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Consultancy: Understanding Vaccine Wastage through the Vaccine Risk Score in Malawi at Nexleaf Analytics

  • Consultancy
  • Malawi
  • Salary: 000

Nexleaf Analytics

Nexleaf Analytics supports the MOH in Malawi to monitor the performance of cold chain equipment (CCE) using remote sensor technology. Real-time temperature data from devices at facilities nationwide is uploaded to an online dashboard, as well as summarized and shared with users through reports. Improved access to temperature data helps managers and decision-makers to identify equipment failures, prioritize routine and preventative CCE maintenance, direct technical assistance and training efforts, forecast CCE procurement needs, and other actions to improve the performance of their cold chain.



Current metrics to assess cold chain performance include the number and duration of temperature excursions and total uptime (percentage of time that CCE registers temperature in the WHO-recommended range of 2 to 8 degrees C). However, these metrics are incomplete. They do not fully account for the severity of temperature excursions and cumulative effect of excursions on the remaining life of vaccines. Relying on these current metrics can create a false sense of security about the performance of the cold chain, and the resulting decisions can be suboptimal for an efficient and effective cold chain.

Vaccine Risk Score

The vaccine risk score (VRS) is a metric developed by Nexleaf which estimates the remaining life of vaccines using RTM data and VVM models. VRS enables health care managers to understand the impact of real-world conditions on vaccine life at different points in the cold chain, and to manage risk accordingly.

Though VRS offers many potential benefits to health care managers, it is not currently used widely. In Malawi, RTM was recently introduced and health workers are starting to gain skills in using RTM data. Experience from other settings have shown that there are barriers to using VRS, such as lack of familiarity with the metric and few opportunities to provide feedback on how data is presented and used. Moreover, VRS has never been compared to actual vaccine wastage records in the field to test how RTM data can better predict and prevent vaccine wastage.

Study Rationale and Questions

This study seeks to understand how VRS metrics could better be used to strengthen cold chains in Malawi and in other settings. By validating the use of VRS in real-world settings, this study seeks to answer the following key questions:

  1. To what extent do VRS metrics reflect vaccine wastage and the health of the cold chain?
  2. What are the factors that contribute to vaccine wastage due to cold chain failure?
  3. What strategies are recommended to reduce vaccine wastage due to cold chain failure?

Scope of Work

Nexleaf and the MOH are conducting an analysis of temperature performance across equipment in Malawi. This includes examining VRS, uptime, and alarms. A summary of high, medium, and low performing equipment by region, zone, and district will be used to draw a sample of 25 facilities to visit for field work.

The sample will be purposefully selected to identify facilities with data patterns that would benefit from further follow up. The sample will include all three regions and both urban and rural settings, approximately proportionate to population size, as outlined in the table below.

Region Rural Urban Total
North 4 1 5
Central 8 2 10
Southern 8 2 10
Total 25

Field work is expected to be conducted in October 2022. A local data research partner is sought to complete the two key tasks listed below and described in more detail in the following sections.

  • Prepare and submit local institutional review board (IRB) application
  • Conduct structured data collection in the selected field sites

Further detail about these two tasks is listed in the sections that follow.

Institutional Review Board (IRB) Application

Nexleaf and the MOH are developing a detailed study protocol, draft data collection tools, and draft consent forms. The selected partner will facilitate and complete the IRB submission process including: provide guidance on IRB application process and components, review draft materials, suggest any necessary revisions, translate data collection tools and consent forms into the local language, submit the IRB application to the relevant local authorities, and respond to questions from the IRB.

Field Data Collection

Field work is expected to be completed over 3 weeks, reaching approximately 2 facilities per day. The site visit protocol and data collection tools are under development and are expected to include:

  • Presentation of facility temperature data (provided by Nexleaf)
  • Examination of paper records of vaccine wastage and vaccine vial monitors at the facility (to compare to reported vaccine wastage data from MOH)
  • Interviews of healthcare staff to examine major causes of vaccine wastage due to cold chain failure and potential solutions (approximately 2 interviews per site, 50 interview total)
  • Completion of checklist on staff adherence to cold chain management protocols

The selected partner will conduct field work in the local language and provide completed data collection and note-taking forms in English.


  • Translated data collection tools
  • Complete IRB application approved by local authorities
  • Field work schedule and implementation plan
  • Site visit data collection forms (English) – 25 sites expected
  • Site visit interview note-taking forms (English) – 50 interviews total expected
  • Participation in field work debriefing session (estimated 2 hours, online)

Additional products are expected to result from this effort including a complete study report, journal article, and dissemination event. The field work partner will be included as an author on future publications and have the opportunity to provide feedback on such products as desired. Additional needs for communication and dissemination will be determined following the completion of the study and, if needed, through a separate scope of work.


The anticipated timeline for completion of deliverables is listed in the table below. Dates may be adjusted with the approval of the project manager according to the availability of field work site staff, other project activities, and the IRB approval process.

Date Activity
September 16, 2022 Proposals due for TOR
September 16-23 Review of proposals, selection and contracting of local partner
September 26-30 Consultations, document review, preparation of IRB package
September 30 Submit IRB
October 1-14 Preparation of field work schedule and implementation plan
October 17-Nov 3 Field work
November 4 Field work debriefing session
November 7-11 Transcription, translation, and preparation of data files and note-taking forms
November 11 Submission of field visit files
December 1 Provide feedback on study analysis and report


Successful candidates will demonstrate the following capabilities in their proposal:

  • Experience coordinating and submitting IRB proposals including informed consent processes and other ethical considerations
  • Experience conducting field research, including the use of document review, checklists, interviews, and direct observation methods
  • Knowledge of Malawian health system and health facility operations
  • Excellent project management and logistical coordination abilities
  • Excellent written and oral communication skills (English and local language)
  • Education and training relevant to support the activity

Key Contacts

Questions about this TOR can be directed to:

  • Patience Mfune, Malawi Program Manager, Nexleaf Analytics,
  • Mphatso Mtenje, National Cold Chain Manager, Extended Programme on Immunization (EPI) Malawi Ministry of Health,

Method of Application

Please submit a proposal no longer than 10 pages that includes a description of relevant qualifications for this scope of work, examples of similar work completed, a proposed technical approach to completing the deliverables, 3 references, and a detailed budget.

Proposals must be submitted by copying in


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