन तथा घोलकलाई +२ °से दे ख + °से
भ डारण गन
ब.िस.जी पाउडरको पमा उपल ध हुने
जे.ई. या सनलाई + २ °से दे ख +८ °से
दादरु ा – बेला मा भ डारण गनु पदछ तर क हले क हँ
या सन भ डारण गन थान अपुग
भएमा -१५ °से दे ख -२५ °से
ताप ममा पिन भ डारण गन स क छ |
रोटा या सन तथा घोलकलाई +२ °से दे ख
ड .पी. ट – हे प + °से भ डारण गन
व – हव
प.िस.िभ.
आई प िभ
ट . ड
टाईफाईद
एच प िभ

 या सन तथा खोप साम ीको मौ दात िसमा

या सन टोरको तह अिधकतम मौ दात युनतम मौ दात
के य या सन टोर ११ म हना ६ म हना
ादे िशक या सन टोर ४.५ म हना ३ म हना
ज ला या सन टोर २.२५ म हना १.२५ म हना
या सन सव - टोर २.२५ म हना १.२५ म हना
या सन वतरण के
वा य सं था
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  या सन तथा सुर त सुई स ब ध साम ीको वतरण
 के य या सन टोरबाट े य या सन टोरमा ३-३ म हनामा
 ादे िशक या सन टोरबाट ज ला या सन टोरमा १-१ म हना
 ज ला या सन टोरबाट ज ला अ तगतका या सन सव – टोरमा १-१ म हनामा

Note :
1. Cold box : are used for transportation of vaccine (Before vaccine is placed in the cold boxes ice pack are placed at
bottom & sides)
2. Ice pack : contain water, not salt, 2 sized (600ml & 400 ml)
- Before transportation of vaccine ice pack should be reconditioned.
 Cold chain (cg'ud ug{ उपकरण _
1. Vaccine vial monitor – VVM
2. Cold chain monitor card.
3. Dial thermometer.
1. Vaccine vial monitor (VVM
 white part contain special chemical(P-Toluenesulphonate ), which is sensitive to heat.
 when exposed to heat this whiter part colour changes, became blue & then black.
Stage
- V.V.M. stage -1 :- aflxl/ uf]nfsf/ leqsf] /ªueGbf
rf/s'g] leqsf] /Ë ;]tf] ePsf] .
- V.V.M. Stage -2 :- rf/s'g] leqsf] /Ë aflxl/ uf]nfsf/ leqsf] /ËeGbf s]lx sd uf9f ePsf] .

- V.V.M. stage -3 :- rf/s'g] leqsf] /Ë / aflxl/ uf]nfsf/ leqsf] /Ë Psgf; ePsf] .

- V.V.M. stage – 4 : - rf/s'g] leqsf] /Ë aflxl/ uf]nfsf/ leqsf] /ËeGbf a9L uf9f -sfnf]_

Note:- (i) V.V.M.-1 &V.V.M. 2 can be used.

