Bangladesh EPI Vaccines Forecasting for 2012-2016 Dr. Giash Uddin, Consultant, SIAPS Mohammad Golam Kibria, Senior Technical Advisor, SIAPS August 14, 2012 EPI-HQ About SIAPS Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program (follow-on program to Strengthening Pharmaceutical Systems [SPS]) 5-year, USAID centrally funded program Implemented by Management Sciences for Health (MSH), a not-for-profit international organization based in Washington, DC 1
Scope of Work of SIAPS-Bangladesh Program Strengthen MOHFW s procurement and supply chain management systems; also key directorates (DGFP, DGHS, DGDA, etc.) to assure availability of quality pharmaceutical products Strengthen management information systems Build local capacity to strengthen health systems Strengthen National TB Program under DGHS Outline Objectives The process until now Summary of major findings Next steps 4 2
Objectives Review and validate available data, assumptions, and methodologies Build additional assumptions based on future programmatic goals Reach consensus and draw agreed assumptions, data, and methodologies for current forecasting 5 The process until now Review of documents 6 o Census 2001, 2011 o BDHS (93, 96, 99, 04, 07, 11) o SVRS (2009) o National Immunization Program (multi-year plan) report, GOB (2012-2016) o EPI annual reports (2008-2011) o NID report (2009-2011) o EPI monthly stock status report o UNICEF/UN population database o Spectrum, WHO vaccines forecasting tool 3
The process until now Discussions with different stakeholders/experts to obtain documents and additional information o EPI o SIAPS Identification of important data items from documents Organization of the data/information identified Analysis of data/information and triangulation of results o Propose different scenarios 7 8 Data from reports Census 2001, 2011 Base year population BDHS o Neonatal mortality rate, post-neonatal mortality, & IMR o Total vaccines (EPI) coverage o TFR o Total CPR and method mix SVRS 2009 o Life expectancy o CBR o TFR o IMR 4
Data from Reports Routine data (district level) o EPI coverage and wastage rate o Stock on hand NID o Coverage and wastage 9 Estimation of Target Population for Different Antigens (Routine EPI) Antigen BCG Penta Measles TT2 Target Population Total births Survival neonates Survival of infants beyond 9 months of age Pregnant women TT 1-5 Women 15-49 5
Estimate of Target Population (Data, Method, & Assumption) Forecast period 2012 to 2016 Morbidity method adopted for forecast Population data (age, sex) from Bangladesh Population Census 2001 used as a base with DemProj to calculate population number for the forecast period Life expectancy by sex: based on trend from SVRS report 2009 for the years 2006-2009, model life tables with expected age pattern of mortality were selected Mortality pattern of UN General Model life tables was selected for population projection; life expectancy at birth for females assumed to be 70.8 in 2016 at annual increase of 0.30 years Life Expectancy at Birth 2001-2008 (Source-SVRS 2009) 69 68 y = 0.5274x-990.823 R 2 = 0.8871 67 66 y = 0.2321x -400.56 R 2 = 0.8145 65 64 63 62 61 2001 2002 2003 2004 2005 2006 2007 2008 Male Female Linear (Female) Linear (Male) 6
Estimate of Target Population (Data, Method, and Assumption) Migration: because of lack of valid international migration data, international migration assumed to be zero Sex ratio at birth estimated to be 1.05 male births per 1.0 female birth; this ratio was assumed to be constant throughout the forecast period TFR value of 2.3 in 2011 based on BDHS 2011 and TFR of 2.0 target set in HPNSDP for 2016 Estimate of Target Population (Data, Method, and Assumption) Scenario I: Current CPR = 61.1%-continue Scenario II: CPR = 72% achieved by 2016 Scenario III: TFR = 2.0 achieved by 2016 7
