TERMS OF REFERENCE

Joint PEI-EPI Workshop on bringing improvement in

PEI Vaccine Management in Pakistan

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Improving Vaccine Management in Pakistan 2022
TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................................................... 2
BACKGROUND ..................................................................................................................................................... 3
GOAL & OBJECTIVES OF WORKSHOP................................................................................................................... 4
GOAL ................................................................................................................................................................ 4
OBJECTIVE ........................................................................................................................................................ 4
DATES, VENUE, PARTICIPANTS & FACILITATORS: ................................................................................................ 4
Federal training................................................................................................................................................ 4
Provincial/Divisional training ........................................................................................................................... 4
District training ................................................................................................................................................ 5
METHODOLOGY: .................................................................................................................................................. 5

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Improving Vaccine Management in Pakistan 2022
BACKGROUND
Pakistan PEI program procures around 250 to 300 million doses of OPV every year and is in
accordance with the country’s approved SIA schedule. A well-functioning vaccine management
system run by immunization program is in place at national and provincial levels. Its components
include in-country vaccine distribution, storage, online information management system for stock
recording, cold chain maintenance through online system for temperature recording and regular
monitoring of stock quantities for both EPI & PEI program. For Pakistan, since large volumes of OPV
are procured for polio campaigns, therefore it makes a major part of funding & budget of the polio
eradication programme.

In Pakistan OPV delivery and documentation at national and subnational level is as per SOPs,
however the documentation and management in peripheries is poorly monitored. Data on leftover
vaccine after each campaign is available at provincial level only and is shared with national level. For
peripheral level it is collected and compiled but is inconsistent and not verified to ensure its
utilization in next campaign. Vaccine management protocols particularly related to reporting and
retrieval, laid down due to use of type 2 vaccine, has improved the situation but still there are gaps
observed with respect to documentation at lower levels.

OPV is a heat sensitive vaccine. Cold chain at national, provincial and district level is maintained
through cold rooms with attached temperature monitoring systems where available or through
temperature monitoring data loggers (FridgeTag2) in ILRs. Cold chain system of vaccine during
storage and transportation is entirely managed by Immunization program. During intra-campaign
phase, polio program’s field staff is responsible for maintaining cold chain of OPV by use of vaccine
carriers and icepacks.

There are functional vaccine management teams at national & provincial level, however one or two
members of DEOCs are nominated as vaccine management focal persons at district level. District
Vaccine Management Committees (DVMCs) functionality is inconsistent.

Currently, following functions are in place under PEI vaccine management:

• Cold chain maintenance protocols are in place as per EPI policy
• Regular weekly reporting of PEI vaccine including reporting on leftover stock is in place at national
and provincial level
• Technical support provided by national and provincial EOCs & EPI for vaccine management.
National/Provincial Vaccine Management teams and Incident Management Teams (now OPRG
team) functional at both levels to provide oversight and guidance on VM related matters
• Nominated focal persons from DEOCs to provide oversight on vaccine management matters
• Recording and reporting forms with vaccine information is in place for regular reporting of stocks.
• Government endorsed Standard Operating Procedures (SOPs) for OPV Vaccine Management are
introduced at provincial and district level. Implementation is inconsistent, especially at lower
levels.
Major components of vaccine management are in place, however implementation in true letter and
spirit is lacking at lower levels. Reasons include lack of staff capacity, lack of accountability,
involvement of staff in other competing priorities, back-to-back activities for planned campaigns and

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Improving Vaccine Management in Pakistan 2022
outbreak response with the simultaneous routine immunization activities resulting in staff fatigue;
and lack of seriousness given to vaccine management matters.
Inconsistencies are observed in documenting PEI vaccine and reporting of leftover vaccine especially
at lower levels. Mostly records are complete at National and sub-national levels; however, complete
documents are not present at district and Union Council level.
Refresher training on vaccine management SOPs and protocols is required. Training will also help in
assigning accountability for oversight and monitoring at district level with regular follow ups on cold
chain maintenance, vaccine utilization, wastage rate and corrective measures. UC staff is not
equipped to analyse vaccine data and relate it to coverages.

GOAL & OBJECTIVES OF WORKSHOP

GOAL
The workshop aims at building capacity of staff in improving PEI Vaccine Management system in
the country
OBJECTIVE
1. To create a pool of master trainers for trickle down training on PEI vaccine management
2. To train EOC/EPI VM teams for improved recording of PEI stocks by respective accountable staff
3. To strengthen capacity of district teams for formulation & functionality of vaccine management
committees at respective levels for ensuring efficient utilization and reporting of PEI vaccine.
4. Dissemination of training package

DATES, VENUE, PARTICIPANTS & FACILITATORS:

Federal training
Two days training will be held at Federal level
• Venue: Islamabad (TBC)
• Dates: 6th & 7th Dec 2022
• Participants: Three persons from each province (Balochistan, KP, Punjab & Sindh), two from
AJK and GB and three from Islamabad. Participants to be preferably members of vaccine
management team. These will include Provincial EPI nominated focal person for PEI vaccine
management, Provincial Vaccine Management officer (VMO) and WHO nominated focal
person for polio vaccines. These will further conduct the next level trickle down training
• Facilitators: Cold chain specialist from HQ, NEOC VM/Ops team, EPI VM team
Certificate of completion will be distributed to participants at the end of training.
Provincial/Divisional training
Two days training will be held at Provincial/Divisional levels:
• Venue: Each provincial/divisional head quarter. (Lahore for Punjab and Divisional HQ for
Sindh, Balochistan, KP, AJK & GB). Venue TBC.
• Dates: Tentative between Dec 2022 – Jan 2023 (Final dates TBC)
• Participants: Two persons from each district. Participants will be district focal persons for
vaccine management. These will further conduct the next level trickle down trainings
• Facilitators: Provincial Master trainers PEOC VM team & EPI VM focal person

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District training
One day training will be held at District level
• Venue: Each district
• Dates: TBC (Tentative anytime between Jan – Mar 2023)
• Participants: UCMOs/UC focal person for vaccine management.
• Facilitators: District VM focal person

METHODOLOGY:
• In person Training of trainers (ToT) at the Federal level will include following by using ToT
package:
o Presentations
o Interactive discussions. Participants will be invited to share best practices
o Group work followed by presentation by each group. Real time scenarios with
documentation/filled forms will be assigned to groups to identify issues, propose, and
plan implementation of most suitable corrective measures
o Hands on practice
o Case studies
• In person training at Provincial (Punjab), Divisional (Sindh, Balochistan, KP, GB, Islamabad & AJK)
level to train district staff by using ToT package and including above techniques (where
applicable)
• In person training at District level to train UC staff (Balochistan, Sindh, AJK, Islamabad & GB) by
using trickle down training package

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