Togo
Nigeria
Niger
Guinea Bissau
Guinea
Central African Republic
Canada
Burkina Faso
Hepatitis B
Vaccine management
POST 00906E : WASTAGE RATES
Follow-up on Posts 00889E, 00894E and 00899E
2 April 2006
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This posting is a continuation of the discussion started by questions on a
new WHO site by Femi Odegbami. In this posting Anthony Battersby
(mailto:[email protected]) contributes further with comments on wastage
rates.
_________________________________
The arguments about "acceptable" wastage rates are as old as EPI. The
point is that any level of wastage is acceptable provided it brings
results and is within a framework that will bring it to affordable levels
in a defined period of time or produces affordable levels of wastage
nationally.
For example if you have a nomadic population that represents say 5% of the
population but is epidemiologically important and can only be reached by
strategies that produce very high wastage, then high wastage for that
group is perfectly acceptable. An example of what is not acceptable is
illustrated below.
In 2005 UNICEF, based on data supplied by NPI, ordered 17,122,166 doses of
Hepatitis B vaccine. This quantity represents more than 20% of all global
Hepatitis B vaccine bought by UNICEF in 2005. The following table shows
the percentage of Hepatitis B vaccine which (from Monthly Routine
Immunization Report, State Summary Reports) appears to have been wasted or
unused in 2004. [DPT3 coverage from the National Coverage Survey 2003 is
also shown.]
Hepatitis B vaccine wasted or in the pipeline at the end of 2004 in eight
States in Northern Nigeria visited by DFID team in February/March 2005
[and, for interest, DPT3 coverage from NCS 2003: DPT3 among surveyed
cohort 12-23 months; and DPT3 before first birthday].
Note : the plain text format is likely to disrupt the table below. If it
is unreadable, please open the attachment to this message,
State HBV wasted DPT3 coverage
Adamawa 82.6% [22.5%; 13.0%]
Bauchi 67.4% [25.7%; 13.6%]
Borno 82.2% [19.5%; 11.7%]
Jigawa no data [15.9%; 4.0%]
Katsina no data [21.8%; 11.9%]
Sokoto no data [ 4.3%; 2.1%]
Yobe 96.8% [ 6.5%; 2.8%]
Zamfara 81.8% [ 7.8%; 2.9%]
At least two of the eight States visited had no Hepatitis B vaccine at the
beginning of 2005.
In the preparation of the estimates for vaccine supply in 2005 UNICEF
records zero balance of stock at the end of 2004 for Hepatitis B vaccine.
The centralized PUSH system of stock management that has been adopted by
NPI seems to have no provision for establishing current stock levels at
Zonal or State stores. Vaccine was either wasted or was in the pipeline at
State level or below.
It is not clear what has happened to the wasted Hepatitis B vaccine, but
it is valuable and sought after in the private sector. Public sector
clients are sometimes asked to pay for their immunizations, so it is at
least possible that vaccine intended for the public sector is being sold
privately. The quantity of Hepatitis B vaccine "wasted" by Nigeria in 2004
would be enough to meet the needs of all the adjacent countries plus Togo,
Guinea Bissau, Burkina Faso and Central African Republic. Nigeria's
estimated "needs" for Hepatitis B vaccine in 2006 is 17,549,600 doses.
As Jack Stack the author of "The Great Game of Business: Unlocking the
Power and Profitability of Open-Book Management" said "We live in a
complex world, don't simplify it, understand it."
Best wishes
Anthony
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