Carl Schütte1, Collins Chansa2, Edmore Marinda3, Teresa A Guthrie4, Stanley Banda5, Zipozihle Nombewu6, Katlego Motlogelwa6, Marita Lervik7, Logan Brenzel8, Anthony Kinghorn9. 1. Strategic Development Consultants, South Africa. Electronic address: carl.schutte@sdc.co.za. 2. World Bank, Zambia Country Office, Zambia. Electronic address: cchansa@worldbank.org. 3. Health and Development Africa (Pty) Ltd., South Africa. Electronic address: edmore.marinda@mottmac.com. 4. Centre For Economic Governance and AIDS in Africa, South Africa. Electronic address: guthriehealthfinancingconsult@gmail.com. 5. Independent consultant, Zambia. Electronic address: bandastanley@yahoo.com. 6. Health and Development Africa (Pty) Ltd., South Africa. 7. Strategic Development Consultants, South Africa. 8. Bill & Melinda Gates Foundation (consultant), USA. Electronic address: Logan.Brenzel@gatesfoundation.org. 9. Health and Development Africa (Pty) Ltd., South Africa. Electronic address: Anthony.Kinghorn@mottmac.com.
Abstract
BACKGROUND: This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. METHODS: The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. RESULTS: The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. CONCLUSIONS: Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses.
BACKGROUND: This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. METHODS: The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. RESULTS: The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. CONCLUSIONS: Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses.
Authors: Clint Pecenka; Spy Munthali; Paul Chunga; Ann Levin; Win Morgan; Philipp Lambach; Niranjan Bhat; Kathleen M Neuzil; Justin R Ortiz; Raymond Hutubessy Journal: PLoS One Date: 2017-12-27 Impact factor: 3.240
Authors: Isabelle Feldhaus; Carl Schütte; Francis D Mwansa; Masauso Undi; Stanley Banda; Chris Suharlim; Nicolas A Menzies; Logan Brenzel; Stephen C Resch; Anthony Kinghorn Journal: Health Policy Plan Date: 2019-06-01 Impact factor: 3.344
Authors: Fangli Geng; Christian Suharlim; Logan Brenzel; Stephen C Resch; Nicolas A Menzies Journal: Health Policy Plan Date: 2017-10-01 Impact factor: 3.344
Authors: Nicolas A Menzies; Christian Suharlim; Fangli Geng; Zachary J Ward; Logan Brenzel; Stephen C Resch Journal: BMC Med Date: 2017-10-06 Impact factor: 8.775