In 2017, Haiti began replacing kerosene vaccine fridges with 850 solar-powered units; vaccination coverage in the North rose from 73.6% to 86% by the end of 2018 | World News
Health workers once had to rely on refrigerators that were powered by gas or kerosene in northern Haiti, to keep vaccines cold in places where electricity was unreliable. The equipment was expensive to operate and vulnerable to fuel shortages.But a solar-powered cold chain began changing that in 2017, as more than 850 solar refrigerators had been installed across Haiti in less than three years, as reported by UNICEF. In the North, vaccination coverage rose from 73.6% in 2017 to 86% at the end of 2018, according to Derline Mentor, a UNICEF cold-chain officer.
Solar-powered vaccine coolers at a health facility in Gonaives, Haiti/A child receives an oral rotavirus vaccine during a vaccination campaign in Haiti | CDC
A cold chain problem was also a distance problemTransporting fuel to health facilities could be difficult in rural and mountainous parts of Haiti, and a refrigerator could also become useless if its fuel supply was interrupted or if equipment broke and repairs were delayed. UNICEF’s account of the program describes the older refrigerators as gas- or kerosene-powered, and health workers said the cost and logistics of maintaining those systems could lead to interruptions in the cold chain.UNICEF said that the solar refrigerators could maintain vaccine temperatures between 2 and 8 degrees Celsius and could be monitored remotely, which allowed health workers to store doses at smaller facilities and then transport them in cool boxes to vaccination sessions in nearby communities.That changed the distance involved in getting a child vaccinated for some families. UNICEF described one mother in the Nord department who previously faced a two- to three-hour journey to the nearest hospital. After a solar refrigerator was installed closer to her community, the vaccination meeting point was about 10 minutes away on foot.Haiti was an early beneficiary of the cold-chain upgradeThe solar refrigerator program was connected to the broader Cold Chain Equipment Optimization Platform supported by Gavi and other partners. Gavi reported that Haiti’s health ministry was the first country to use the platform to overhaul its aging vaccine cold chain. In 2017, more than 191 modern solar-powered refrigerators were deployed in rural and mountainous areas.In remote mountain communities, it was difficult carrying propane cylinders to power conventional refrigerators. The new equipment could operate without depending on a regular fuel delivery system. Gavi described the investment as part of a wider push to replace outdated or damaged refrigeration equipment and expand cold-chain capacity in countries where reliable electricity was unavailable.Technicians had to install and maintain the refrigerators, vaccines still had to be transported, and health workers still had to persuade families to attend vaccination sessions. The technology addressed one of the physical barriers in that chain, which was keeping doses within the required temperature range before they reached children.Solar power moved refrigeration closer to patientsUNICEF described nurses taking vaccine doses from a solar refrigerator at a vaccination point in La Suisse, in northern Haiti, and placing them in a cool box and traveling by motorcycle to vaccinate children. The arrangement meant that the refrigerator could support a smaller network of vaccination points.UNICEF later described solar refrigeration as part of its wider effort to strengthen Haiti’s immunization cold chain. By 2021, UNICEF said it had installed more than 920 solar-powered refrigerators in Haiti and had equipped 96% of the country’s health institutions with solar fridges for vaccine storage.
Captured in 2014, in the northern Haitian commune of Gonaives, this image depicted Centers for Disease Control and Prevention (CDC) staff members, Becky and Roody, inside a structure that housed the Dometic TCW 3000 SDD, solar operated, blue-colored vaccine coolers | Kathy Cavallaro, Global Immunization Division
The coverage figure came alongside the equipment rolloutThe increase in northern Haiti’s reported vaccination coverage was recorded during the same period in which the solar cold-chain program was expanding. UNICEF reported coverage of 73.6% in the North in 2017 and 86% at the end of 2018. The figures show the change in vaccination coverage, but they do not establish that solar refrigerators alone caused the increase. Other parts of the immunization system were operating at the same time, including vaccine supply, outreach and health-worker services.The refrigerators addressed something more specific, which was the ability to keep vaccines properly stored in places where conventional refrigeration depended on unreliable electricity or fuel. The solar units reduced one of the logistical obstacles between vaccine supply and the children who needed it by bringing cold storage closer to remote communities.