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Immunization management system is important and effective when it ensures the high quality of vaccines ensures continuity of immunization services with high coverage and reduces wastage. Consequently, lack of an effective immunization management system leads in the low performance as it is noted within numerous immunization management systems with poor vaccine stock monitoring at each and every level, poor handling and storage of vaccine in addition to high vaccine wastage. Immunization is one of the most vital public health achievements of the 21st century since immunization aids in saving lives as well as in prevention of fatal diseases. Immunization has demonstrated to be a cost-effective public heath gauge that can be delivered efficiently to individuals of all ages inclusive of hard-to-reach and susceptible populations. The key aim of immunization is to protect people and the society from vaccine preventable illnesses. Currently, immunization management systems have been effective in eliminating several vaccine preventable diseases like polio, measles and diphtheria. These diseases have been controlled through effective immunization management systems (Caroline 22-24).
Immunization management system protect people from vaccine preventable diseases and at the same time provides protection to the larger society by “herd immunity”, a kind of community that takes place when the vaccination of high percentage of the population offers protection to venerable people. A decline in immunization rates can result to outbreaks or a reappearance of these diseases. As a result, maintenance of effective immunization management system with high vaccine coverage is vital for people and the larger society. In this paper, I will examine the significance of an effective immunization management system in promoting standardized practices, with respect to the necessary assessment of status of school pupils. Immunization management system gives guidelines to public health units to additionally support Public Health Standards within the area of immunization in addition to vaccine preventable disease control (Caroline 26-28).
Immunization management system provides the standards that establish the objectives and requirements for programs, and anticipated board of health and societal results. Immunization management system is a component of the infectious diseases standard. Protocols within Immunization management system further define the specific details as well as the requirements in every sub-program (Caroline 32-34).
Effective immunization management assessment
Effective immunization management assessment is a tool that is used in assessment of the quality of vaccines’ supply chain. It makes use of a quality management approach structured around nine principles by which supply chains are supposed to conform. Effective immunization management assessment is used is assessing vaccine store across all categories of the system: from the national to health center category (O'Carroll 25-26).
The strengths of effective immunization management system include that almost each and every site that is assessed has good temperature monitoring, sufficient cold chain capacity, along with solid buildings, equipment and transport infrastructure along with opportunities for improvement. During strengthening of the system, it is important to catalyze the development of standard operating processes to enhance arrival of vaccines, management and distribution of the stock (Louis 40).
Board of Health Roles and Responsibilities
The boards of health are responsible for supporting standardized practices with respect to immunization management system for the evaluation and management of immunization records for the school pupils. The provided roles and requirements offer a reliable means for interpretation, implementation as well as enforcement of the standards. Public health units are required to evaluate, keep and maintain record and report regarding immunization status of school going children. It is very important to take a consistent positive message and approach when implementing the record review process, mainly during enforcement of ISPA. Even though collection, review and follow up on immunization is a positive involvement in health protection and disease prevention for children, it may be perceived as a negative approach. Incoherent interpretation, implementation and enforcement of the ISPA can cause confusion and frustration to the parents, teachers and even public health units (O'Carroll 24).
Currently, public health units make use of a provincial database, immunization records information system in recording and maintenance of student immunization records.
Collection, Storage and Disclosing of Immunization Information
Collecting Immunization Records
Collection of immunization information regarding children in schools should conform to the relevant legislation. Public health units can determine the requirement to gather all or some of this information from every student: full names, date of birth, sex and the name of the school.
All immunization information for the selected diseases including type of vaccine, the vaccination date and any reactions to the vaccine, Statement of medical exemption, statement of conscience or religious belief in addition to notice transfer (O'Carroll 26).
Evaluating the immunization status for the students
The immunization information received by the public health unit is supposed to be evaluated to make sure that the immunization of the child is up to date and has been carried out in accordance with the current Immunization requirements. After the collection of the immunization information, these guidelines for inputting and evaluating the information.
- Entering the information into the database
- Contacting of the parents or the guardians to get more information if there is a need for extra information or if clarification is needed.
