1. EPI Vaccines
Forecasting
Exercise
Dr Giash Uddin,
Consultant, SIAPS
Mohammad Golam Kibria,
Senior Technical Advisor, SIAPS
14 August 2012
EPI-HQ

2. 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

3. 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. 4
Outline
• Objectives
• The process till now
• Summary of major findings
• Next steps

5. 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. 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

7. 7
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

8. 8
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
SVRS 2009
o Life expectancy
o CBR
o TFR
o IMR

9. 9
Data from reports
 Routine data (district level)
o EPI coverage and wastage rate
o Stock on hand
 NID
o Coverage and wastage

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 18
EPI Reports – Number of birth 2008-2011
3.75
3.39
3.44
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(inMillion)
Birth
Linear (Birth)
Estimated Birth in 2012: 3,632,025

19. EPI Reports – Survived Children 2008-
2011
Probability of surviving (0-1 year)=0.95
3.51
3.21
3.26
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
Surviedinfant(inMillion)
surv.infant
Linear (surv.infant)
Estimated Survival Children in 2012: 3,430,961

20. 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
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 -

21. 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

22. 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

23. Estimated Vaccine doses
Target
Populatio
n
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

24. 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

25. 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

26. Thanks !