Service volume and other factors affecting the costs of immunizations in the Gambia.

The total cost of the Expanded Programme on Immunization and of its various components in the Gambia over a period of one year (from July 1980 to June 1981) was investigated, and the costs per immunization dose and per fully immunized child were calculated. The total costs were to a large extent (45%) due to the cost of personnel and fixed costs. Where there was efficient delivery of immunizations, the average cost per dose was about one-fifth of that in the most costly facilities (range: US$2.32 to $0.41). The lower costs were related to more intensive use of the facilities. The national average cost was $1.09. The implications of the results of this study for policies to reduce costs are discussed, and further areas of research are suggested that will provide improved information to guide decision-makers in the use of scarce immunization programme resources for better health in the world.