http://prabir.heck.in/vaccine-usage.

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Vaccine Usage [03-Aug-10]
At Shamserganj we heard that most sub centres expect around 300 newborns
every year. Certainly there are none like Indranagar in Suti 2 which has 180
expected births. Suppose a centre needs to give 210 Measles injections a year.
They need to give 17 each month. This can be achieved by 4 sessions at the sub
centre. Vaccine Usage for a 5 dose vial will be 85 per cent. If there are 2 sub
centre and 2 outreach they still use 4 vials for the 17. Even though outreach can
safely give 40 injections vs 70 at the HSC

Measles Used
Each child who gets Measles represents around 12 injections at the site. So a
session with 48 injections means 4 Measles and outreach with 36 injections
means 3 Measles. Total vials used for 2 sub centre sessions and 2 outreach is 4.
Here Usage is also 85 per cent. But if there is only 1 sub centre session they need
4 outreach and the Usage drops to 68 per cent. On the other hand if there were
10 dose vials they would still need 5 vials but Usage would be 34 per cent.
Tamil Nadu has less births. All children there go to the PHC for vaccines.

How to Reduce Costs

In the past there were large vials - 20 doses of BCG per ampoule. But large
numbers to be immunized and high birth cohorts kept the cost per vaccinated
child low. Now that births are dropping we can either continue to reduce vial sizes
or else centralize immunization. Small vials need larger storage space per dose.
So there is a limit beyond which smaller vials can start increasing costs. Another
route is the Tamil Nadu way. First reduce outreach and later even move vaccines
to the PHC. Centralize vaccines.

Immunization in Bengal
Centralization in South Bengal with low births and high population density has
already come to 2 sub centre sessions a month. Hospitals have weekly sessions.
In North Bengal distances are large and births low. 2 sub centre sessions a month
and weekly sessions at hospital need to be supplemented by quarterly outreach.
In the high density and high birth blocks of Dhuliyan Kaliachak and Chakulia few
large institutions cater to the villages. Here outreach needs to be reduced and sub
centres strengthened.

At most a mother can travel for half an hour from home for a non-emergency
vaccine. This is nearly 2kms if one walks. But it is barely 1 km in a Kolkata bus at
10 am. Half an hour in Tamil Nadu buses on the highway is 20km. On the state
Highway in Raiganj it is around 10km. Obviously the distance of an immunization
session will depend on accessibility in the area. Near Chopra sub centres can be
as far as 10km from a village they cover- and there are no buses/ jeeps.