Cost analysis of routine immunisation in Zambia.
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.
Strategic Development Consultants, South Africa. Electronic address: carl.schutte@sdc.co.za.
Carl
C
Schütte
World Bank, Zambia Country Office, Zambia. Electronic address: cchansa@worldbank.org.
Collins
C
Chansa
Health and Development Africa (Pty) Ltd., South Africa. Electronic address: edmore.marinda@mottmac.com.
Edmore
E
Marinda
Centre For Economic Governance and AIDS in Africa, South Africa. Electronic address: guthriehealthfinancingconsult@gmail.com.
Teresa A
TA
Guthrie
Independent consultant, Zambia. Electronic address: bandastanley@yahoo.com.
Stanley
S
Banda
Health and Development Africa (Pty) Ltd., South Africa.
Zipozihle
Z
Nombewu
Health and Development Africa (Pty) Ltd., South Africa.
Katlego
K
Motlogelwa
Strategic Development Consultants, South Africa.
Marita
M
Lervik
Bill & Melinda Gates Foundation (consultant), USA. Electronic address: Logan.Brenzel@gatesfoundation.org.
Logan
L
Brenzel
Health and Development Africa (Pty) Ltd., South Africa. Electronic address: Anthony.Kinghorn@mottmac.com.
Anthony
A
Kinghorn
D003365:Costs and Cost Analysis; D003625:Data Collection; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics*; D006291:Health Policy; D006298:Health Services Administration / Q000191:economics*; D006801:Humans; D011897:Random Allocation; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000191:economics* / Q000379:methods; D015024:Zambia
Africa; Costs; EPI; Routine immunisation; Sustainability