EPI Vaccines Forecasting

ExerciseDr 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

4

Outline

• Objectives

• The process till now

• Summary of major findings

• Next steps

5

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

6

The process till now• Review of documents

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

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The process till now…

• Discussions with different stakeholders/ experts to get documents and additional informationo EPIo 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

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Data from reports

Census 2001, 2011 Base year population

BDHSo Neonatal mortality rate, Post Neonatal mortality and

IMR

o Total Vaccines (EPI) Coverage

o TFR

o Total CPR and Method mix

SVRS 2009o Life expectancy

o CBR

o TFR

o IMR

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Data from reports

Routine data (district level)

o EPI coverage and wastage rate

o Stock on hand

NID

o Coverage and wastage

Estimation of Target Population for Different Antigens (Routine EPI)

Antigen Target Population

BCG Total births

Penta 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)

y = 0.5274x-990.823

R2 = 0.8871

y = 0.2321x -400.56

R2 = 0.8145

61

62

63

64

65

66

67

68

69

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)

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

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EPI Reports – Number of birth 2008-2011

3.75

3.393.44

3.93

3.10

3.20

3.30

3.40

3.50

3.60

3.70

3.80

3.90

4.00

2008 2009 2010 2011

Birth

(in

Million)

Birth

Linear (Birth)

Estimated Birth in 2012: 3,632,025

EPI Reports – Survived Children 2008-2011

Probability of surviving (0-1 year)=0.95

3.51

3.213.26

3.72

2.90

3.00

3.10

3.20

3.30

3.40

3.50

3.60

3.70

3.80

2008 2009 2010 2011

Surv

ied infa

nt

(in M

illio

n)

surv.infant

Linear (surv.infant)

Estimated Survival Children in 2012: 3,430,961

Estimated Annual Target Population

Spectrum- Scenario ICurrent Consumption Trend

BCG-Total Birth 3,694,813 3,632,025

Penta- Survival Neonates

3,576,579 3,515,800

Measles- Infant (9 month +)

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 dataDHS 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

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

Estimated Vaccine doses

Target

Population

Required

dose

Covera

ge

Wastag

e

Wastag

e factor

Annual need

BCG

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

Penta

Scenario-I: 3576579 3 96% 1.4% 1.01 10,446,803

Consumption 3515800 3 96% 1.4% 1.01 10,269,273

Measles

Scenario-I: 3535936 1 96% 71% 3.45 11,705,168

Consumption 3475848 1 96% 71% 3.45 11,506,254

OPV

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

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

Thanks !