title: Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance.
abstract: Vaccine cold chain equipment (CCE) in developing countries is often exposed to harsh environmental conditions, such as extreme temperatures and humidity, and is subject to many additional challenges, including intermittent power supply, insufficient maintenance capacity, and a scarcity of replacement parts. Together, these challenges lead to high failure rates for refrigerators, potentially damaging vaccines and adversely affecting immunization coverage. Providing a sustainable solution for improving CCE performance requires an understanding of the root causes of failure. Project teams conducted small-scale studies to determine the root causes of CCE failure in selected locations in Uganda and Mozambique. The evaluations covered 59 failed refrigerators and freezers in Uganda and 27 refrigerators in Mozambique. In Uganda, the vast majority of failures were due to a cooling unit fault in one widely used refrigerator model. In Mozambique, 11 of the 27 problems were attributable to solar refrigerators with batteries that were unable to hold a charge, and another eight problems were associated with a need to adjust thermostat settings. The studies showed that tracking and evaluation of equipment performance and failure can yield important, actionable information for a range of stakeholders, including local CCE technicians, the ministry of health, equipment manufacturers, and international partners such as the United Nations Children's Fund, World Health Organization, and Gavi, the Vaccine Alliance. Collaborative efforts to systematically collect and communicate data on CCE performance and causes of failure will help to improve the efficiency and reach of immunization programs in low- and middle-income countries.
authors.affiliation: PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA. Electronic address: plennon@path.org.
authors.forename: Pat
authors.initials: P
authors.lastname: Lennon
authors.affiliation: PATH, PO Box 7404, Kampala, Uganda. Electronic address: batuhaire@path.org.
authors.forename: Brian
authors.initials: B
authors.lastname: Atuhaire
authors.affiliation: Nexleaf Analytics, 2356 Pelham Avenue, Los Angeles, CA 90064, USA. Electronic address: Shahrzad@nexleaf.org.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Yavari
authors.affiliation: VillageReach, 2900 Eastlake Avenue East, Suite 230, Seattle, WA 98102, USA. Electronic address: vidya.sampath@villagereach.org.
authors.forename: Vidya
authors.initials: V
authors.lastname: Sampath
authors.affiliation: PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA. Electronic address: mmvundura@path.org.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mvundura
authors.affiliation: Nexleaf Analytics, 2356 Pelham Avenue, Los Angeles, CA 90064, USA. Electronic address: nithya@nexleaf.org.
authors.forename: Nithya
authors.initials: N
authors.lastname: Ramanathan
authors.affiliation: PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA. Electronic address: jrobertson@path.org.
authors.forename: Joanie
authors.initials: J
authors.lastname: Robertson
mesh_terms: D004356:Drug Storage / Q000379:methods*; D004868:Equipment Failure; D006801:Humans; D017589:Immunization Programs; D009073:Mozambique; D012034:Refrigeration / Q000295:instrumentation*; D014454:Uganda; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Cold chain equipment; Mozambique; Root cause analysis; Uganda