EPI Vaccines Forecasting Exercise Dr Giash Uddin, Consultant, SIAPS Mohammad Golam Kibria, Senior Technical Advisor, SIAPS 14 August 2012 EPI-HQ
About SIAPS Management Sciences for Health (MSH) o A not-for-profit international organization based in Washington, USA Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program (is a follow-on program of Strengthening Pharmaceutical Systems - SPS) 5 year USAID centrally funded program
Scope of Work of SIAPS-Bangladesh Program Strengthen procurement and supply chain management systems of the MOHFW and its 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 till now Summary of major findings Next steps 4
Objectives To review and validate the available data, assumptions and methodologies To build additional assumptions based on future programmatic goals To reach consensus and draw agreed assumptions, data and methodologies for the current forecasting 5
The process till 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
The process till now Discussions with different stakeholders/ experts to get documents and additional information o EPI o SIAPS/MSH Identification of important data items from the documents Organization of the data/ information identified Analysis of the data /information and triangulation of the results o Propositions of different scenarios 7
Data from reports Census 2001, 2011 Base year population BDHS o Neonatal mortality rate, Post Neonatal mortality and IMR o Total Vaccines (EPI) Coverage o TFR o Total CPR and Method mix 8 SVRS 2009 o Life expectancy o CBR o TFR o IMR
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 Target Population Total births Survival Neonates Measles Survival of infants beyond 9 months age TT2 Pregnant women TT 1-5 Women of 15-49 age
Estimation of Target Population (Data, Method and Assumption) Forecast period 2012 to 2016. Morbidly method of forecasting was adopted for the forecast. The population data (Age sex) from Bangladesh Population Census 2001 was used as a base for the calculation population number for the forecast period using DemProj. Life expectancy by sex: Based on the trend from SVRS report 2009 for the years 2006-2009, model life tables with expected age pattern of mortality were selected The mortality pattern of United Nations (UN) General Model life tables were selected for the population projection. Life expectancy at birth for female is assumed 70.8 in 2016 at annual increase of 0.30 year
Life Expectancy at birth from 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)
Estimation of Target Population (Data, Method and Assumption) Migration: Due to lack of valid International migration data, international migration was assumed to be zero The sex ratio at birth: was estimated to be 1.05 male births per 1.0 female birth. This ratio was assumed to be constant throughout the forecast period. The TFR value of 2.3 in 2011 based on BDHS 2011 and TFR of 2.0 target set in HPNSDP for the year 2016
Estimation of Target Population (Data, Method and Assumption) Scenario I: Current CPR=61.1 percent-continue Scenario-II CPR=72 percent achieved by 2016 Scenario III TFR=2.0 Achieved by 2016
Estimated Target Population Population (In Million) 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
Estimated Target WRA WRA (Million) Scenario- I: Scenario- II: 2012 2013 2014 2015 2016 43.3 44.1 44.8 45.6 46.3 43.3 44.1 44.8 45.6 46.3 Scenario- III: 43.3 44.1 44.8 45.6 46.3
Birth (in Million) EPI Reports Number of birth 2008-2011 4.00 3.90 3.93 3.80 3.70 3.75 3.60 Birth 3.50 3.40 3.39 3.44 Linear (Birth) 3.30 3.20 3.10 2008 2009 2010 2011 Estimated Birth in 2012: 3,632,025 18
Survied infant (in Million) 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 surv.infant 3.30 3.20 3.21 3.26 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 Measles- Infant (9 month +) 3,576,579 3,515,800 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 -
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 Year BCG Penta OPV Measles Covera ge Wasta ge Covera ge Wasta ge Coverag e Wastag e Covera ge Wasta ge 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
Estimated Vaccine doses BCG Penta Measles OPV Target Populatio n Required dose Covera ge Wastag e Wastag e 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 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 Populati on Required dose Covera ge Wastag e Wastag e 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 Scenario-I: 43,332,044 5 26% 30% 1.43 80,473,796 Consumption 43,332,044 5 30% 30% 1.43 92,854,380
Next Steps Handing out of print-out of important data and information based on the review and analysis to date Evaluating the available data/information Incorporating additional data/ assumptions; if needed Reaching consensus on the input data, assumptions and methodologies for the current quantification (2012-2016) Forecasting the demand for EPI commodities and Logistics ( 2012-2016) based on the feedback from the technical meeting - Use of Forecasting tools : Spectrum, Vaccine forecasting tools (WHO) Producing final technical report on the Forecasting exercise
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