Post00320 : WASTAGE FACTORS Continued

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. ___________________________________________________________________________ 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