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)
______________________________________________________________________________