Estimated Target Population Population (millions) 2012 2013 2014 2015 2016 Scenario I 159.5 162.2 165.0 167.7 170.5 Scenario II 159.3 161.7 163.9 165.9 167.7 Scenario III 155.7 157.7 159.8 161.8 163.7 Estimated Target Births Births 2012 2013 2014 2015 2016 Scenario I 3,694,813 3,728,550 3,761,103 3,791,529 3,818,506 Scenario II 3,512,200 3,347,500 3,172,000 2,984,100 2,775,800 Scenario III 3,048,922 3,030,029 3,008,487 2,983,157 2,952,574 8
Birth (in Million) 04/16/2013 Estimated Target WRA WRA (millions) 2012 2013 2014 2015 2016 Scenario I 43.3 44.1 44.8 45.6 46.3 Scenario II 43.3 44.1 44.8 45.6 46.3 Scenario III 43.3 44.1 44.8 45.6 46.3 EPI Reports Number of Births 2008-2011 4.00 3.90 3.93 3.80 3.70 3.75 3.60 3.50 3.40 3.39 3.44 Birth Linear (Birth) 3.30 3.20 3.10 2008 2009 2010 2011 Estimated births in 2012: 3,632,025 18 9
Survied infant (in Million) 04/16/2013 EPI Reports Survived Children 2008-2011 Probability of surviving (0-1 year)=0.95 3.80 3.70 3.72 3.60 3.50 3.51 3.40 3.30 3.20 3.21 3.26 surv.infant Linear (surv.infant) 3.10 3.00 2.90 2008 2009 2010 2011 Estimated Survival Children in 2012: 3,430,961 Estimated Annual Target Population Spectrum- Scenario I Current Consumption Trend BCG-Total Birth 3,694,813 3,632,025 Penta-Survival Neonates 3,576,579 3,515,800 Measles-Infant (9 months+) 3,535,936 3,475,848 OPV Total Births 3,576,579 3,515,800 TT-Pregnant women (births* 1.10) 4,064,294 3,995,227 TT-1-5 43,332,044-10
EPI Coverage -DHS data DHS 1993-4 1996-7 1999-00 2004 2007 BCG 79.4 84.2 90.0 93.3 96.8 DPT-1 78.9 82.6 88.4 92.9 96.8 DPT-2 71.6 77.1 80.7 86.8 93.9 DPT-3 59.0 66.5 70.2 80.3 90.0 OPV-1 79.5 84.3 89.1 96.3 97.7 OPV-2 71.7 78.1 80.7 88.0 93.8 OPV-3 59.7 60.1 69.1 81.6 89.7 Measles 55.0 61.2 62.1 70.3 77.2 All 46.2 46.9 52.8 68.4 76.0 TT-1 16.4 15.3 17.5 21.2 22.9 TT-2+ 49.4 59.4 63.7 63.6 59.7 EPI Coverage and Wastage-Consumption Data BCG Penta OPV Measles Year Coverage Wastage Coverage Wastage Coverage Wastage Coverage Wastage 2008 90.0 84.6 95.0-95.0 31.4 95.0 69.6 2009 95.0 85.0 96.0 1.4 99.0 32.5 99.0 70.9 2010 95.0 85.0 96.0 0.5 96.0 30.5 95.0 70.5 2011 95.0 85.0 96.0 1.2 96.0 32.0 96.0 71.5 11
Estimated Vaccine Doses BCG Penta Target Population Required dose Coverage Wastage Wastage factor Annual need Scenario I 3,694,813 1 95% 85% 6.67 23,400,482 Consumption 3,632,025 1 95% 85% 6.67 23,002,823 Scenario I 3576579 3 96% 1.4% 1.01 10,446,803 Consumption 3515800 3 96% 1.4% 1.01 10,269,273 Measles OPV Scenario I 3535936 1 96% 71% 3.45 11,705,168 Consumption 3475848 1 96% 71% 3.45 11,506,254 Scenario I 3576579 4 96% 32% 1.47 20,197,152 Consumption 3515800 4 96% 32% 1.47 19,853,929 Estimated Vaccine doses Target Population Required dose Coverage Wastage Wastage factor Annual need TT-2 Scenario I 4064294 5 12% 30% 1.43 3,483,681 Consumption 3995227 5 12% 30% 1.43 3,424,480 TT-1-5 43,332,044 5 26% 30% 1.43 80,473,796 Scenario I Consumption 43,332,044 5 30% 30% 1.43 92,854,380 12
Next Steps Hand out print-out of important data and information based on review and analysis to date Evaluate available data/information Incorporate additional data/assumptions, if needed Reach consensus on input data, assumptions, and methodologies for current quantification (2012-2016) Forecast demand for EPI commodities and logistics (2012-2016) based on feedback from technical meeting - Use of forecasting tools: Spectrum, vaccine forecasting tools (WHO) Produce final technical report on the forecasting exercise Thanks! 13