Scope and magnitude of private sector financing and provision of immunization in Benin, Malawi and Georgia

Abstract

Background Little is known about the role of private sector providers in providing and financing immunization. To fill this gap, the authors conducted a study in Benin, Malawi, and Georgia to estimate (1) the proportion of vaccinations taking place through the private sector; (2) private expenditures for vaccination; and (3) the extent of regulation. Methods In each country, the authors surveyed a stratified random sample of 50 private providers (private for-profit and not-for-profit) using a standardized, pre-tested questionnaire administered by trained enumerators. In addition, the authors conducted 300 or more client exit interviews in each country. Results The three countries had different models of private service provision of vaccination. In Malawi, 44% of private facilities, predominantly faith-based organizations, administered an estimated 27% of all vaccinations. In Benin, 18% of private for-profit and not-for-profit facilities provided vaccinations, accounting for 8% of total vaccinations. In Georgia, all sample facilities were privately managed, and conducted 100% of private vaccinations. In all three countries, the Ministries of Health (MoHs) supplied vaccines and other support to private facilities. The study found that 6–76% of clients paid nominal fees for vaccination cards and services, and a small percentage (2–26%) chose to pay higher fees for vaccines not within their countries’ national schedules. The percentage of private expenditure on vaccination was less than 1% of national health expenditures. The case studies revealed that service quality at private facilities was mixed, a finding that is similar to those of other studies on private sector vaccination. The three countries varied in how well the MoHs managed and supervised private sector services. Discussion/Conclusion The private sector plays a growing role in lower-income countries and is expanding access to services. Governments’ ability to regulate and monitor immunization services and promote quality and affordable services in the private sector should be a priority.

Contingent assessment of the COVID-19 vaccine

“…In addition, considering that income is one of the important factors for the WTP for a vaccine, it is proposed that the government or the authorities in charge of public health carry out free COVID-19 vaccination campaigns, especially for people with lower incomes, leaving private provision to households with higher incomes. This last strategy is endorsed by the literature [24].…”

Determinants of the uptake of childhood immunization in Kinshasa Province, the DRC: ordered logit regression analyses to assess timely infant vaccines administered at birth and six-weeks of age.

“…Previous studies on immunization uptake in SSA have cited a facility's religious a liation driving a mother's choice to seek care there (13). In terms of private facilities, studies show that mothers visiting private facilities tend to be of higher income levels (23), a factor that was positively associated with timely vaccine uptake and may explain our ndings. Future research could examine the reasons that vaccination rates are higher among those who select private facilities.…”

Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review

“…A comparative study in Benin and Malawi illustrated that satisfaction with care can be linked to one’s expectations of a facility. In the study, 20% of clients in Benin and 17% of clients in Malawi were dissatisfied with median waiting times that ranged from 20 to 38 min and 5–13 min, respectively [ 58 ].…”