title: Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12.
abstract: BACKGROUND
  India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP.
  
  
  METHODS
  We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status.
  
  
  RESULTS
  Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services.
  
  
  CONCLUSIONS
  In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state.
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA Precision for Value, Boston, MA, USA abhi0991@bu.edu abhisheksharma0991@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Warren A
authors.initials: WA
authors.lastname: Kaplan
authors.affiliation: Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Maulik
authors.initials: M
authors.lastname: Chokshi
authors.affiliation: Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Zodpey
mesh_terms: D000067576:Child Health; D002675:Child, Preschool; D006801:Humans; D007114:Immunization / Q000639:trends*; D017589:Immunization Programs / Q000458:organization & administration* / Q000639:trends; D007194:India / Q000453:epidemiology; D015233:Models, Statistical; D017149:Private Sector; D014611:Vaccination; D014612:Vaccines
chemical_list: D014612:Vaccines
keywords: Child health; India; health systems; private sector; vaccination