POST 00936E : WASTAGE RATES

POST 00936E : WASTAGE RATES Follow-up on Posts 00906E and 00910E 6 June 2006 ______________________________________________________________ This discussion is derived from another initiated in Post 00889E by questions on a new WHO site submitted by Femi Obegdami. This posting contains two contributions, one from Anthony Battersby (mailto:[email protected]) from the United Kingdom, and the other from Anil Varshney (mailto:[email protected]) from India who both further comment on vaccine wastage. Please also refer to Post 00925E (New site/Questions) that deals with some of the issues. ___________________________________ Claude, I have just revisited the wastage page. It states "WHO recommend the following maximum wastage rates for the estimation of vaccine needs: for lyophilized vaccines: 50% wastage rate for 10-20 dose vials; 10% wastage rate for 1-2 dose vials. " The problem with this whole web site is that the meaning of the English is unclear. If WHO is going to post guidance on the web the material must be edited by an English (mother tongue) editor. EPI used to have an English-speaking editor for just this reason. As a native English speaker I find this document to be unclear. For example "...vaccine doses consumed (used)" means two different things, and I can only guess what "loosed" means. Readers will either fail to understand the contents of the site or worse may think they have understood its meaning when in fact they have not. For all the work and effort that goes into preparing a web site it makes no sense to publish it without having the editor edit it first. I still do not understand why, when WHO has invested all the time and trouble to develop "Monitoring vaccine wastage at country level" it is necessary to present the abbreviated version in this web site, The site should refer readers to the document. Overall this site appears to try and simplify subjects which should not be simplified. For example for the last 25 years WHO has supplied guidance on indicative wastage rates, it has not recommended them. Now with vaccines costing an order of magnitude more per dose wastage is even more important than it was before, the subtleties of wastage and how to avoid it need to be understood, not simplified. Wastage has always been presented as a managerial tool, low wastage is as important to know about as high wastage. For example very low measles wastage might indicate that health workers are keeping their reconstituted measles vaccine. I do not understand what this site is trying to achieve. WHO has many documents covering all the aspects touched on by this site. If the site is intended to be an entry point why does it not simply supply the links that will take the reader to the particular document. Anthony ---------------------------------- Hello On going through the various postings on Technet on vaccine wastage and storage I would like place my views. The health staff dealing with immunization at the lowest delivery level has his/her own limitations of understanding the wastage and stocks, all terms must be simplified . I suggest the following : a. Minimum / reserve level of stock - that should be maintained at any storage level b. Order point - level at which stocks are to be replenished - this must take into consideration the consumption at the store and levels below which it supplies, the delivery time from higher level. ( the consumption includes vaccine given to children and wastages- which should be minimum) c. The best solution to this is to supply from higher store to lower store on fixed day delivery schedule so as to ensure that minimum stock is always maintained at each store. The minimum stock should be vaccines needed in the delivery period PLUS a marginal buffer for unforeseen situation if the vaccine is not delivered or collected. Immunization coverage should always be planned for 100% coverage and all efforts must be put into it - identifying the reasons for not achieving the same? Are they system failures, problems in service delivery, or constrains of the target population? Vaccines must be procured for 100 % coverage PLUS wastage factor which will vary form SDP to SDP, in case of low coverage the vaccine utilization will be low, wastage may be high or within acceptable limits. The balance of vaccines which are in stock will lead to less order or replenishment at each level, while ordering at the national level. Vaccine stock at each store minus the minimum level would be the excess vaccine stock which must be reduced from the supply order with 100% coverage calculations. As the coverage increases the wastage will reduce. No wastage rates should be set for any country. I agree with Rudi these must be minimised and as mentioned earlier all efforts to reduce and identify the causes must be carried out as an essential exercise at each level of service delivery. In fact whenever immunization session takes place the wastage must be recorded as a separate head (in absolute and percentage). Regards, Dr Anil Varshney ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de internationale en sant, Canada (http://www.ccisd.org) ______________________________________________________________________________