The cost structure of routine infant immunization services: a systematic analysis of six countries

Abstract

Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites.

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

“…Many of these children are socioeconomically marginalized, live in fragile or remote settings, and have limited access to health care. A delivery model that relies primarily on nurses and clinical officers to administer vaccinations at fixed sites and provide periodic outreach is costly, places a large burden on parents, and likely to be insufficient to achieve and sustain high vaccination coverage levels in resource-poor countries with large dispersed rural populations [23]. China has more than half a century of experience successfully using community-based health workers to periodically come to clinics to collect vaccines in cold boxes to take back to their villages for pulse administration increasing rural access, community buy-in, and sustained high coverage levels.…”

New Routes and Opportunities for Modular Construction of Particulate Vaccines: Stick, Click, and Glue

“…The difficulty of manufacturing a vaccine is a major factor in the overall vaccine cost ( 16 ). The Bill and Melinda Gates Foundation have set a target of US $0.15 per human vaccine dose, while even lower costs may be needed for veterinary and food-safety vaccines ( 28 , 29 ). Mass production of an abundant, stable, and easy-to-conjugate VLNP scaffold could accelerate vaccine generation.…”

The efficiency of routine infant immunization services in six countries: a comparison of methods

“…This includes all resources expended for site-level immunization activities (staff salaries, per diems, volunteer incentives, transport, buildings, utilities, equipment, and non-vaccine consumables). We excluded vaccine and vaccine supplies, as these may be less sensitive to site-level decisions, and show low variation across sites per unit of output [23]. Administrative costs incurred by district, regional, and central offices were also excluded from the analyses.…”

“…In this analysis we draw on a unique data set of immunization service costs collected as part of the EPIC studies, funded by the Bill & Melinda Gates Foundation to fill the knowledge gap around immunization costs and financing. These data describe the costs and performance of a large, representative sample of immunization sites in Benin, Ghana, Honduras, Moldova Uganda and Zambia [22][23][24]. Using these data, we investigate different quantitative approaches for estimating the efficiency of immunization sites, to describe their relative performance and draw conclusions about their utility for efficiency evaluation within infant immunization programs, as well as provide summary estimates of efficiency at a country level and describe within-country variation in efficiency.…”