Pharmacy Education (2023) 23(2) 37 - 41

https://doi.org/10.46542/pe.2023.232.3741

IAI SPECIAL EDITION

RESEARCH ARTICLE

Evaluation of COVID-19 vaccine storage at

community health centres in Mataram city
Baiq Lenysia Puspita Anjani, Cyntiya Rahmawati, Baiq Nurbaety, Baiq Leny Nopitasari, Anna Pradiningsih
Department of Clinical and Community Pharmacy, Faculty of Health Sciences, University of Muhammadiyah Mataram, Mataram,
Indonesia

Keywords
Community health centre
Abstract
COVID-19 vaccine Background: The government of the Republic of Indonesia issued a Regulation of the
Mataram city Minister of Health in 2021 concerning the implementation of vaccination in the context of
Storage overcoming the Coronavirus pandemic (COVID-19). Vaccination will be more cost-
effective than treatment if evaluated from an economic point of view. A high accuracy of
vaccine management in healthcare facilities such as in community health centres
(puskesmas) will positively impact the health sector’s medical, social and economic
aspects. Objective: To explore the suitability of COVID-19 vaccine storage at puskesmas
Correspondence throughout Mataram City based on Good Drug Distribution Method (CDOB) in 2020 and
Cyntiya Rahmawati the Ministry of Health of the Republic of Indonesia number HK.01.07/MENKES/4638/2021.
Department of pharmacy Method: This study was an observational study with quantitative approach. Result: The
Universitas Muhammadiyah Mataram average percentage of indicators of COVID-19 vaccine storage at puskesmas throughout
Mataram Mataram City were as follows: 1) officers and training (33.3%); 2) buildings (17.8%); 3)
Indonesia facilities (11.8%); 4) operational (78.5%); 5) maintenance (57.7%); 6) calibration,
[email protected] qualification and validation (73.3%), and on the suitability of COVID-19 vaccine storage
(92.5%). Conclusion: The suitability of COVID-19 vaccine storage at puskesmas
throughout Mataram City based on CDOB 2020 and the regulation shows that the average
category is 52.1%, which falls into the category of ‘not good’.

Introduction productivity. Herd immunity can only be formed if

vaccination coverage throughout the region is high and
Coronavirus 2019 (COVID-19) is an infectious disease
evenly distributed. If evaluated from an economic point
that spreads through droplets and causes respiratory
of view, the provision of a vaccination plan will be more
tract infections in humans, ranging from cold and cough
cost-effective than the plan to carry out treatment
symptoms to more serious infections such as Middle
(Kemenkes RI Dirjen P2P, 2021).
East Respiratory Syndrome (MERS) and Severe Acute
Respiratory Syndrome (SARS) (WHO, 2020). Efforts to In overcoming the COVID-19 outbreak, the government
overcome COVID-19 continue with other strategies of the Republic of Indonesia issued Regulation of the
because the long-term COVID-19 outbreak has Minister of Health 23 of 2021 concerning the
significantly impacted the economy and social life of Implementation of Vaccination in the Context of
large populations. Another more effective and Overcoming the COVID-19 Pandemic (Kementerian
economical intervention to prevent disease Kesehatan RI, 2021). The central government aims to
transmission is vaccination efforts (Makmun & implement the COVID-19 vaccination by involving local
Hazhiyah, 2020). COVID-19 vaccination aims to reduce governments and regency/city governments as well as
the transmission or spread of COVID-19, reduce the legal entities or business entities. The COVID-19 vaccine
morbidity and death rate due to COVID-19, achieve will be distributed to puskesmas (the Indonesian term
herd immunity and protect the community from for community health centres), clinics, hospitals, Port
COVID-19, all in order to maintain social and economic Health Offices (KKP), or vaccination service posts

