Development of an Information System to Evaluate Vaccine Wastage for Brazil s National Immunization Program Presented by: SAMIA ABDUL SAMAD, MD September 2012
Background: Brazil s National Immunization Program Information system Conceptual issues Methods Results Limitations Conclusions Recommendations
192 million inhabitants (2010 census) Largest country in South America (only Portuguese-speaking country) Covers 8.5 million km 2 (larger than the continental United States) Borders 10 South American countries (all except Chile and Ecuador) Divided into 5 regions, 27 states and 5,565 municipalities 75% of the population lives in urban areas
Annual budget of ~US 2.7 billion in 2011 Recommended immunization schedules for children, adolescents, adults, elderly and indigenous populations Vaccines offered every day that other services are provided Program staff instructed to avoid missed opportunities for vaccination. No appointment required. Recommended vaccines available in all the 34,000 vaccination pointsof-service
National Immunization Program (NIP) there were no studies and tools to control the movement of vaccines in the country. NIP s expansion from 6 vaccines in 1973 to 45 vaccines in 2011. 34,000 vaccination services in 5,565 municipalities. Acquisition of 350 million doses of vaccines annually. Existing parameters are insufficient to manage vaccine supplies.
Different Platforms (Windows / Linux) Software free Java language PostGreSQL database Integrated System: Individual vaccination record included in the same information system
Conceptual Issues: Requirements for the Information System To provide technical information for acquisition and distribution of vaccines (complexity of a large and heterogeneous country) To provide tools for better monitoring and control of vaccine supplies at point-of-use To invest in modernization, information flow and regular inputs To make information available at all management levels (local, state, national) The Program designs the system and the IT Department develops computerized tool
Using the data entered into the information system, determines the following: Stock, delivery/transfer and balance Vaccine loss according to the type of vaccine and reasons for loss; Number of vials that could not be used: Broken Expired Incorrect temperature storage Number of unused doses in opened vials - discarded after established time; Estimates actual vaccine cost per dose administered; Provides NIP with an analysis of the current distribution system
Technical loss Physical loss It only occurs in open vials This loss is not recorded It calculated the difference between the number of doses used (open vials) and the number of doses Rate: difference / used X 100 It only occurs in closed vials It recorded the number of doses in case of loss Rate: Number of losses / available balance in the period X 100 Reasons Broken vial Lack of electricity Equipment failure Expiration date Inadequate procedure Failure in transport Other reasons
No more Direct record of vaccines at each provider
National Database Municipalities NIP Vaccine provider Vaccine provider Regional State
Source: IPN/ Ministery of Health Brazil
Physical loss more important for single-dose vials (rotavirus). Technical loss (unused doses are discardedafter opening the vial) accounted for >80% of wastage with multi-dose vials.
Evaluation of vaccine wastage in Brazil using data provided by new information system. Provides a baseline for wastage by vaccine presentation (1 or multi-dose vials), as well as reasons for wastage and costs. Indicated much higher wastage for multi-dose vials in participating states than previous estimates used by national immunization program (MMR 20%, DTP/Hib 10%, BCG 40%)
Implement the system in all municipalities in Brazil. Plan vaccine needs and distribution with state and municipal immunization programs. Assess need for strategic stockpile of vaccines. Improve integration with family health program and community health workers. Evaluate production, distribution and storage costs for vaccine vials with lower numbers of doses.
Need for technical training to accurately record vaccine stock movements and immunization at all levels throughout Brazil. Universal implementation of the information system for the National Immunization Program to monitor vaccine delivery and usage. Reducing vaccine wastage while maintaining access is a priority of the immunization program: Reduce costs increase services
Challenges
Vaccines are for the whole family Thank you...