(ii) V.V.M.-3 & V.V.M-4 should not be use.
 Most heat sensitive vaccine is OPV.
 Most cold sensitive vaccine is Hep. B.
 Most light sensitive vaccine is Measles.
 Shake test is done to know whether vaccine is freezed or not (mostly used in DPT,TT & Pentavalent)
2.
Dial thermometer is the instrument used to monitor the temperature of cold chain at PHCC (Twice daily)
Type of vaccine:
1. Live attenuated vaccine:- BCG, OPV, measles, Rubella, JE, mumps yellow fever, chicken pox, corona vaccine,
Typhoid, influenza etc.
2. Killed Vaccine: Hep. A&B, Pertusis, Rabies, salk(IPV) Cholera, meningitis, Typhoid, Influenza etc.
3. Toxoid vaccine : - Diptheria, Tetanus.
4. Cellular fraction :- Meningococcal & pneumococcal vaccine.
5. Combined Vaccine: DPT, Pentavalent, TD, MR, MMR etc.
3. Contraindication of vaccine :
1. Pregnancy :- All live vaccine except yellow fever & meningococcal.
2. HIV/AIDs.
a. Asymptomatic = None
b. Symptomatic = All live vaccine except BCG.
3. Immunocomprized Patient:- All live vaccine
4. Steroid therapy :- All live vaccine
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 5. Fever :- Typhoid vaccine.
6. ARI/ Diarrhea :- None
7. Severe ARI/Diarrheas :- All live vaccine.
8. Preterm (Premature birth) wt. <2.5 kg :- Hepatitis B
9. Age < 1 yrs = Yellow fever, meningococcal & typhoid
10. Age < 2yrs :- Yellow fever, meningococcal
11. Neurological disorder :- Pertusis but not in controlled epilepsy
12. Only absolute contraindication to killed vaccine :- Severe local or general reaction to previous dose.
Side effect of vaccine:
1. G.B. (Gullian Barre syndrome) :- Killed influenza vaccine
2. Vaccine associated paralysis:- OPV- 3rd dose (Sabin)
3. Toxic shock syndrome:- measles,MMR.
4. Shock :- DPT (Pertusis mainly)
5. Hypersensitivity :- Hepatitis B, Meningococcal, DPT, TD.

 LOGISTIC MANAGEMENT INFORMATION SYSTEM.

 It is defined as systemic & process of planning, implementing & controlling the efficient and effective flow & storage of
resources from the point of origin to the consumption in order to meet the acstomer's requirement.
 In health care set up logistic management refers to medicine, equipment & materials management.
Milestone of LMIS
Date Land marks
1993 A.D. (2050/51) Logistic management division has been established under DOHS.
LMIS establish in pilot programme from 4 district of eastern region
1994 A.D.(2051/52)
with support of JSI & USAID
1997 A.D. LMIS expanded throughout the country
Pull system was implemented for increasing availability of drugs
2004/5(2061/62)
throughout year from 6 district.
2065/66 Pull system expand all over country
2065/66 LMD started Telemedicine programme in 25 hill & Mountain district.
June 2008 (2065/66 ) LMD has initiated web based LMIS.
Web based LMIS implemented nationwide include regional medical
2009 A.D.
store
LMD introduced real time inventory system in DHO & DPHO by
2072/73 B.S.
customizing the existing Inventory management system software.
Web based LMIS upgrading into online inventory management system
2016 A.D. ( 2073/74)
called online inventory Management system.
Electron LMIS was implemented in 22 district of province 5 & 6,
2018 A.D. ( 2075
Province medical store & 6 central medial store with the support of
baishakh )
USAID GHSC- PSM project.
2077/78 eLMIS implementation at all local level

Note:-
1. Training duration of "pull system" is 4 days.
2. Training duration of "Telemedicine programme" is 7 days.
3. ASL (Authorized stock level) & EOP ( Emergency order point) Should determine by each health institution.
Health Institution EOP ASL
SHP/HP/PHCC 1 month 5 months
District level 3 months 10 months
4. EOP for vaccine is 1.25 months and ASL for vaccine is 2.5 months.
Goal: Qualities health commodities available at health facility & Community level around the year.

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 Overall objective:
 To plan and carry out the logistics activities for the uninterrupted supply of essential medicine, vaccine, contraceptives,
equipment, HMIS/LMIS form & allied commodities ( including repair & maintainable of bio-chemical equipment) for the
efficient delivery of health care services from the health institutions of government of Nepal in the country.
Key health commodities:
1. Family planning : - Condom, Depo, Pills, Implant, IUCDs.
2. MCH commodities :- Vitamin A, ORS, cotrim, iron, Amoxicillin
3. Essential drags : - PCM, Albendazole, Chlorompheniramine, Benzoic acid etc.
Estimated price of drugs are
 Mountain: Average maximum price.
 Hill: - 15% less than average maximum price.
 Terai : 20% less than average maximum price.
Component of logistic management
1. Product selection.
2. Forecasting
3. Procurement
4. Distribution
5. LMIS
6. Monitoring evaluation
7. Serving customers.
Golden point:
 The colour page used in LMIS :- White & yellow
 White for :- Health facility, yellow fore : Rural Municipality/Municipality.
 No commodities, No program is related to Inventory management.
 SWAP stands for sector wide approach.
 HIV AIDs logistic system is started from 2012 A.D.