Pharmacy Education 23(2) 37 - 41 37

ISSN 1477-2701 online © 2023 FIP
Anjani, et al Evaluation of COVID-19 vaccine storage at community health centres

designated as COVID-19 vaccination service places data from interviews with vaccine management
(Kementerian Kesehatan RI, 2021). The types of officers.
vaccines used for the vaccination programme by the
Indonesian government are the CoronaVac vaccine Assessment
produced by Sinovac, and the AstraZeneca vaccine
produced by the University of Oxford. The vaccine used The observation sheet used in this study was sourced
for mutual aid vaccination (legal entities or business from CDOB 2020 and the Ministry of Health of the
entities bear funding) is the Sinopharm vaccine Republic of Indonesia number HK.01.07/MENKES/4638/2021
produced by the Beijing Institute of Biological Product concerning Technical Guidelines for the
(Kemenkes, 2021). Implementation of Vaccination in the Context of
Overcoming the COVID-19 Pandemic. Seven storage
The accuracy and thoroughness of vaccine indicators measure COVID-19 vaccine storage from a
management will positively impact the medical, social, checklist or observation sheet: officers and training on
and economic aspects of the health sector. Vaccines COVID-19 vaccine management; COVID-19 storage
are very vulnerable products, so careful handling is buildings; COVID-19 storage facilities; COVID-19
needed to maintain the quality of the vaccine. For vaccine storage operations; maintenance of COVID-19
example, the vaccine's effectiveness will decrease or vaccine storage; qualification, calibration, and
disappear if it is not stored at the correct temperature. validation of COVID-19 vaccine storage equipment; the
The potential for vaccine damage can be prevented by suitability of COVID-19 vaccine storage based on the
carrying out correct distribution, storage, and Ministry of Health of the Republic of Indonesia 2021.
management practices (Saputri, 2018).
Previous research that has been carried out regarding
the suitability of COVID-19 vaccine storage based on
(Good Drug Distribution Methods) CDOB 2020 and the Results
Decree of the Director General of Disease Prevention This research has received ethical clearance with
and Control Number HK.02.02/4/1/2021: those number 30/EC-04/FK-06/UNIZAR/V/2022 from the
conducted at the Puskesman Karang Pule showed that Faculty of Medicine, Al-Azhar Islamic University,
80.0% had good suitability for COVID-19 vaccine Mataram. The average table of percentage indicators
storage, and those conducted at the Mataram City of COVID-19 vaccine storage suitability is shown in
Pharmaceutical Installation showed that 67.0% were Table I. The average percentage of suitability for
suitable for COVID-19 vaccine storage (Julyasti & COVID-19 vaccine storage based on the 2020 CDOB and
Dyahariesti, 2021; Zuhroh & Dyahariesti, 2021). The the Indonesian Ministry of Health number
previous research was only carried out in one health HK.01.07/MENKES/4638/2021 at ten Puskesmas in
service facility, the puskesmas and the Pharmacy Mataram City is 52.1%, this falls into the category of
Installation in Mataram City. The current study was ‘not good’. The average percentage of COVID-19
conducted in all puskesmas providing COVID-19 vaccine storage suitability is lowest in Puskesmas B and
vaccination services in Mataram City by looking at the Puskesmas H at 34.1% with the category of ‘not good’,
suitability of COVID-19 vaccine storage based on the and the highest percentage of suitability is at
2020 CDOB and (Decree of the Minister of Health of the puskesmas D at 79.5% which falls into the ‘good’
Republic of Indonesia) the Ministry of Health of the category. The average percentage of conformity of the
Republic of Indonesia number HK.01.07/MENKES/ COVID-19 vaccine storage indicator is the lowest in
4638/2021. storage facilities at 11.8%, which is in the category of
‘not good’. The highest percentage of conformity based
on the Ministry of Health of the Republic of Indonesia
in 2021 is 92.5%, which is in the ‘good’ category.
Methods
Design
Research methods employed descriptive observational
Discussion
with quantitative approaches. The study was
conducted at ten puskesmas in Mataram City. The average percentage for officers and training on
Researchers and COVID-19 vaccine management COVID-19 vaccine storage in ten Mataram City Health
officers filled out a checklist of observation sheets by Centers is 33.3% with the category of not good because
looking directly at the conditions of storage of the the vaccine management officers in eight puskesmas
COVID-19 vaccine at the health centre, accompanied by are not pharmaceutical workers, but other health
professionals. Based on the 2020 CDOB, the person in

