THE COST STRUCTURE OF ROUTINE IMMUNIZATION SERVICES: RESULTS FROM SIX COUNTRIES

   Purpose:  There is little information on the cost structure of immunization services provided in low and middle-income settings. Using a large and unique dataset of immunization service costs, this analysis investigated how the distribution of costs across input types and programmatic activities changes as a function of observable site-operating characteristics.

   Method: The EPIC study collected data on the costs of routine infant immunization services from >300 sites across 6 countries (Benin, Ghana, Honduras, Moldova, Uganda, Zambia) using a standardized approach. We analyzed these data to understand the typical cost structure of sites and how this varied by country and other site characteristics. First, we estimated total site-level economic costs and the distribution of these costs across input types and programmatic activity categories. We constructed regression models to predict spending within each category as a function of a standard set of predictors. A seemingly unrelated regressions (SUR) approach was used to allow errors to be correlated across regression equations.

   Result:  By budget category, labor and vaccine costs formed the largest share of total costs, comprising 86% of the total costs on average across six countries. The relative share to vaccines and labor varied widely between countries, with labor costs substantially greater than vaccine costs in Moldova and the reverse true in Benin. By programmatic activity, the largest proportion went into facility-based service and outreach service, comprising 63% of the total costs on average across six countries. Based on the regression analyses, site with the highest service volume had a greater proportion of costs devoted to vaccines and a lower proportion to labor. Across all countries, sites operating more efficiently (lower total costs for a given service delivery volume) had a lower fraction of total spending devoted to labor.

   Conclusion:  There is substantial variation in the cost structure of immunization services between and within countries. Service volume and other characteristics of site operations impact cost distributions and cost efficiency levels in difference ways. Given that different budget categories can be supported by different funders or using different mechanisms, these results inform planning and budgeting for infant immunization services as programs grow and change.