 IHMIS (Integrated Health Management Information system)

 Management Information system & Integrated Health management system was established in 1993 A.D. (2050 B.S.)
 IHMIS road map 2078/79 – 2087/88 ( 2022-2030 )
Function of MIS:
1. To generate report
2. To answer what – if question asked by management.
3. To support decision making
There are mainly nine sector of management information system.
1. Health management information system (HMIS)
2. Logistic management information system. (LMIS)
3. Financial Management information system. (FMIS)
4. Health Infrastructure Information system. (HIIS)
5. Planning & management of assets in Health care system. (PLAMAHS)
6. Human Resource Information system.(HRIS)
7. Training Information management system (TIMS)
8. Ayurved Reporting system. (ARS)
9. Drug Information Network (DIN)

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  HEALTH MANAGEMENT INFORMATION SYSTEM.
 HMIS is defined as integrated effort to collect, process, report & use health information & Knowledge to influence policy
making programme & research.
 HMIS is P1 Programme under management division & stared in 2051/52 (1994) from 2 district (Dang & Kaski)
 HMIS is expanded throughout the country 2052/53
 The newly HMIS form and format revised in 2070/71 and implementation in 2071/72 throughout the country.
 Newly revised HMIS tools in 2078/79 ( 68 recording tools and 5 reporting tools )
 HMIS-2 colour page.
(i) white colour = (Rural Municipality/Municipallity)
(ii) Yellow colour = (Office copy)
 HSIS (Health sector Information system) was started in fy 2065/66 B.S. with 3 district (Lalitpur, Parsa, Rupandehi)
(i) HSIS to get information from all heal related sector dispensary chemistry, Police & army hospital etc.
 DHIS-2 tools is used for HMIS of Nepal started from 8 Mansir, 2073 (November 2016 A.D>) using for all district
& in fy 75/76 the target is to expand data entry upto every local level.
 HMIS online reporting Via DHIS2 expanded to 753 LLGs in 2076 BS

 OBJECTIVE OF HMIS :-
 TO monitor the achievement coverage, contineuty & quality of health services.
 To access progress towards district health programme.
 To provide information that can be used to improve the quality of care.
 To health senior manager develop appropriate health policy guideline.
 To link data information to all department, division & center for quick application of data.
 To support planning, Evaluation & Monitoring of all health programme.

 CHARACTERISTIC / QUALITY OF HMIS REPORT :-

 Accuracy
 Clarity
 Complete
 East to understand
 Comprehension
 Timely
 Reliable document
 Proper date and signature

 Reporting status of HMIS in F/Y 2079/80 :- FCHV - 96 % , HP and PHCC - 100% and public hospital – 95%

Flow of HMIS
S.N. From To Date of submission
1 VHW/MCHW SHP/HP/PHCC Last data of month or within 1 st data of months
2. SHP HP/PHCC Within 3 days of months
3. HP/PHCC DPHO/DHO Within 7 days of months.
4. DPHO/DHO DOHS/RHD Within 12 days of month
5. DOHS/RHD MOHP/NPC Once 4 months within 30 days of period

 Annual review meeting of HMIS should be conducted at local level within 15th bhadra
 Annual review meeting of HMIS should be conducted at district level 15th ashoj
 Annual review meeting of HMIS should be conducted at province level 15th kartik
Note :- Minimum Standard Service (MMS ) Should Be Conducted In Every Six Months .