Pharmacy Education 23(2) 37 - 41 38

Anjani, et al Evaluation of COVID-19 vaccine storage at community health centres

charge of the vaccine warehouse must be a pharmacist must be carried out by pharmaceutical technical
who meets the qualifications and competencies of laws personnel (BPOM, 2020). However, several health
and regulations. Suppose the person in charge of the centres coordinate with pharmaceutical personnel in
vaccine warehouse cannot carry out their duties within charge of managing pharmacy warehouses.
the specified time. In that case, the delegation of duties

Table I: Average percentage of COVID-19 vaccine storage suitability indicators

Puskesmas COVID-19 vaccine storage indicators (%) Average Category
Officers Building Facilities Operational Maintenance Calibration Suitability
and Qualification Based on the
Training Validation Ministry of
Health
A 33.3% 0% 0% 84.6% 46.2% 100% 100% 52.0% Not Good
B 0% 0% 0% 76.9% 61.5% 0% 100% 34.1% Not Good
C 33.3% 0% 0% 76.9% 38.5% 100% 100% 49.8% Not Good
D 66.7% 88.9% 54.5% 69.2% 76.9% 100% 100% 79.5% Good
E 33.3% 0% 0% 76.9% 69.2% 100% 100% 54.2% Not Good
F 33.3% 0% 0% 84.6% 53.8% 100% 100% 53.1% Not Good
G 66.7% 0% 0% 76.9% 76.9% 33.3% 100% 50.5% Not Good
H 33.3% 0% 0% 76.9% 53.8% 0% 75.0% 34.2% Not Good
I 33.3% 0% 0% 76.9% 53.8% 100% 75.0% 48.4% Not Good
J 0% 88.9% 63.6% 84.6% 46.2% 100% 75.0% 65.5% Good
Enough
Average 33.3% 17.8% 11.8% 78.5% 57.7% 73.3% 92.5% 52.1% Not
Good
Category Not Not Not Good Not Good Good Good
Good Good Good Enough
*Answer score on the observation sheet checklist (answer "yes" = 1; answer "no" = 0) (Julyasti & Dyahariesti, 2021)
*The total score on each indicator is calculated as a percentage (Arikunto, 2016).
*The average percentage is categorized with assessment criteria, not good (<60%), good enough (60% - 75%), and good: (>75%) (Julyasti & Dyahariesti, 2021).

Training on vaccine management and routine buildings and special vaccine storage facilities. COVID-
evaluation is not carried out by all COVID-19 vaccine 19 vaccine storage in eight other puskesmas is in one
management officers at ten Mataram City Health building with a storage area for drugs, files, and other
Centers. Based on the Ministry of Health in 2021 and goods, so the list of questions for building indicators
CDOB in 2020, training and evaluation need to be and facilities is irrelevant to ask puskesmas that do not
carried out for officers involved in implementing the have buildings and storage facilities for vaccines. Based
vaccination programme and, programme managers on the 2020 CDOB, buildings for storing cold chain
and supervisors by involving programme health products must be separated and locked, and equipped
training agencies. It is intended to increase the capacity with facilities such as room temperature meters,
of vaccinators and other health workers involved in humidity meters, Light Fire Extinguishers (APAR),
implementing vaccination services (BPOM, 2020; generators, cold rooms, freezers, and others (BPOM,
Kemenkes, 2021). Knowledge related to the 2020). Vaccine storage facilities and infrastructure are
distribution and storage of vaccines is very much important things that can support the correct storage
needed by vaccine management officers for proper of vaccines so that vaccines remain stable and effective
vaccine handling because vaccines are very sensitive (Santoso et al., 2020).
products if exposed to hot temperature conditions or
The average percentage for COVID-19 vaccine storage
freezing temperatures resulting in the vaccine being operations in ten Mataram City Health Centers is 78.5%
damaged (Sarmadi & Waty, 2020).
with a good category, but not yet optimal in the good
The average percentage for buildings (17.8%) and category because all puskesmas did not destroy the
facilities (11.8%) of COVID-19 vaccine storage in ten COVID-19 vaccine themselves but were returned to the
Mataram City Health Centers are included in the not Mataram City Pharmacy Installation for destruction. All
good category because only Puskesmas D and J have health centres do not have a special place for damaged

