In many parts of the world, workshops on the administration of immunization programs have already been organized. These courses are intended for two groups: senior management personnel and mid-level administrators. They include training in: a) epidemiology of immunizable diseases; b) vaccines; c) cold chains; d) programming; and e) evaluation. This program was developed for the Americas by the Pan American Health Organization.
Another EPI training program, prepared by the World Health Organization for application in other parts of the world, includes training in: a) public participation; b) management of vaccination sessions; c) allocation of resources; d) management of disease surveillance; e) supervision of tasks; f) provision of training; g) evaluation of vaccination coverage; and h) administration of the cold chain.
Personnel and the Cold Chain
The importance of people in the cold chain cannot be emphasized enough. It is often thought that the cold chain refers only to vaccine refrigeration. But even with the finest and most modern equipment and the best means of transport, this chain will not be effective if personnel do not handle the vaccine properly.
To manage the cold-chain system well, it is necessary to ensure that the following activities are properly carried out throughout the chain: a) obtaining vaccines; b) maintaining equipment; and c) preserving vaccines. The specific tasks involved in these activities will vary according to the point at which they are carried out along the cold chain.
There are small variations in the activities related to equipment maintenance or the quantities of vaccine handled at different levels: local, health-center, district or regional, central or national, and at airports. In any case, the main areas of responsibility remain the same: a) obtaining and dispatching vaccine; b) preserving vaccine; and c) maintaining equipment.
a) The vaccine must be obtained from the immediately higher level. Beforehand, the responsible person must calculate the quantity of vaccine needed, also making sure that there is enough cold-chain equipment available to store the vaccine, that the quantity of vaccine and diluent obtained is equal to the amount calculated, and that the expiration date has not passed. Vaccines must be obtained and dispatched at regular intervals.
b) When vaccines are administered to mothers and children at vaccination sites, care must be taken not to expose the vaccine unnecessarily to heat and sunlight. The following activities are also necessary for proper vaccine preservation: inspecting vaccine stocks, monitoring temperatures, repeating potency tests, keeping records of the quantity and type of vaccine stored, using first the vaccines with the nearest expiration dates, keeping records of vaccine receipts and withdrawals, and recording the remaining stocks.
c) For the cold chain to be effective, its equipment must be properly maintained. A detailed description of cold-chain maintenance is presented in the respective EPI manuals published and distributed by PAHO and WHO.
Required Training
Special training is highly desirable for health personnel assigned to immunization-program activities. Training can be used to improve the techniques required for immunization activities, as well as to emphasize the importance of immunization as a component of primary healthcare.
Examples of special training courses include the PAHO EPI Workshop for the Americas and the WHO training course for mid-level administrators. It is essential to include immunization topics as part of continuing-education courses scheduled periodically.
The first step in organizing special training is to describe the skills or knowledge required for a specific position. On the basis of that description, a training objective is then developed, setting out the specific skill to be learned and how it should be performed.
If this step is part of retraining, attention must be concentrated on the particular skill or knowledge that the person appears to lack. By contrast, if it is part of a basic training program, it will be necessary to make a list of all the skills the person must know in order to carry out the programmed activity, since this is a new job for that person.
After the training objectives have been determined, the next step is to decide on an effective method for teaching the skill or imparting the knowledge needed. Training methods may be very simple or very complex. Training does not always mean classroom instruction or a three-day seminar at headquarters, and it often must be something more than didactic written communication.
