Post00320 WASTAGE FACTORS Continued 13 February 2001
CONTENTS
1. ESTIMATING VACCINE WASTAGE FACTORS Continued
2. ESTIMATING VACCINE WASTAGE FACTORS REQUIRES STOCK RECORDS + SOFTWARE
1. ESTIMATING VACCINE WASTAGE FACTORS Continued
In Technet Forum Post00316, ESTIMATING VACCINE WASTAGE FACTORS, 29 January
2001, and in Post00311, 15 January 2001, a discussion on estimating vaccine
wastage and vaccine wastage factors was posted. The context of the
discussion was the need for GAVI, the Global Alliance on Vaccines and
Immunization, to look at vaccine wastage - with its potential for enormous
unsustainable vaccine costs. The other discussion context was and remains
the need for national programs to monitor and appropriately manage vaccine
wastage to contain costs and enhance program sustainability.
It was difficult to post the various comments and discussion points in
meaningful logical sequence, particularly with some pieces of the discussion
missing. All indications are that these postings were confusing.
* Robert Steinglass, BASICS II, clarifies the recent discussions on
estimating wastage FACTORS and proposes a simple method of calculating both
wastage factors and wastage rates. Robert notes that many of the Technet
Forum messages were in favour of promoting simpler methods for estimating
wastage.
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Date: Mon, 29 Jan 2001
From: "Robert Steinglass"
To: [[email protected]][email protected][/email]
Subject: Re: Post00316 ESTIMATING WASTAGE FACTORS
Dear Allan,
A very valiant attempt on your part to make everything clear. But I fear
that confusion still reigns for a number of reasons:
a) primarily because it is unclear who is or who was commenting on which
formula and for which purpose and at which point in time!; and
b) legitimate differences of opinion on what is important to monitor and how
best to do it.
So, once again into the fray...but with a simple proposal.
This all began as a simple e-mail from John Lloyd to a few people last
November with his proposed calculation of wastage rates. I suggested to him
some corrections IF he was to continue with that standard approach to
calculating wastage rate. However, my point (and one which Mark Weeks and
Anton Luchitsky have also made in the last two postings), and which I
believe Bob Davis is also alluding to, is that simpler methods should be
promoted.
Mark, Anton and I are all referring to the method used in the NIS where
wastage factors (although given by some a new name of "wastage coefficient")
are directly calculated INSTEAD of wastage rates. After all, it is the
wastage factor, as Souleymane says, which one needs to forecast vaccine
requirements for a given population.
So my proposed method to calculate the wastage factor is to:
___________________________________________________________________________
Use stock records in any give time period to determine the number of doses
"utilized" (i.e., starting balance of usable vaccine in doses PLUS newly
received doses MINUS doses used, expired and tossed).
If 300 doses are "utilized" to vaccinate 200 kids (possibly modified as Hans
Everts suggests to be only "persons of the correct age"), then the wastage
factor becomes simply 1.5 (300 divided by 200).
If one then wanted to calculate the wastage rate, then the most familiar
formula would be 300 doses utilized MINUS 200 kids vaccinated DIVIDED by 300
doses utilized (i.e., 300-200/300), or 33%.
___________________________________________________________________________
I hope that helps. In my opinion, a larger point illustrated by this useful
exchange of different views from lots of experienced TECHNET subscribers is
that, 20+ years into the EPI, some of the basics precepts are being
questioned and that a forum is still needed to share divergent views and
reach consensus.
Robert
Robert Steinglass
Immunization Team Leader
BASICS
1600 Wilson Blvd., Suite 300
Arlington, VA. 22209
USA
voice: 1-703-312-6800
fax: 1-703-312-6900
e-mail: [[email protected]][email protected][/email]
____________________________________*______________________________________
1. ESTIMATING VACCINE WASTAGE FACTORS REQUIRES STOCK RECORDS + SOFTWARE
Reflecting on the recent discussions on estimating vaccine wastage factors,
Mogens Munck points out that to calculate wastage you need stock records.
At the operational country level inventory control software is needed to
manage and monitor stock movement - including utilization, and VVM status.
Mogens notes the earlier usefulness of the now unsupported Commodities
Logistics Module [CLM] for these purposes.
* Mogens suggests: "Could we not agree on making available for all EPI-
programs suitable computer software that will effectively support stock
management as required for traditional and new vaccines?"
Opinion, comments and additions please: [[email protected]][email protected][/email]
or use your reply button
___________________________________________________________________________
From: Munck Mogens
To: Technet Moderator
Subject: Re: Vaccine Wastage
Date: Wed, 31 Jan 2001
Hi Allan,
Re.: Vaccine wastage.
I have followed the discussion about vaccine wastage and the algebra
regarding how best to calculate it.
I would like to add the following comments:
In order to do anything about vaccine wastage (and stock management in
general) you must have records of data about stock levels, consumption etc.
In addition, our colleague, Mr. Gordon Larsen, WHO, rightly recommends not
only to include information on manufacturer, lot number, and expiry dates,
but also "to design a mechanism for recording and keeping track of VVMs".
In short, there are so many parameters to keep track of that computer
software is required, but not a simple spread sheet program, like the ones
you see in use almost everywhere, except where only an old-fashioned stock
book is utilized.
Last year in April I asked for computer software, please see post #00244. I
was referred to CLM, but CLM is not year 2000 compatible and MSH, Boston has
not yet come up with a new version.
The Family Planning Program in Nairobi has used for a long time a database
program that is considered very successful. It was developed by John Snow
Inc. I saw a presentation of it in the Ministry of Health Maputo, and
although everybody liked it, and found it suitable with only a few
modifications, USAID declined to support the introduction of the software in
the EPI program in Mozambique.
It appears to me that the current discussion about vaccine wastage is very
theoretical, impractical and unrealistic, as long as proper stock management
is not implemented. I am afraid it can not be done without suitable computer
software.
Right now you will be lucky, if you see stock cards in use! It takes long
time and much persuasion to get answers to simple questions like: "what were
the stock levels in your store of each antigen at the end of each month last
year?" and how many Technet members have seen implemented the simple and
good recommendations put forward by Mr. Gordon Larsen?
Could we not agree on making available for all EPI- programs a suitable
computer software that will effectively support stock management as required
for traditional and new vaccines?
Best regards!
Mogens Munck
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