Pharmacy Education 23(2) 37 - 41 39

Anjani, et al Evaluation of COVID-19 vaccine storage at community health centres

or expired COVID-19 vaccines, and some puskesmas do (KIPI) and reduce the effectiveness of vaccines
not have a place to quarantine the COVID-19 vaccine. (Kemenkes, 2021; Lumentut, 2015).
The COVID-19 vaccines stored in ten health centres are
The average percentage of the suitability of COVID-19
Sinovac and AstraZeneca with a storage temperature of
vaccine storage based on 2020 CDOB and the Ministry
2 - 8°C. According to the 2020 CDOB, vaccine ware- of Health of the Republic of Indonesia Number
houses must have a quarantine area to separate the
HK.01.07/MENKES/4638/2021 at ten puskesmas in
returned, damaged products for which they will be
Mataram City is 52.1%, with a not good category
withdrawn. The destruction was carried out by the
because eight puskesmas do not have COVID-19
person in charge of the facility and witnessed by vaccine storage buildings and facilities. Moreover, the
officers of the Provincial Health Office and the local
competence of vaccine management officers is low and
Food and Drug Supervisory Center (BPOM, 2020).
inappropriate, and COVID-19 vaccine management
The average percentage for maintenance of COVID-19 officers do not optimally maintain COVID-19 vaccine
vaccine storage in ten Mataram City Health Centers is storage.
57.7% with a not good category because vaccine
management officers monitor the refrigerator's
temperature two times a day: morning and afternoon.
When cleaned, the vaccine refrigerator body only uses Conclusion
a wet cloth without a dry cloth, the vaccine refrigerator The suitability of COVID-19 vaccine storage at
condenser is not cleaned with a soft brush, and puskesmas throughout Mataram City based on CDOB
maintenance recording is not carried out every week 2020 and the Ministry of Health of the Republic of
and every month. Based on the 2020 CDOB, Indonesia Number HK.01.07/MENKES/4638/2021
temperature monitoring is carried out at least three shows the average category is not good, with a
times a day every morning, afternoon, and evening and percentage of 52.1%.
must be documented to maintain the temperature in
the vaccine storage. The vaccine storage warehouse
must be provided with written procedures, cleaning
programmes, and documentation of the Acknowledgement
implementation of cleaning. The cleaning equipment
used must be appropriate so as not to become a source This article was presented at the 2022 Annual Scientific
of contamination to the vaccine (BPOM, 2020). Conference of the Indonesian Pharmacist Association.
The authors thank all puskesmas throughout Mataram
The average percentage for qualification, calibration, City for participating in this study, and also the
and validation of COVID-19 vaccine storage equipment Research and Community Service Institute University of
in ten Mataram City Health Centers is 73.3% with a Muhammadiyah Mataram for supporting this study.
good enough category, but not yet optimal in the good
category because Puskesmas B and H have not
calibrated the COVID-19 vaccine storage equipment,
and Puskesmas G has just replaced the vaccine Source of funding
refrigerator. Based on the 2020 CDOB, the equipment
used must be calibrated and verified regularly and Research and Community Service Institute, University
documented by competent parties so that the vaccine of Muhammadiyah Mataram.
quality remains safe and stable (BPOM, 2020).
Calibration of tools is essential to ensure the availability
of medical devices according to service standards,
quality requirements, safety, benefits, safety, and fit for References
use (Susana et al., 2020). Arikunto, S. (2016). Prosedur Penelitian Suatu Pendekatan
Praktik. Rineka Cipta
The average percentage for suitability based on the
Ministry of Health in ten Mataram City Health Centers BPOM (Badan Pengawas Obat dan Makanan). (2020).
is 92.5% with a good category, but not yet optimal Peraturan Badan Pengawas Obat dan Makanan nomor 6
tahun 2020 tentang Cara Distribusi Obat ynag Baik. Berita
because Puskesmas H, I, and J do not have temperature negara. 229
monitoring devices on vaccine carriers. A temperature
monitoring devices are needed to maintain and Julyasti, D., & Dyahariesti, N. (2021). Evaluasi manajemen
monitor the temperature of the vaccine carrier so that penyimpanan sediaan vaksin Covid-19 di puskesmas karang
pule. Universitas Ngudi Waluyo
there is no increase in temperature which can result in
an increase in the Post-Immunization Follow-up Event Kemenkes. (2021). Keputusan Menteri Kesehatan Republik
Indonesia Nomor HK.01.07/Menkes/4638/2021 Tentang

