From Crisis To Opportunity

Medicines and other pharmaceutical products can degrade over time if exposed to high temperatures. In USAID-supported countries, excessive heat can threaten the quality of medicines stored in warehouses.

In Haiti, GHSC-PSM manages a warehouse where the project stores antiretroviral and essential medicines, contraceptive pills, injectables, and implants, HIV rapid test kits, and other health commodities (including for COVID-19 and cholera emergency response) that must be stored in a temperature-controlled environment at manufacturer specified
temperatures.

Until recently, GHSC-PSM maintained all pharmaceutical-grade commodities at a constant temperature of 22 degrees Celsius, using air conditioners powered by generators. These protocols required the presence of at least one warehouse staff member around the clock to prevent interruptions in cooling when generators failed. Project staff could be called at any hour of the night or weekends to mobilize repair technicians. The continuous operation of generators also resulted in constant wear and tear of the equipment, requiring frequent repairs and ongoing preventive maintenance.

These temperature control protocols are common across the pharmaceutical storage sector. GHSC-PSM began to question these protocols in October 2022 when gangs blocked Haiti’s international port, fuel depot, and terminal, leading to severe fuel shortages and increased fuel costs. These challenges significantly impacted the project’s ability to keep generators operating around the clock.

Graphic: Pharma and non-pharma temperatures on an unusually hot day. GHSC-PSM used data like this to determine the hours of operation for air conditioning to maintain acceptable temperatures. 

Remote temperature monitoring devices provide real-time updates and send automatic alerts to report any temperature excursions. 

Despite reducing average air conditioning use by 60 percent, the warehouse maintained acceptable temperatures at all times. Under these new protocols, temperatures ranged from 22.3 to 28 degrees during eleven months of operation, with no instances of unacceptable temperature excursions. 

Graphic: Average temperature from October 2022 to August 2023. In October, warehouse temperatures were unnecessarily low as staff learned when air conditioning needed to operate. They realized that they could turn on the air conditioning up to two hours later than assumed, but would need to leave it on a bit later than assumed. 

With no adverse effect on pharmaceutical quality, GHSC-PSM achieved potential cost savings of approximately $201,000 annually. In addition to about $177,000 annual cost savings in fuel consumption, generator and air conditioning maintenance costs fell by about $24,000 as a result of decreased equipment use from 24 hours a day to 11 hours or less, depending on the season. 

In addition to the financial savings, the project has decreased its carbon footprint by about 40,000 gallons (60 percent) in fuel consumption annually. This aligns with USAID’s Climate Strategy 2022-2030 which envisions “a resilient, prosperous and equitable world with net-zero greenhouse gas emissions.” 

The project maintains close monitoring and reporting of temperature data, making adjustments as necessary. GHSC-PSM also plans to improve insulation in the ceiling and walls and to increase door sealants and padding to further reduce the need for air conditioning even more.

GHSC-PSM’s experience in Haiti suggests that pharmaceutical grade warehouses in regions with hot summers could greatly cut costs and reduce environmental impact while maintaining product quality. The project’s findings also suggest that traditional protocols for maintaining warehouse temperatures at a constant 22 degrees Celsius may represent significant over-use of air conditioning. The program faced limitations in potential cost savings due to increased fuel costs in Haiti resulting from ongoing violence. In countries with stable fuel prices, it is likely that even greater cost savings can be achieved. For those implementing a similar strategy, prepare for the transition to a new model with the following activities:

Conduct a baseline analysis of the entire stock. Review manufacturer documentation for acceptable temperatures and determine the value and volume of commodities falling within different temperature ranges. Use this information to determine volumes of commodities to be stored in cold rooms versus refrigerated spaces.

Document current fuel consumption. To enable future analysis, document current monthly fuel consumption, including both volume and associated cost.

Monitor temperatures. Set up a cost-effective, wireless temperature monitoring system. Many relatively low-cost solutions are available in the open market. Temperature mapping, which monitors temperatures in different areas of the warehouse, can be costly and may not be necessary. 

Provide power to vital systems. Although air conditioning will no longer operate around the clock, other critical systems will require constant power. These could include temperature monitors using wireless loggers, routers with internet connectivity, computer servers and equipment, and surveillance cameras. For GHSC-PSM in Haiti, these systems operate using a solar panel and inverter system.

Partner with warehouse staff for effective change management. Engage all warehouse staff in discussions and planning for the anticipated shift. Even those not in charge of operating air conditioning and generators will be impacted. When average temperatures in the warehouse change, staff can also feel uncomfortable at first but adjust over time. (Temperatures of 27 degrees remain safe for staff working in the warehouse.) Staff will be less likely to resist the change when they understand the program’s overall benefits, including the benefits to patients of quality assured medicines. 

Once ready to implement, consider the following tactics:

Implement a shift in schedules and routines. The benefits to key staff are many, including elimination of overnight shifts or emergency maintenance at odd hours. However, the new schedules will still require staffing during weekend operation hours and will require someone to be present at the warehouse before opening hours (when needed) to turn on systems and after closing hours (when needed) to turn them off. In GHSC-PSM’s warehousing in Haiti, two individuals have the primary duty of operating the air conditioning and generators.

Hone the air conditioning schedule. Seasonal temperatures can vary greatly from place to place. Warehouse staff should use the temperature monitoring equipment to hone the air conditioning schedule to avoid over or under-conditioning. Set an air conditioning schedule (log) and write down what time the system was turned on and off. Weekly averages are useful to modify the schedule over time. Pay attention to short-term weather forecasts to determine necessary daily or weekly adjustment.

Consider other ways to maintain cool temperatures. Instead of using the exterior doors of the temperature-controlled section of the warehouse for receiving and dispatching orders, GHSC-PSM established a new procedure to only use the exterior doors of the ambient section. Pharmaceutical-grade commodities move exclusively between the ambient and temperature-controlled sections through smaller internal doors. This new procedure significantly reduces the volume of cold and warm air flow between the temperature-controlled section and the outside environment.

Analyze and share results with key partners. Using baseline data, conduct the kind of analysis found in this brief and share the findings with staff, donors, and other key partners. Be prepared for discussions about how to leverage cost savings. For example, the funds saved could be used to invest in additional energy-saving equipment such as solar panels, or be reallocated to support care and treatment programs.