Implementation Strategy and Cost of Mozambique’s HPV vaccine demonstration project

Abstract

Background Cost is as an important determinant of health program implementation. In this study, we conducted a comprehensive evaluation of the implementation strategy of Mozambique's school-based HPV vaccine demonstration project. We sought to estimate the total cost of the program and the cost per fully immunized girl (FIG), and to project the total cost of implementing a similar immunization program at the national level. Methods We collected primary data through document review, participatory observation, and key informant interviews with project implementers at the central offices of the national immunization program, provincial and district health directorates, and in health facilities. We used a combination of micro-costing methods-the identification and measurement of resources quantities and valuation by application of unit costs, and gross costing-the consideration of resource bundles as they apply to the number of FIGs. We extrapolated the cost per FIG to the HPVvaccine-eligible population of Mozambique under current guidelines to demonstrate the projected total annual cost for a similarly executed HPV vaccine program. Results The total cost of the Mozambique HPV vaccine demonstration project was $523,601. The mean cost per FIG was $72 (95% the analysis were vaccine price, number of doses administered per recipient, program startup costs, and the costs of demand creation. Conclusion National adaptation and scale-up of Mozambique's school-based HPV vaccine strategy would result in substantial costs. To achieve national-level HPV vaccine roll out and sustainability, stakeholders will need to negotiate vaccine prices and achieve better efficiency in startup activities and demand creation. Contributions To The LiteratureResearch has shown considerable heterogeneity within and between countries for HPV vaccine delivery cost determinants. Our findings provide country specific cost data that can inform Mozambique's national immunization program HPV vaccine delivery scaling up strategyThe paper provides a costing framework and methodology that other HPV vaccine delivery researchers can replicate, thus promoting generalizability of research findings