Some believe that, for evaluation or assessment to be valid, these activities should be carried out by external personnel who are supposedly in a better position to present a more objective report. It is true that those who carry out vaccinations should also take part in evaluating vaccination coverage in their own areas. Likewise, they should be the recipients of feedback related to the evaluation of their activities.
But external evaluators, even well-informed ones, do not always fully understand the program’s goals, methods and objectives. Program personnel, providers and consumers are usually better informed about what the program is trying to do and where the problems are. Including providers and consumers in the evaluation process increases the likelihood that evaluation data will be used appropriately. Most, if not all, program personnel take part in evaluation and assessment in one way or another, whether by providing information, gathering it, analyzing it or distributing it.
Inventory System
An effective system in this respect can be maintained by training the responsible personnel in the correct methods for taking inventory and properly recording that information. They must know the reasons for carrying out an accurate inventory and how that information is used in planning for future needs.
Forms should record only essential data and be as simple and uncomplicated as possible. Supportive supervision should be carried out regularly to ensure that the inventory process is practiced correctly and at the right time. A good communications system can be an invaluable aid in properly maintaining inventory.
Quality Control of Vaccines and the Cold Chain
An ampoule of active vaccine in the hand of a vaccinator looks and feels the same as an inactive vaccine. Only through circumstantial evidence or through testing after vaccination can it be said whether the vaccine will protect the vaccinated child or pregnant woman.
If an active quality-control system has been maintained, then there will be solid evidence that the vaccine is good and will protect the vaccinated person. Without quality control at all levels, the vaccine must be considered suspect.
Quality control also serves as an evaluation mechanism. If the vaccine being used in the field at the lowest levels is tested and found to be active, this is a good sign that the entire distribution system is functioning well. If quality control is maintained, it can serve as an effective mechanism for locating problem points in a program that require attention.
The alternative to quality control is finding that vaccinated children are falling ill, attacked by the disease against which they were supposed to have been immunized. By then it is too late, because the harmful loss of public confidence has already occurred.
Vaccine control must continue from transport into the country until the vaccines are used. Vaccine manufacturers are currently applying WHO packaging standards to ensure that sufficient insulation is provided during transit to a country. Time and temperature indicators are being tested with some UNICEF and PAHO vaccine shipments.
These enzyme-based markers change color when exposed to certain temperatures after a period of time, so they can provide a record of the temperature conditions encountered during transit. Quality-control monitoring within the country should begin at the airport, when the vaccine is received.
Recording the condition of the ampoules and storage temperatures must continue while the vaccine is in transit to the central warehouses and proceed down to the local level. If vaccine records show that it has been exposed only to appropriate temperatures throughout its entire life, and those records are accurate, this is a strong indication that the vaccine is active.
If a vaccine-control laboratory is established in a country, it can perform the dual function of verifying the quality of vaccines that arrive and also checking the quality of those that have been distributed and handled within the country. Samples may be taken from all levels and reviewed within the country at the control laboratory.
Quality control of equipment can also be carried out at all levels. If supervisors or special evaluation groups specifically review the functioning of cold-chain equipment, they can detect improper use by personnel or defective equipment. That information can then be used in future training courses or when purchasing new equipment.
Defective equipment can be reported to the manufacturer for improvement, and to other countries so that only the best available equipment is acquired. Since equipment varies at different levels, quality control must be present at all levels. However, since most equipment failures occur at the local level, it is considered that the strictest controls should be there.
In addition, since the best way to inspect the work of the entire cold chain is to assess the vaccine that has reached the end of the chain, this is another reason to maintain strict controls in the field or at the local level.
