Cost of implementing the Intensified Mission Indradhanush Programme

Presenter: Anita Pinheiro

Co-authors: Palash Das, Susmita Chatterjee, Logan Brenzel, William Lodge, Christian Suharlim, Nicholas Menzies, Stephen Resch

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Background: Despite being operational over 30 years, only 65% children in India receive complete immunization during their first year of life through India’s Universal Immunization Programme (UIP). Intensified Mission Indradhanush (IMI) programme was a government of India initiative to reach each and every child up to two years of age and all those pregnant women who have been left uncovered under UIP. IMI was implemented in 173 low coverage districts in 24 states for 7 days every month between October 2017 and January 2018. The basic strategy of IMI involved • a process of head count survey to identify children with missing doses • prepare a due list with missed children • prepare a microplan accordingly to identify areas for outreach sessions • deliver immunization at identified temporary vaccination sites during one week of each month for four consecutive months Special drive like IMI requires additional resources, however, no information on the incremental cost of conducting such special initiative. Objective: Estimate actual additional government expenditures for IMI Methods Sampling: We purposefully selected five states: Assam, Bihar, Maharashtra, Rajasthan and Uttar Pradesh which have a high concentration of IMI activity. Within these five states, we selected 40 districts including six urban districts, 91 blocks (sub-districts) and 281 sub-centres. Data collection: A five member team were responsible for data collection during the period of July 2018 to January 2019. Data were collected from administrative records, financial records as well as interviewing different categories of staff involved in IMI. Financial cost components include Vaccines, Syringes, Vaccine transport, Communication, Training, Meeting, Mobility support, Payment for alternate vaccine delivery (AVD), Incentives for Accredited Social Health Activists (ASHAs), Printing, Waste management, Supervision, Microplanning, Mobile team, Line listing, Travel expenses to session sites. District wise additional financial costs were calculated to understand the incremental resource requirements for IMI. Results: Vaccines and supplies were the major cost components for Bihar, Rajasthan and Uttar Pradesh. In Maharashtra, communication, incentives for accredited social health activists (ASHAs) and supervision were the major cost components. In Assam, no specific trend of expenditure was found across study districts. Cost of reaching per child during IMI programme was US$2.15 in Uttar Pradesh while the same was US$8.25 in Assam. Discussion: Given the lower baseline coverage in Rajasthan and Uttar Pradesh, the increasing cost per dose in Rajasthan, Uttar Pradesh to Maharashtra probably reflect the increasing marginal cost of covering more children in a given population. Higher unit cost and cost per child in Assam is probably because of the geographical hard to reach areas in the state which includes riverine islands, hilly terrain.