The Costs of Different Vaccine Delivery Strategies to Reach Children Up to 18 Months in Rural and Urban Areas in Tanzania
Presenter: Fatuma Manzi
Co-authors: Kassimu Tani, Carl Schutte, Emma Clarke, Kelsey Vaughan
Poster file: [download]
Updated cost data is needed to ensure smooth operations of Immunization and Vaccine Delivery (IVD) (including new vaccine introduction), and to strengthen resource mobilization efforts, particularly as Tanzania enters the Gavi Preparatory Transition phase in 2020. The study aimed to estimate the average delivery cost per dose and per fully immunized child (FIC), defined as children up to 18 months receiving measles 2nd dose, and the cost of facility delivery and outreach at existing coverage levels in urban areas, rural areas without nomads, and rural areas with nomads. We performed an ingredients-based, retrospective full financial and economic costing study from a government/provider perspective, collecting data from a randomly selected, nationally representative sample of 54 health facilities. We used the calibration estimation method to estimate the costs of the country-wide program, based on auxiliary information about national delivery volumes, and calculated average unit costs using inverse probability of sampling weights and volume-weights. We estimate the total economic cost of the IVD routine program is approximately US$130 million and the economic cost per FIC is US$81. The economic cost per dose delivered through outreach is estimated to be 19% higher than at facilities and the economic cost per dose is lowest in rural areas with nomads; this may be due to lower labor costs. Rural areas without nomads have the second lowest economic cost per dose, followed by urban areas; part of this difference may be driven by sampling error.