This posting is one of four, each discussing a different indicator. This post discusses the availability of vaccine. Over 40% of countries reporting to the JRF in 2013 reported shortages of one or more vaccines for at least one month at central level. Disruption of supplies of this scale at central and intermediate stores places immunization programs at risk but a stock-out at service delivery level denies women and children the protection of immunisation. If the amount of vaccine remaining in stock at the end of the supply period is above the threshold of the ‘minimum stock level’ (the reserve) and below the maximum stock level (minimum + consumption) the management of vaccine availability is satisfactory. Below the minimum stock level an ‘emergency’ supply trip be needed and, worse still, if the vaccine stock drops to zero, immunization sessions are disrupted. The table below sets out the options for an indicator of availability of vaccine by type. Table: Alternative Vaccine Availability Indicators by Type *Recommended SC indicator for District Supervisors to monitor Health Center performance. The Table presents most of the candidate indicators for managing stocks by type at Health Center level and District level. Health Centers do not usually keep reliable, daily, written records of vaccine stocks because the stock is small enough to be seen and counted visually in the refrigerator. But most health centers report the remaining doses of vaccine at the end of each supply period. These reports, when combined with data from District vaccine stock ledgers (or software applications) can be used to generate the candidate indicators by vaccine type in the Table. Summarising the four choices shown in the HEALTH CENTER sector of the table, by choice:
A ‘YES” status for all vaccines confirms to the health worker that stock is sufficient, never excessive and no action need be taken. This message for the last day before re-supply, when sent to the supervisor confirms good performance. A “NO” status for any or all vaccines indicates a possible high stock situation to alert the supervisor at the next routine visit.
A ‘YES” status for all vaccines confirms to the health worker that stock is sufficient though at times excessive but no action need be taken. This message for the last day before re-supply, when sent to the supervisor confirms fair performance. A “NO” status for any or all vaccines indicates a possible low-stock or high-stock, a stock-out situation requiring further supervisor check.
A “YES” status for some vaccines and no zero stocks for the rest on any day warns the health worker to check sufficiency of stock until next re-supply and re-assess next routine order quantities. The supervisor would be alerted to the storekeeping issue but unless notified, would not act.
A ‘YES” status for some vaccines in either b) or c) indicates total stock-out of one or more types of vaccine. This would require the health worker to order emergency supply of vaccine and to notify the supervisor. Stores with such reports to the supervisor would be visited as a priority by supervisor.
All four indicators help Health Workers decide an appropriate on-site response. But the data to generate these are mostly kept at District level so the District Supervisor would analyse the performance results for the District. If the process is manual, a single District Indicator a), reported and analysed by vaccine type, would have the greatest diagnostic power for District supervisors: “The quantity of each vaccine remaining in stock greater than the minimum and less than the maximum stock level for every vaccine type throughout the supply period.” If the process is automated with transfer of district data being made electronically to a central server, all the indicators could be used to generate monthly or quarterly or annual reports and zero-reporting of stock-outs could be provided at any level. We look forward to hearing your opinions however critical, and your ideas!
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