The morbidity method uses disease frequency and treatment guidelines to forecast commodity needs. It requires morbidity data on disease incidence/prevalence in the target population, standard treatment guidelines, and assumptions about scaling up plans and attrition rates. The calculation steps involve: 1) Establishing the medicines list with specifications 2) Categorizing diseases to address 3) Calculating quantities needed per treatment episode 4) Estimating monthly case numbers during the forecast period 5) Calculating total quantities for each commodity by multiplying estimated monthly cases by the forecast period and quantities per episode 6) Calculating total costs by multiplying total quantities by unit costs.

1. FORECASTING
MORBIDITY METHOD
DR. MOE KYAW KYAW
GHSC-PSM, MYANMAR
MARCH, 2017

2. Morbidity Method
o Uses the frequency/ies of disease occurrence in
the population or Incidence/prevalence of
diseases
o Requires standard treatment guidelines (STGs)
o Best approach for justifying a budget request
o Suitable for use where consumption data is not
available
o New treatment therapy, formulation, guideline,
policies, new programs
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3. Data Requirement for Morbidity
method
• List of health commodities with minimum
specifications
• Morbidity data –
o Target population, Incidence and/or prevalence of disease or
frequency of the disease
o Scaling up plan
o Regimens and formulations used and respective proportions
o Attrition Rates for chronic diseases
• Standard treatment guidelines, including generic
drug and dosing schedules
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4. Assumption and limitations – 1
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Assumptions Limitations
1. The historical disease
patterns remain the
same in forecasted
period
 Not accurate for irregular disease
pattern
2. Morbidity
data/reports are
accurate and
comprehensive
 Not accurate if reporting rate is
low, the estimated disease frequency
could be lower than actual

5. Assumption and limitations – 2
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Assumptions Limitations
3. Needs assumptions for
• Scaling up plan and targets
• Attrition rates
• Failure rates
• Proportion of treatments
 Complex calculation especially
for chronic diseases. Time
consuming and computer
analysis may need
4. STG exists and the treatment
services follows the guideline
 Not applicable if there is no STG
 Not accurate, if the services do
not follow the STG

6. CALCULATION STEPS
MORBIDITY METHOD
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7. Step 1: Establish the list of medicines
to be quantified
Generic Names of medicines with minimum
specifications of:
◦ Strength
◦ Basic Unit
◦ Form
◦ Accounting units
◦ Price per accounting unit
Other specification for analysis
◦ Item categories
◦ VEN status
◦ Suppliers
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8. Step 2: Categorize the diseases to be
addressed with this quantification
Disease classification can be at different levels
Example:
Level 1 classification
o Infectious, Non-infectious diseases
Level 2 classification
o Pneumonia, Malaria, TB
o Hypertension, Diabetes
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9. Step 3: Calculating the Quantity required
to treat an episode of the disease
QE = DBU × ND × LD
QE = Quantity needed for each treatment episode
DBU = Basic units (of the product) per dose/administration
ND = Number of doses per day
•LD = Length of treatment in days
DBU = DAD ÷ SPR
DAD = Dosage per administration of medicine. E.g. 500mg
SPR = Strength of product. E.g. 250mg
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10. Example for step 3 – Acute Cases
One treatment for pneumonia includes
o 500mg Amoxicillin, 3 times per day for 7 days
o Available 250mg tablet
QE = (DAD ÷ SPR) × ND × LD
QE = (500 ÷ 250) x 3 x 7
QE = 2 x 3 x 7 = 42 tablets
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11. Example for step 3 – Chronic Cases (ARV)
For regimen AZT/3TC/EFV
o AZT+3TC (300+150)mg 2 times/day
o EFV (600)mg 1 time/day
AZT+3TC = 1 × 2 × 30 = 60 tabs/month
EFV = 1 × 1 × 30 = 30 tabs/month
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12. Step 4: Calculate numbers of Estimated cases
per month for each health condition during
forecasted period
For Acute Cases
Incidence: # of new cases/diseases in a period
Prevalence: # of all cases/diseases in a period
Number of treatment (Episodes)
Example:
Prevalence of 12 cases/1,000 in 100,000 population
Disease episodes = (12 x 100,000)/1,000 = 1200/yr
Estimated cases per month (ECM) =1200/12 = 100
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13. Scaling-up for chronic cases (ARV)
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10 20 30 40
Total patients treated per month
(Patient-months) 
10 10
10 10
10
10
10
10
10
10
Jan Feb Mar Apr
Total person-months for all period  10+20+30+40 = 100
Number of ARVs = ARV/day x 30.5 x 100

14. Step 5. Calculate the total quantity of each
commodity required for the forecast period
QT = ECM x FP x QE
QT = Total quantities
ECM = Expected Cases Per month
FP = Forecast period in months
QE = Quantity needed for each treatment episode
E.g. 4 month forecast quantities for acute cases
 QT = 100 x 4 X 42 = 16,800 tabs
E.g. 4 month forecast quantities for chronic cases
 QT for AZT/3TC = 100 x 60 = 6,000 tabs
 QT for EFV = 100 x 1 x 30 = 3,000 tabs
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42 tabs/ full treatment course
AZT/3TC → 60 tabs/month
EFV → 30 tabs/month

15. Step 6: Calculate the cost of each
commodity required for the period
CT = QT x Unit Cost
CT = Total cost of product for forecast period
Example: CT for Amoxicillin 250mg cap
= 16,800 x 20 = 33,600 Kyats
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