Pharmacy Education 23(2) 37 - 41 40

Anjani, et al Evaluation of COVID-19 vaccine storage at community health centres

Petunjuk Teknis Pelaksanaan Vaksinasi Dalam Rangka Santoso, R., Anggriani, A., & Suryaman, A. (2020).
Penanggulangan Pandemi Corona Virus Disease 2019 Penyimpanan & distribusi sediaan vaksin di dinas kesehatan
(COVID-19). Jurnalrespirologi.Org, 2019(2), 1–4. kabupaten garut. Ikra-ith humaniora: Jurnal Sosial Dan
http://www.jurnalrespirologi.org/index.php/jri/article/view Humaniora, 4(2), 66–72
/101
Saputri, E. (2018). Evaluasi Penyimpanan Sediaan Vaksin Di
Kemenkes RI Dirjen P2P. (2021). Keputusan Direktur Gudang Programme Dinas Kesehatan Kabupaten Magelang
Jenderal Pencegahan dan Pengendalian Penyakit Nomor Berdasarkan Pada Permenkes Nomor 12 Tahun 2017
HK.02.02/4/1/2021 tentang Petunjuk Teknis Pelaksanaan Tentang Penyelenggaraan Imunisasi Periode April–Juni
Vaksinasi dalam Rangka Penanggulangan Pandemi Corona 2018. Skripsi, Universitas Muhammadiyah Magelang
Virus Disease 2019 (COVID-19). Kementerian Kesehatan RI,
4247608(021), 114. Sarmadi, T., & Waty, N.R. (2020). Hubungan pengetahuan
https://www.kemkes.go.id/article/view/19093000001/peny dan perilaku sumber daya manusia tentang distribusi dan
akit-jantung-penyebab-kematian-terbanyak-ke-2-di- penyimpanan vaksin di puskesmas seberang ilir kota
indonesia.html palembang. Pengelola jurnal kesehatan pharmasi poltekkes
kemenkes palembang, 2(1), 70
Kementerian Kesehatan RI. (2021). Keputusan Menteri
Kesehatan Nomor 23 Tahun 2021 tentang Pelaksanaan Susana, E., Nursyamsi, I., Kristianti, W., & Komarudin, A.
Vaksinasi Dalam Rangka Penanggulangan Pandemi Corona (2020). Gerakan SAKAMED Sebagai Upaya Meningkatkan
Virus Disease (COVID-19). Kementerian Kesehatan RI, 866, Kesadaran Pentingnya Kalibrasi Peralatan Kesehatan di
1–11. Puskesmas. Dinamisia: Jurnal Pengabdian Kepada
https://peraturan.bpk.go.id/Home/Details/192068/permen Masyarakat, 4(2), 346–353
kes-no-23-tahun-2021
WHO (World Health Organization). (2020). Advice on the
Lumentut, G.P. (2015). Evaluasi Penyimpanan Dan use of point-of-care immunodiagnostic tests for COVID-19:
Pendistribusian Vaksin Dari Dinas Kesehatan Kota Manado scientific brief
Ke Puskesmas Tuminting, Puskesmas Paniki Bawah Dan
Puskesmas Wenang. Pharmacon, 4(3), 9–15 Zuhroh, H., & Dyahariesti, N. (2021). Evaluasi manajemen
penyimpanan sediaan vaksin covid-19 di gudang instalasi
Makmun, A., & Hazhiyah, S.F. (2020). Tinjauan Terkait farmasi dinas kesehatan kota mataram. Universitas Ngudi
Pengembangan Vaksin Covid 19. Molucca Medica, 52–59 Waluyo

Pharmacy Education 23(2) 37 - 41 41