Cold Chain Management In India

International Practices.

Presentation By Jagdish Gohire 13th Nov 2010.

What is Cold Chain

Segment of supply chain where temperature sensitive goods are stored and supplied within 20 to 80 C The equipment and people that keep the vaccines cold during their journey are together called the Cold Chain The cold Chain is as strong as its weakest Link. We are all part of the Cold Chain.

What is Cold Chain

What is Cold Chain

Cold Chain Management International Practices

Coming Home to India - We are Different.

5,000 year old ancient civilization 325 languages spoken 1,652 dialects 18 official languages 28 states, 7 union territories 600 districts 3.28 million sq. kilometers - Area 7,516 kilometers - Coastline 1.1 Billion population. GDP $576 Billion. (GDP rate 8%) Parliamentary form of Government Worlds largest democracy. Worlds 4th largest economy. Largest English speaking nation in the world Indian Railways Largest employer in the world. 4th in terms of Volume ( Pharma Market ) 12th in terms of Value ( Pharma Market )

The Indian Economy.

Growth Of Healthcare Industry In India

Increasing mobile penetration

Distribution Channel
Pharma Companies
5,000

95% of the Trade

CFA s

Primary Sales

95% of the Trade

Distributors / Stockists*
60,000

Secondary Sales

Sub-stockists*
32,000

Retailers*
500,000 85% Contribution

Hospitals

Dispensing Dr

Patients

Doctor

Snapshot of Stocks at each Level in the Chain.

As we move down the Channel, the Awareness / Knowledge levels Tend to Deteriorate. Chances are We might lose conrol over Quality

Links in Cold Chain

( time is Critical )

MANUFACTURER
60 HOURS

WAREHOUSE
60 HOURS

Maximum Control

C & F Agent
48 HOURS

STOCKIST
24 HOURS Restricted Control

RETAILER/ Institution/Hosp..

Receiving Stocks at Warehouse / CFA

Check the Shipment for any outer damage -mention appropriate remarks on the Docket.

Check the Vaccine for appropriate temperature at the time of receipt. Download TT4s / Temptales ( if available with shipment ).

Move Stocks Immediately to Cold Storage Facility. Counting/Segregation to be done in the ANTI Room Preferably.

Storage Of Stocks at Warehouse / CFA

Place Cold Room Temperature Readings Outside the Cold Room & Ambient Room.

Readings taken every-day after every 3 to 5 minutes intervals. - Prefer Automated System
Ensure WIC with 100% Backup

Maintain Deviation SOPs & Register

Have appropriate Backup Facility

Conduct Regular Temperature Mapping / Open Door Test etc.

Use Non-Refrigerant Liquid Test to ascertain impact on product.

Audits at Warehouse / CFA

Auditors may not Know your Products.

Stock Taking to be done Inside the Cold Room.

Educate the Auditor on the Product Storage Conditions

Ensure Plastic Curtains are there at the Doors.

Measures - if The Temperature starts moving to the Unsafe range.

Dispatching Stocks from CFA to Stockist. Packing: To be packed in thermocol boxes with adequate ice packs Freeze Ice Packs for Sufficient time. Outer package to be made with corrugated boxes for avoiding damage Gel Packs to be stored @ -20 degree & Foam Bricks at 2 to 8 degree

Dispatching Stocks from CFA to Stockist.

Check that the vaccine is transported in proper condition. Inform supplier Not to transport in improper way.

Have appropriate Labels on Cartons Educating Carriers / Stockists to Store the Vaccine in cold Chain immediately.

Now Starts the Real Challenge..

How to Implement Cold Chain at

The Secondary / Tertiary Level ?

Controls could be brought at 3 Levels

1. While Selecting a Cold Chain Stockist 2. Educating the Stockist On Cold Chain Management and Implications - How to maintain Cold Chain 3. Have Customer Friendly / Informative Packing

Selecting a Stockist.
1. While Selecting a Cold Chain Stockist Ensure the Stockist has a Walk in Cooler / Cold Chain Facility Adequate Knowledge on Cold Chain Product Handling Get the stockist sign a Quality Agreement / Undertaking.

Educating - Stockists
Use refrigerators that would best suit your stocks.

Have separate temperature controls.

Have appropriate Warning Signage ( In Local Language ) & Plug Guards.

Educating Stockists
Avoid Keeping Items Other than Vaccines in the Refrigerator.

Educating Stockists

Do Not Store 2 to 8 degree stocks in the Freezer / Top Shelf.

Educating Stockists
Put Vaccines on the top and middle shelves of the main section. Arrange the boxes of Vaccine in Stacks between which the air can move. Keep Un-opened vials in a special box To be used First. Keep Ice Packs in the Top and Bottom Shelves They help to keep the temperature constant.

Ice Packs

Vaccines

Vaccines

Ice Packs

Measures at Stockist Level

Measures at Stockist Level

Check the electricity Supply Connection Check the GAS supply Does the Refrigerator Door Close properly Has anybody left the door open for a long time Is the Fridge Opened quite often Is the Fridge Over-loaded How thick is the ice build-up in the freezing compartment De-Frost if the ice is more than 0.5 cm thick Contact your supervisor for a backup facility.

Immediately Switch to the Backup

Customer Friendly / Informative Packing

VVM ( Vaccine Vial Monitoring ) This is printed on the label of the Vial / CAP As the vial is exposed to more heat, the vial becomes darker and darker. Return these vaccines at the earliest.

Customer Friendly / Informative Packing

Freeze Watch Indicators.. It consists of a small vial of red liquid attached to a white card & covered in plastic. The vial breaks if the temperature near the indicator drops below 00 C for more than 1 hour. Manufacturers pack temperature indicators with DTP & TT vaccines to monitor them during transportation & Storage

Customer Friendly / Informative Packing

Vaccine Cold Chain Monitors (CCM). These are Cards that changes colour when the vaccine is exposed to temperatures that are too high. - Health Workers use them to estimate the length of time the vaccine was exposed to high t e m p e r a t u r e . Companies use these monitors with the BCG, DTP, polio and measles vaccines supplied by WHO/UNICEF

Whos Responsibility :

Responsibility lies with both the Consignor as well as the Consignee to ensure compliance to Cold Chain Logistics

Thank You.