Introduction of oxytocin with time temperature indicators into the EPI cold chain

Research in Ghana showed that 74% of oxytocin sampled was below the recommended potency, largely due to difficulties maintaining the cold chain. Loss of potency reduces the efficacy of oxytocin in preventing and treating postpartum hemorrhage, one of the top 3 causes of maternal mortality in Ghana.

In response, USAID Systems for Health began working closely with Ghana Health Service and our partner, PATH, to pilot the introduction of oxytocin with time temperature indicators into the EPI cold chain. The time temperature indicators (TTI) change color when exposed to high temperature for a period of time, alerting health care providers that the drug is no longer at optimal potency.

Implemented in 10 facilities in two regions between April to November 2016, the study assessed the feasibility, implications and results of distributing oxytocin with TTI through the cold chain system. The study aimed to look not only at the logistics and cost of using the TTI, but also the acceptability and ease of use for health care providers at various facility levels.

Findings from the study, disseminated in August 2017, indicate that time-temperature indicators on oxytocin are acceptable and feasible within the existing Ghana Health Service cold chain distribution system. Midwives reported increased confidence when using oxytocin with a time temperature indicator. To reduce the cost, the study suggests placing the TTI on a pack of 10 ampoules.

The study findings note that while TTIs are important and useful tools, larger cold chain issues (including lack of vaccine carriers or refrigerators, defective equipment, and intermittent access to electricity) continue to contribute to patients receiving low-quality oxytocin.


HEATmarker TTI Indication Chart
HEATmarker TTI Indication Chart for USAID Systems for Health (Ghana)
Publication Date 
October 2017
Resource Type 
Success Stories
Regions/ Countries