title: Estimating the costs of the vaccine supply chain and service delivery for selected districts in Kenya and Tanzania.
abstract: Having data on the costs of the immunization system can provide decision-makers with information to benchmark the costs when evaluating the impact of new technologies or programmatic innovations. This paper estimated the supply chain and immunization service delivery costs and cost per dose in selected districts in Kenya and Tanzania. We also present operational data describing the supply chain and service delivery points (SDPs). To estimate the supply chain costs, we collected resource-use data for the cold chain, distribution system, and health worker time and per diems paid. We also estimated the service delivery costs, which included the time cost of health workers to provide immunization services, and per diems and transport costs for outreach sessions. Data on the annual quantities of vaccines distributed to each facility, and the occurrence and duration of stockouts were collected from stock registers. These data were collected from the national store, 2 regional and 4 district stores, and 12 SDPs in each country for 2012. Cost per dose for the supply chain and immunization service delivery were estimated. The average annual costs per dose at the SDPs were $0.34 (standard deviation (s.d.) $0.18) for Kenya when including only the vaccine supply chain costs, and $1.33 (s.d. $0.82) when including immunization service delivery costs. In Tanzania, these costs were $0.67 (s.d. $0.35) and $2.82 (s.d. $1.64), respectively. Both countries experienced vaccine stockouts in 2012, bacillus Calmette-Guérin vaccine being more likely to be stocked out in Kenya, and oral poliovirus vaccine in Tanzania. When stockouts happened, they usually lasted for at least one month. Tanzania made investments in 2011 in preparation for planned vaccine introductions, and their supply chain cost per dose is expected to decline with the new vaccine introductions. Immunization service delivery costs are a significant portion of the total costs at the SDPs.
authors: PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA. Electronic address: mmvundura@path.org.
authors: Mercy
authors: M
authors: Mvundura
authors: PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
authors: Kristina
authors: K
authors: Lorenson
authors: PATH, A.C.S. Plaza, 4th Floor, Lenana and Galana Road, PO Box 76634, Nairobi 00100, Kenya.
authors: Amos
authors: A
authors: Chweya
authors: PO Box 33810, Dar es Salaam, Tanzania.
authors: Rosemary
authors: R
authors: Kigadye
authors: PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
authors: Kathryn
authors: K
authors: Bartholomew
authors: PATH, 10th Floor, Amani Place, Ohio Street, Dar es Salaam, Tanzania.
authors: Mohammed
authors: M
authors: Makame
authors: PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
authors: T Patrick
authors: TP
authors: Lennon
authors: Unit of Vaccines and Immunization, Ministry of Health, Nairobi, Kenya.
authors: Steven
authors: S
authors: Mwangi
authors: Unit of Vaccines and Immunization, Ministry of Health, Nairobi, Kenya.
authors: Lydia
authors: L
authors: Kirika
authors: Unit of Vaccines and Immunization, Ministry of Health, Nairobi, Kenya.
authors: Peter
authors: P
authors: Kamau
authors: Unit of Vaccines and Immunization, Ministry of Health, Nairobi, Kenya.
authors: Abner
authors: A
authors: Otieno
authors: PATH, A.C.S. Plaza, 4th Floor, Lenana and Galana Road, PO Box 76634, Nairobi 00100, Kenya.
authors: Peninah
authors: P
authors: Murunga
authors: PATH, A.C.S. Plaza, 4th Floor, Lenana and Galana Road, PO Box 76634, Nairobi 00100, Kenya.
authors: Tom
authors: T
authors: Omurwa
authors: Expanded Program on Immunizations, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors: Lyimo
authors: L
authors: Dafrossa
authors: PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
authors: Debra
authors: D
authors: Kristensen
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007630:Kenya; D012034:Refrigeration / Q000191:economics*; D013636:Tanzania; D014611:Vaccination / Q000191:economics*; D014612:Vaccines / Q000191:economics* / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Cost per dose; Expanded Program on Immunization; Kenya; Micro-costing; Tanzania; Vaccine supply chain cost