OPTIMIZE VACCINE SUPPLY CHAIN LOGISTIC COSTING TOOL FORM IV: HEALTH CENTER QUESTIONNAIRE

Transcription

1 OPTIMIZE VACCINE SUPPLY CHAIN LOGISTIC COSTING TOOL FORM IV: HEALTH CENTER QUESTIONNAIRE Name of interviewee: Name of health center: Interviewee title: District: Interviewee role: Region: Name of interviewer: Date: HEALTH FACILITY GENERAL INFORMATION Cold chain function: Which of the following cold chain functions does the health facility provide? Mark ALL boxes that apply Storage Outreach immunization services Static immunization services ne facility energy sources available to power cold chain equipment Grid electricity: What is the duration of grid electricity access per day for this health facility? Mark only ONE box ne <8 hours per day 8 16 hours per day >16 hours per day Kerosene: What is the availability of kerosene for the health facility? Mark only ONE box Available and clean Available but dirty t available POPULATION DATA Total population Mode of routine vaccine supply: How are routine supplied to this health facility? Mark only ONE box Delivered Collected Both Bottled gas: What is the availability of bottled gas for the health facility? Mark only ONE box Available, reliable Available, unreliable t available Solar energy: Please indicate the site conditions at the health facility. Mark ALL boxes that apply Facility grounds shaded from sun >1 hr/day Heavy clouds for weeks Number of children <12 months of age Number of pregnant women Number of women of child-bearing age DRY GOODS DATA rate for syringes: % rate for safety boxes: % Form IV 1

2 VACCINE DATA Time period for data reported below is: to coverage coverage coverage coverage coverage coverage coverage Form IV 2

3 HUMAN RESOURCES Complete the following information for each health with vaccine or injection supply logistics. Name of health : Job title: Civil servant grade level: Responsibilities and dry. Check all tasks that apply and fill in the appropriate information for each task. Task ORDERING Estimating the needs for the health center Preparing and completing the paperwork for orders Entering orders into the computer Checking and approving orders COLLECTION/TRANSPORT Collecting/transporting STOCK MONITORING Temperature monitoring of freezers/fridges with vaccine s Receiving, updating ledgers, organizing and packing hours spent on per time period? dry Dry hours spent on per time period? Form IV 3

4 Name of health : Job title: Civil servant grade level: Responsibilities and dry. Check all tasks that apply and fill in the appropriate information for each task. Task ORDERING Estimating the needs for the health center Preparing and completing the paperwork for orders Entering orders into the computer Checking and approving orders COLLECTION/TRANSPORT Collecting/transporting STOCK MONITORING Temperature monitoring of freezers/fridges with vaccine s Receiving, updating ledgers, organizing and packing hours spent on per time period? dry Dry hours spent on per time period? Form IV 4

5 Name of health : Job title: Civil servant grade level: Responsibilities and dry. Check all tasks that apply and fill in the appropriate information for each task. Task ORDERING Estimating the needs for the health center Preparing and completing the paperwork for orders Entering orders into the computer Checking and approving orders COLLECTION/TRANSPORT Collecting/transporting STOCK MONITORING Temperature monitoring of freezers/fridges with vaccine s Receiving, updating ledgers, organizing and packing hours spent on per time period? dry Dry hours spent on per time period? Form IV 5

6 Name of health : Job title: Civil servant grade level: Responsibilities and dry. Check all tasks that apply and fill in the appropriate information for each task. Task ORDERING Estimating the needs for the health center Preparing and completing the paperwork for orders Entering orders into the computer Checking and approving orders COLLECTION/TRANSPORT Collecting/transporting STOCK MONITORING Temperature monitoring of freezers/fridges with vaccine s Receiving, updating ledgers, organizing and packing hours spent on per time period? dry Dry hours spent on per time period? HUMAN RESOURCES CROSSCHECK Total staff involved for each task: Ordering Dry Collection/transportation Stock monitoring Form IV 6

7 COLD CHAIN INVENTORY Refrigerators/freezers (record data only on those that are currently in working order) Does this facility have cold chain storage equipment such as refrigerators and freezers? Fill in a separate line for each refrigerator/freezer found at health facility in the table below. Proceed to next question on cold boxes and vaccine carriers. Make Model Year purchased # of units Storage capacity (L) % of capacity used for EPI Cold boxes and vaccine carriers Fill in a separate line for each cold box or vaccine carrier found at health facility. Type Capacity (L) # of units Ice packs Enter the standard ice packs of each size available at the health facility. 0.3 Liter 0.4 Liter 0.6 Liter STORAGE Dry Type of space used to store : Type of space used to store dry : Shared space Shared space Separate room dedicated Separate room dedicated Separate building dedicated Separate building dedicated Size of space utilized for vaccine storage (m 2 ): Size of space utilized for dry storage (m 2 ): Space utilized by vaccine storage for EPI (m 2 ): Space utilized by dry storage for EPI (m 2 ): Form IV 7

8 TRANSPORTATION One-way distance (km) between the health center and: District store Regional store National store Vaccine collection Please provide the following information for vaccine collection. Collection point for for this health center: Dry collection Please provide the following information for dry collection. Collection point for dry for this health center: Number of health s that travel to collect : Number of trips per year to collect : Are per diems provided for trips to collect? Amount of per diem per trip: TRANSPORT MODE Vaccine transport Please provide the following information for all modes of transport utilized in transport of. Is public transport utilized for vaccine transport? One-way cost per trip: Number of trips on public transport for vaccine collection in past year: Is a private vehicle owned by a health care utilized for vaccine transport? Reimbursement per km: Number of trips in private vehicle for vaccine collection in past year: Are dry collected on the same trips as? Yes Proceed to vaccine transport section. Number of health s that travel to collect dry : Number of trips per year to collect dry : Are per diems provided for trips to collect dry? Amount of per diem per trip: Dry transport ONLY IF DRY GOODS ARE NOT COLLECTED WITH VACCINES provide the following information for all modes of transport utilized in transport of dry. Is public transport utilized for dry transport? One-way cost per trip: Number of trips on public transport for dry collection in past year: Is a private vehicle owned by a health care utilized for dry transport? Reimbursement per km: Number of trips in private vehicle for dry collection in past year: Is a health center vehicle owned by the MOH utilized for vaccine and/or dry transport? Fill in the information below in the VEHICLES section for each vehicle. Form IV 8

9 VEHICLES center vehicle #1 Type: Make/model: Year purchased: Fuel type: Car Petrol Truck/pick-up/4WD Motorcycle Diesel insurance cost: maintenance cost: Total km traveled last year: center vehicle #2 Type: Make/model: Year purchased: Fuel type: Car Petrol Truck/pick-up/4WD Motorcycle Diesel insurance cost: maintenance cost: Total km traveled last year: center vehicle #3 Type: Make/model: Year purchased: Fuel type: Car Petrol Truck/pick-up/4WD Motorcycle Diesel insurance cost: maintenance cost: Total km traveled last year: Vaccine and dry collection trips Vehicles (please list) Vehicle #1: Fill in columns A and B if and dry are collected at the same time. # of trips to collect BOTH and dry (A) Total km traveled for collection of BOTH and dry (B) Fill in columns C, D, E, and F if and dry are collected on separate trips. # of trips to collect ONLY (C) Total km traveled for vaccine collection ONLY (D) # of trips to collect dry ONLY (E) Total km traveled for dry collection ONLY (F) Vehicle #2: Vehicle #3: Form IV 9