- Making a class list from the data base and comparing it with the class list obtained from the operator.
- Asking for clarification from the school operators in case there is any discrepancy within class list obtained from the operator and the one produced within the database.
- Questionnaires are supposed to be generated for the attendees whose immunization is not updated for all vaccines within the data base and communicate about this to the parents or the guardians.
- Run coverage reports as required (James 55-58).
It is recommendable that when the questionnaires are being run within the database that the public health units do so for all the vaccines as this is important in identifying the attendees who might not have received the recommended immunization, for instance pneumococcal conjugate vaccine and varicella vaccine. A date for the response to the requested information is supposed to be clearly designated on the information sent home to the guardian and the parents, in case there is no response from the guardian and the parent by the deadline, public health unit personnel ought to the parents or the guardian through the phone. Public health unit personnel are supposed to give the parent or the guardian a date to respond to second request information. Incase the parent or the guardian fails to respond even to the second request, a request is supposed to be made to the operator of the licensed school in order for the operator to arrange for a meeting with the health unit at the facility with the parent and the guardian. The immunization record of the child is considered as complete if the following criterion is fulfilled;
- The child has been given all recommended vaccines in accordance with the age
- The child has been given some of the vaccines for the age and has evidence of intention to go on with the immunization process, for instance future immunizations appointments have been booked.
- The child has been given some of the recommended vaccines for the age and a written notice excluding them from particular vaccines is on file that has been signed by the guardian or the parent or legitimate medical exclusion(s). The guardian or the parent is supposed to be counseled probable requirement for exemption in case there is an outbreak of a vaccine preventable disease.
- A written exclusion from all public vaccines is signed by the guardian or the parent and is filed or in valid medical exceptions. Parents and guardians are supposed to be counseled on the probable need fro exemption in case there is an outbreak of a disease that can be prevented through vaccination (O'Carroll 26).
Consent to Collecting Personal/ Health Information
Consent might be needed in situations when collecting PHI, when using the information and when disclosing it. The type of consent needed is dependant on who the information is being shared with as well as the main reason for collecting the information. Public health units are supposed to review their information gathering practices with their privacy and legal advisors periodically to make sure that there is conformity with practical laws and best practices (James 25).
Other Information at Public Health Unit’s Diplomacy
All public health units are supposed to consult with their information privacy office or legal counsels to make sure a legal justification for the collection of personal health information for immunization management systems. Public health units are supposed to have policies as well as secure systems in place to safeguard the security of the PHI that is gathered, for instance stored with confidentiality and locked environment. While collecting PHI, public health units are supposed to provide, notice illustrating the PHI being collected, a rationale for the reason of collecting the information, information regarding the information being collected and the way in which the information will be used. It is also important to make sure that people are aware that they have the mandate of giving or withholding consent to offer PHI being requested without any penalty and consent documents for treatment are supposed to clearly differentiate consent to treatment from consent to collecting the information (James 52-58).
Commune Cooling Assessment
The purpose of commune cooling assessment is to collect information regarding the maintenance of vaccines at controlled temperatures at the commune level. The assessment also consist of a temperature monitoring component which is responsible for measuring temperatures both inside and outside of the cold chain (Durch 25).
Good Storage and Distribution Practices
Storage, shipping in addition to storage and distribution of pharmaceutical products are some of the activities involved in the immunization management system. The nature of the risk involved might generally be those involved during the manufacturing of the vaccines. This includes the mix ups, exposure of the vaccines to extreme environmental conditions as well as both contamination and cross contamination of the vaccines (Durch 20-25).
The quality of immunization products can be affected by lack of enough control over several activities encountered during storage and distribution procedure. Additionally the distribution procedure has just been recently effectively-emphasized with regard to the requirement for establishing, developing, maintaining and controlling of activities involved in management of immunizations. To maintain the original quality of immunization products, all activities involved in the storage and distribution should be carried out in accordance with the principles and standards of Good Manufacturing Practices (GMP), Good Storage Practice (GSP) and Good Distribution Practice (GDP).
