Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).
BACKGROUND
Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia.


METHODS
This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented.


RESULTS
The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing.


CONCLUSIONS
This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial.
Bill & Melinda Gates Foundation, Seattle, Washington, United States. Electronic address: logan.brenzel@gatesfoundation.org.
Logan
L
Brenzel
UNC Gillings School of Global Public Health, Chapel Hill, NC, United States. Electronic address: young.darwin@gmail.com.
Darwin
D
Young
Bill & Melinda Gates Foundation, Seattle, Washington, United States. Electronic address: Damian.walker@gatesfoundation.org.
Damian G
DG
Walker
D001541:Benin; D002202:Capital Financing; D003625:Data Collection / Q000379:methods; D005869:Ghana; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics*; D006291:Health Policy; D006298:Health Services Administration / Q000191:economics*; D006721:Honduras; D006801:Humans; D008966:Moldova; D011897:Random Allocation; D014454:Uganda; D014611:Vaccination / Q000191:economics* / Q000379:methods; D015024:Zambia
Costs; Financing; Low-income; Productivity; Routine immunization