Framework for Action

In 2015, WHO and UNICEF issued a joint statement recommending integrating oxytocin into EPI cold storage where storage for oxytocin was inadequate¹.

In Uganda, in 2017, health facilities without adequate cold chain capacity for oxytocin were instructed by the MOH to leverage EPI cold chain systems, with Gavi providing support for more than 600 refrigerators containing specific compartments for oxytocin. Integration of oxytocin required the development of guidelines, SOPs and visual aids, implementation in two demonstration districts, then plans for scale-up throughout the country².

Added Value:
The EPI program, through cold chain upgrades supported by Gavi, was able to add value to PHC by strengthening access to safe and effective health products, in this case, oxytocin.

PHC levers:
Enabling factors: Political commitment & leadership (high level commitment & active involvement from MOH & partners); governance & policy frameworks (development of national scale-up plans and SOPs to guide implementation); physical infrastructure (Gavi investment in cold chain expansion included separate compartments for oxytocin); systems for improving quality of care (enhanced and integrated supportive supervision to ensure QoC).

Constraining factors: M&E (stock management forms were not integrated, therefore record keeping was a challenge); physical infrastructure (concerns about longer term sustainability should EPI add antigens and need additional cold chain space and an ongoing need for storage for other medical products; PHC workforce (concerns that HCWs could confuse oxytocin with vaccines).

When to consider this approach:

  • In contexts where a comprehensive assessment of existing EPI cold chain capacity,
    policies and vaccine stock inventory (conducted prior to integration), indicates that
    sufficient space exists.
  • Where EPI refrigerators already contain separate storage compartments for vaccines
    and diluents and other temperature-sensitive health products (e.g. oxytocin).
  • When planning EPI cold chain upgrades, also consider storage needs for other PHC
    commodities. Reflect strategies in national immunization strategies, annual operational
    plans, Gavi full portfolio planning, etc.).