There are therefore, elements in storage in addition to distribution to which principles of good manufacturing practice must be applied. They include, though not limited to, storage, distribution, transporting, packaging, labeling, documentation and record-keeping practices.
Good storage and distribution practices help in making sure that the quality and integrity of immunization products when storing, shipping and distributing these products. Effective monitoring of storage facilities as well as distribution procedures is a vital aspect of good storage and distribution practices in immunization management system. Furthermore, all regulatory bodies give strict scrutiny in these fields and require correct measurement and documentation as well (O'Carroll 45-46).
Immunization products are supposed to be stored within locations that adhere to conditions established by the manufacturer of the immunization products. Shippers and distributors should comply and follow the required and appropriate storage and shipping requirements as specified by the manufacturer. More so, storage and distribution is a vital activity of the integrated supply chain management of immunization products. Different people and entities are normally responsible for the handling, storing and distributing the immunization products. Numerous up to date guidelines are on hand to focus on significant elements that assist in making sure that the safety and efficacy of immunization products when storing, shipping and distributing them is observed (O'Carroll 42-44).
WHO Perspective in Immunization Management System
Immunization programs are faced with several challenges especially in developing nations. The worldwide goals of immunization management system for the next few years include;
- Eradicating poliomyelitis, controlling and eliminating measles and controlling of yellow fever and well as eradication of maternal neonatal tetanus and many more.
- Improvement of immunization coverage and extension of immunization services to remote populations, particularly among private sectors.
- Introduction of numerous new vaccines.
Every task is a new challenge that amplifies within a cumulative fashion and that managers handling immunizations and vaccines should be committed to tackle. The opinion that cold chain and immunization products’ distribution mechanisms in numerous nations are disintegrating has impelled WHO to mainly focus in strengthening the immunization management system. The high level of vaccine wastage, poor employment of available policies in addition to tools like vaccine Vial Monitor (VVM), and multi-dose vial policy (MDVP) have also emphasized the requirement to have improved and better immunization management practices (James 46).
Undesirable incidences because of partially inapt vaccine distribution practices are also perceived to have a negative impact on immunization management system. With pressures like multi-skilled health staff, high staff turnover rates, and introduction of new vaccines and technologies, the requirement for training in improved immunization management practices has turned out to be a priority. This environment prompts for the establishment of a new support system to optimize immunization management systems. This therefore rationalizes the establishment of immunization management training courses under WHO (World Health Organization 2-5).
Cold Chain and Logistics
This refers to the system of individual, policies, processes, transportation, equipment in addition to technologies that work jointly to ensure that vaccines offered to individuals are safe and effective. Since most of the immunizations have specific temperature requirements, an efficient cold chain and logistics management system avoids both extreme heat and cold from interfering and damaging the vaccines from the time they are manufactured till when they are used (Durch 45-48).
Importance of Cold Chain and Logistics in Immunization Management System
An efficient and competent logistics system and effectively maintained cold chain are necessary and important for safe and effective immunization service delivery. An inappropriately functioning cold chain can result into wasted immunization products, missed opportunities to carry out immunization because of lack of vaccines, as well as children getting vaccines that do not safe guard them as intended or that in reality make them sick. Problems with aging or deficient cold chain equipment, in addition to transport and storage gave turned out to be more critical as new and costly vaccines are being introduced. Each immunization management system is supposed to evaluate cold chain equipment at times and reinstate broken equipment not worth repairing. With the plans of introducing, developing, implementation of new vaccines in the immunization management system, further equipment is required in order to handle the increased storage needs. Financing for cold chain and logistics is also supposed to be given a priority (World Health Organization 4-6).
Information System Assessment
Immunization management system should be optimized. Optimize refers to the strengthening of the system to allow the new vaccines to reach new target groups. The information system assessment is supposed to collect data on the current reporting methods as well as collect information regarding information systems used in the management of vaccine stocks and also immunization services and supervision. According to several studies, while the present immunization management system accomplishes quasi-perfect coverage with a monthly session-based system, whereby about 96 percent of children are completely immunized according to survey results. The immunization management system is very information and labor intensive as well and depends on the communal administrative system and dedication of the staff involved with immunization processes. There are various ways of improving the accuracy of information reported in immunization management system whereby a computerized system can be implemented. The computerized system is important in tracking movements of every lot of vaccine and automates immunization reporting within immunization system (World Health Organization 6).
