21 st May pm WHO conference room Expanded Program on Immunization

Before TC PamImmediately after (first 72hrs) Emergency phase (72hrs to 6 weeks) National Vaccine Supply and Cold Chain System was functional EPI unit working with WHO/UNICEF in focusing to strengthen RI and cover the immunity gap for Measles with SIA campaign and new vaccine introduction (IPV Rubella). NDMO has prepositioned gasoline Pool of nurses in the country NGOs on the ground Microplans, tools, CCE Inventory available Good coverage in 2014 due to implementation of RI strengthening activities. No vaccine damages: Immediate assessment & actions in cold room; power restored in <48Hrs: -Flooded area cleaned up; -generator, cold room were fixed; -Passive containers, conditioned ice packs were secured for vaccine storage Pool of resources MOH, UNICEF,WHO, NDMO (financial, TA, gasoline) Procured 10 KVA generator and 3 stabilisers Power Grid resumed 1week post TC Pam MOH commitment, Partners Support & Coordination -Emg Measles campaign started on 5 th day in Evacuation centers and cont -other services (timely arrival of supplies) integrated: VAC, Deworming, MUAC, IYCF, HW w/soap -Cold chain vaccine mgt orientations for vaccinators -Microplanning, RCA -Intensify AFR Surveillance

Before TC PamImmediately after (first 72hrs) Emergency phase (72hrs to 6 weeks) Staffing: -No national cold chain officer & technician -Weak routine outreach public health service delivery ( less HR, vaccine stock outs in remote health facilities, low provincial public health management ) causing low routine coverage and immunity gap for measles ( PV, Tanna ) Lack of functional VPD surveillance No Cold Chain contingency plan at almost all levels Power grid not restored No gasoline for the standby generator; low access to daily supply of gasoline x 1 week Cold room not meeting WHO PQ standards Lack of stabilisers for Ice Lined Refs Low HR capacity Power restored only after 1 week Cold Room Building and space not meeting global standards Solar refs installations not disaster resilient Lack of hired MOH vaccinators to conduct campaigns Inadequate routine community based mobile outreach services Health facilities lack vaccinators

Before TC PamImmediately after (first 72hrs) Emergency phase (72hrs to 6 weeks) Develop contingency plans for cold chain/vaccine management at all levels esp central store Secure sustainable and predictable funding and implement routine community based mobile outreach vaccinations integrating essential population based services Analyse immunization program management by province/HFs and develop equity focused microplan ( vulnerable high risk areas) Follow EVMA standards on contingency planning, and implementation for disasters Update National cold chain inventory according to recent global standards; procure additional equipment Implement Measles Campaign Plan with Budgets during Emergencies Ensure Cluster Assessment tools include adequate Cold chain variables Ensure quality supervision and monitoring during measles campaign Continue best practices e.g. good partners collaboration, MOH commitments