title: Costing analysis and anthropological assessment of the vaccine supply chain system redesign in the Comé District (Benin).
abstract: At the end of 2013, a pilot experiment was carried out in Comé health zone (HZ) in an attempt to optimize the vaccine supply chain. Four commune vaccine storage facilities were replaced by one central HZ facility. This study evaluated the incremental financial needs for the establishment of the new system; compared the economic cost of the supply chain in the Comé HZ before and after the system redesign; and analyzed the changes induced by the pilot project in immunization logistics management.
  
  
  
  The purposive sampling method was used to draw a sample from 37 health facilities in the zone for costing evaluation. Data on inputs and prices were collected retrospectively for 2013 and 2014. The analysis used an ingredient-based approach. In addition, 44 semi-structured interviews with health workers for anthropological analysis were completed in 2014.
  
  
  
  The incremental financial costs amounted to US$55,148, including US$50,605 for upfront capital investment and US$4543 for ongoing recurrent costs. Annual economic cost per dose administered (including all vaccines distributed through the Expanded Program on Immunization (EPI)) in the Comé HZ increased from US$0.09 before system redesign to US$0.15 after implementation, mainly due to a high initial investment and the operational cost of HZ mobile warehouse. Interviews with health workers suggested that the redesigned system was associated with improvements in motivation and professional awareness due to training, supportive supervision, and improved work conditions.
  
  
  
  The system redesign involved a considerable investment at HZ level. Benefits were found in the reduction of transportation costs to health posts (HP) and commune health center (CHC) levels, and the strengthening of health workers professional skills at all levels in Comé. The redesigned system contributed to a decrease in funding needs at HP and CHC levels. The benefits of the investment need to be examined after the introduction of new vaccines and after a longer period.
authors.affiliation: Agence de Médecine Préventive, France. Electronic address: xxhuang@aamp.org.
authors.forename: Xiao Xian
authors.initials: XX
authors.lastname: Huang
authors.affiliation: Agence de Médecine Préventive, France. Electronic address: eGUILLERMET@aamp.org.
authors.forename: Elise
authors.initials: E
authors.lastname: Guillermet
authors.affiliation: Agence de Médecine Préventive, France. Electronic address: jblegargasson@aamp.org.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Le Gargasson
authors.affiliation: University of Abomey-Calavi, Benin. Electronic address: dalebalfa@yahoo.fr.
authors.forename: Daleb Abdoulaye
authors.initials: DA
authors.lastname: Alfa
authors.affiliation: University of Abomey-Calavi, Benin. Electronic address: gbodjar@yahoo.fr.
authors.forename: Romule
authors.initials: R
authors.lastname: Gbodja
authors.affiliation: Benin's Ministry of Health, Benin. Electronic address: sossoujustinadanmavokin@yahoo.fr.
authors.forename: Adanmavokin Justin
authors.initials: AJ
authors.lastname: Sossou
authors.affiliation: Agence de Médecine Préventive, France. Electronic address: pjaillard@aamp.org.
authors.forename: Phillippe
authors.initials: P
authors.lastname: Jaillard
mesh_terms: D001541:Benin; D004356:Drug Storage / Q000191:economics* / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D009934:Organization and Administration / Q000191:economics*; D010865:Pilot Projects; D012189:Retrospective Studies; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Benin; EPI; HERMES; Health logistics; Health workforce; Logistics cost; Low- and middle-income countries; Supply chain; Vaccination programs