Fee-Based Immunization Service Assessment
Fee-based immunization is the delivery of vaccines that are not included within most available free national immunization program. These immunizations are present at the private and public clinics. Qualitative evaluation of the immunization management system consists of interviewing the facility managers, procurement officials, storekeepers, the ones administering immunizations, who are the vaccinator in addition to the clients. Immunization practice and facility checklists should also be completed. All immunization facilities should have a solid infrastructure, excellent knowledge of vaccine storage and should also possess strong immunization practices (American Medical Informatics Association 10-12).
Modeling an Optimal Public Sector Supply Chain
In order to develop a model of an effective immunization management system, cost data related with the appropriate immunization system. This includes cold chain storage, maintenance of equipment, transportation, employee salary, facilities and supply of vaccine and immunization. Normally, costs related to the supply chain comprise of about 35% of the total cost of completely immunized child. Apart from product inventory, human resources and cold chain costs account for the most of the costs of the vaccine supply chain system. The government together with the concerned bodies is supposed to work jointly and use the immunization management system in assessing the effect of numerous potential changes to the supply chain. This includes changing the frequency of vaccine delivery. Moreover, the immunization management system should be expanded to include supplementary regular vaccines or fee based vaccines (World Health Organization 4).
Cold Chain Related Risk Management
The risk management refers to the process of identifying, evaluating, mitigating and monitoring of the risks involved during the supply of vaccines. In the framework of present Good cold chain management Practices, this is supposed to include the management of the risks associated with temperature and humidity. This should also include qualification and validation of individual parts of the Cold Chain in addition to constant monitoring and appraisal of manufacturing, storage and shipping conditions (American Medical Informatics Association 5).
The quantity and quality of Cold Chain associated information obscures the immunization management system considerably and therefore this requires the availability of committed tools and processes to facilitate an economically feasible constant risk review process. It is hence important to effectively manage the temperature associated risks within the overall risk management procedures. Technical likelihoods, available tools and approaches, existing best practices and also processes should always be evaluated and appraised to make sure that the immunization management system is effective (American Medical Informatics Association 5-8).
An effective immunization management system basically is supposed to cover the following:
- Make sure that the vaccines receives are of assured quality. This should be done by ensuring that the vaccines have met the requirements specified by the National Regulatory Authority or World Health Organization.
- Make sure that there is availability of enough quantities of appropriate immunization-allied supplies in order to guarantee safe administration of the vaccines during immunization. These supplies include diluents, syringes and needles, wicks and kerosene for refrigerators and other.
- Stock-outs should be avoided to ensure that there is continuous implementation of immunization activities.
- Appropriate handling and storage conditions should be maintained to avoid overstocking as well as avoidable expiration of materials before they are used.
- It should be ensured that there is sufficient cold store capacity for vaccines. This means that the vaccines being used in immunization should be stored at the recommended storage temperatures and enough dry store capacity for injection supplies (Kumar 32-35)..
For the children and adults who do not have written documentation of immunization or incase there is doubt regarding the validity of the record or vaccines used, immunization utilizing the original series schedule as suitable for their age should be started. It is recommendable that for everyone who newly arrives in the country to receive all the immunizations that are entitled for at the time of their appointment except if medically contraindicated. If this is impossible, it is recommendable that immunizations which are designated within the ISPA 5 be given first. There are several resources available to help public health units in providing accessible care to people of different nations where language barrier is a problem. If possible, translation services should be sought.
The immunization management system should have both computerized and manual methods as this will increase the immunization rates for the high risk people and high risk children as well. By making use of the inpatient as well as outpatient monitoring of all the immunizations, with suitable follow-ups, the immunization rate is likely to have a remarkable increase. Moreover, it will also possible to know and monitor the number of immunizations administered as well as maintaining effective flow of vaccines (Kumar 42-44).
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