KINSHASA, Democratic Republic of the Congo (June 27, 2012) — Poor infrastructure and difficult terrain isolate many villages of the Democratic Republic of the Congo (DRC). This lack of access is the greatest obstacle to the country’s provision of health care.
It also poses significant problems to the country’s cold chain—the system of refrigerated storage and transportation that ensures vaccines remain potent during distribution. The absence of functional cold chains puts hundreds of thousands of children at risk of deadly but preventable diseases like polio.
Impassable roads, rivers and mountains separate most of the country’s population of 66 million, making transportation a challenging and expensive enterprise.
It can take two days to reach Kimvula, a town nestled in the mountains of Bas-Congo Province, from capital city Kinshasa. Kimvula’s chief health officer, Dr. Nick Kajila Nianga, says that during the dry season, health workers delivering vaccines have to cross sandbars and during rainy season they have to cross waterlogged terrain, both delaying travel.
Once in Kimvula, vaccines must be delivered to local health centers by motorcycle or foot.
And in interior provinces, lifesaving vaccinations can only be delivered by airplane, which tremendously increases the cost of healthcare distribution.
Once vaccines do arrive in provincial health centers, there are further difficulties dispatching them to districts, health zones, health centers and villages; they are often transported by car, motorcycle, boat, or bicycle, or they are simply transported by foot in a vaccine cooler. Chief health officer in Mbanza Ngungu, Dr. Isaac Mpambu Malanda, says many health zones do not have a car to facilitate distribution, and when they do, it’s often not in good working condition.
The oral polio vaccine is extremely sensitive to heat and must be stored at a specific temperature to be preserved properly.
At the national depot, the vaccine is properly stored in cold chambers between -4 degrees Fahrenheit and -13 degrees Fahrenheit. At the Ministry of Public Health’s Expanded Program on Immunization (PEV) in Kinshasa, 19 UNICEF-donated cold chambers work around the clock to keep vaccines at the right temperature. However, the city’s regular power cuts mean that two generators are required to maintain this constant temperature.
Once in the provincial health zone, the vaccines are at risk of spoiling because of the lack of electricity and aging refrigeration equipment.
When the vaccine travels to provinces, it can be kept for one month in a refrigerator and for a few days in a cooler, but Malanda says that much of his equipment has fallen to pieces. The three refrigerators aren’t working, the freezer is broken and one of the fridge doors doesn’t close properly.
Many areas are working to update their equipment, with gasoline- or solar-powered refrigerators used where there is no electricity. Still, it remains difficult to ensure that all health zones have the capacity to store vaccines under proper conditions.
More must be done to maintain and support the cold chain. Success of polio eradication in DRC depends largely on the country’s ability to provide quality vaccination, delivered under the strictest condition, to even those living in the most remote communities.