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Taking stock of wastage

Aarti Dhar
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Universal immunisation:Makes better impact.
Universal immunisation:Makes better impact.

The vaccine wastage in Tamil Nadu and Kerala dropped by almost half following the introduction of pentavalent vaccine, though there was no change in the vaccine coverage rates. A post-introduction evaluation of pentavalent (DPT+HepB+Hib) vaccine in Tamil Nadu and Kerala carried out by the World Health Organisation (WHO) says that the findings indicate that States in India are ready and able to successfully introduce new antigens in their immunisation programmes.

Pentavalent vaccine was introduced in Tamil Nadu and Kerala in December 2011. It protects children against five diseases —TB, hepatitis, diphtheria, tetanus and pertussis.

In Tamil Nadu, the reported DPT vaccine wastage rate for April to July 2011 was 16.4 per cent which came down to 8 per cent for pentavalent vaccine for April to July 2012. No district reported more than 15 per cent wastage for the vaccine. Similarly in Kerala, the reported pentavalent vaccine wastage rate was 11.5 per cent during the first three months of introduction of pentavalent vaccine which further decreased to 7.5 per cent in the next three months.

The post-introduction evaluation was done in July 2012. For rural areas, interview and observation were conducted at the block level. Two blocks were selected per district. Within each block, at least one

Community Health centre, one Primary Health Centre and one outreach session at the Sub-centre were selected. For the urban areas, interviews and observations were conducted at one urban health facility in Kerala and two in Tamil Nadu and one medical college or district hospital immunisation facility.

While the health staff was largely knowledgeable about immunisation safety, the safe practice, however, was inconsistent. The evaluation teams observed a few unsafe injection practices and a number of instances of suboptimal waste disposal practices. Additionally, some areas did not have functional hub-cutter, and sufficient well-constructed safety pits. “The waste collection and disposal from health facilities in urban areas, in both States, was outsourced to a private agency and was working well. However, the waste disposal was still an area of concern in peri-urban and rural areas,” the report says.

There was adequate cold chain capacity to store all Universal Immunisation programme vaccines and to accommodate pentavalent vaccine, at all levels. There was an ongoing expansion and rehabilitation of cold stores at various levels in both States. The delivery for pentavalent vaccine was well planned and properly communicated. Vaccine management practices were reinforced with policy guidelines that included ‘phasing-in’ of pentavalent vaccine, how to handle DPT and HepB vaccine stocks, and in Tamil Nadu, re-sensitisation of general vaccine management practices.

“These guidelines were well understood by most staff, and accordingly, only minimal vaccine stock outs were reported or noted from the records, by the evaluation teams.” Importantly, there was a major issue with the stocks of Hepatitis B vaccine, which was not re-positioned after pentavalent vaccine was introduced, the review said.

Correction:

In the story ‘Coached to Control’ published on March 27, it had been erroneously mentioned that the training module was for Block Development Officers, it is meant for Block Medical Officers.

Introduction of the Pentavalent vaccine has reduced the wastage rate of immunisation vaccines, finds a WHO study

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