This posting is one of four, each discussing a different indicator. This post discusses vaccine utilisation efficiency. Another efficiency indicator measures the level of vaccine administered expressed as a percentage of the vaccine consumed (Doses ‘Consumed’ = ‘Doses ‘administered’ to clients + ‘Doses wasted’). This is the inverse of vaccine wastage. Overall vaccine wastage is the sum of: Doses in closed/sealed vials, condemned by expiry or exposure   Doses in opened vials, abandoned for administrative reasons and due to be destroyed. But opened vial wastage is mainly caused by small immunization sessions where the number of clients is much less than the number of doses per vial. So high levels of opened vial wastage can be a normal consequence of small sessions, for example in areas of low population density and may not be changed by management. Closed vial wastage on the other hand is due to expiring vaccine or vaccine with VVMs at stage 3 or 4 and should be manageable. Overall wastage should not exceed national policy ‘targets’ that are expressed as % doses wasted (both types) of total doses consumed. Wastage or utilization efficiency may be tracked in a number of ways that are summarized in the Table below. Table: Alternative Vaccine Wastage Indicators *Recommended SC indicator for District Supervisors to monitor Health Center performance. As part of the health worker’s Standard Operating Procedure he/she checks on a daily basis that vaccine has not been exposed to freezing temperatures and that the expiry date has not been passed. If vaccine in closed vials is no longer useable the affected vials are set aside for disposal and they become one part of the overall vaccine wastage. This wastage is avoidable in most cases by improving vaccine handling or practicing stock turnover or rejecting attempts to supply vaccine near expiry. Indicator a) is therefore the best indicator of wastage to track compliance with best practices but the data has to be measured in the health centre and passed monthly to the district. The indicator at the district would therefore be: “The number of doses of vaccine in closed vials that have been discarded due to expiry or cold chain failure as a percentage of doses consumed within the last supply period” The second indicator b) is a measure of overall wastage, including both the closed vial wastage and all vaccines discarded in opened but unfinished vials. This ‘administrative’ wastage is influenced heavily by the size of immunization sessions, the extent of outreach and several factors that are only partly able to be managed. As an aggregate record of wastage or utilization it can be calculated at any level of the system but is most useful to the District Supervisor. The trend of this level of wastage (monthly for >3 months) is a more valid measure than direct comparison area to area because it is so dependent on the local situation.