Effects of demography, disability weights and cervical cancer burden on HPV vaccination impact estimates of the PRIME model

Presenter: Kaja Abbas

Co-authors: Kevin van-Zandvoort, Mark Jit

Poster file: [download]
The PRIME (Papillomavirus Rapid Interface for Modelling and Economics) model has been used to assess the health impact and cost-effectiveness of HPV vaccination in girls for prevention of cervical cancer caused by HPV types 16 and 18. Our aim is to compare the health impact estimates generated by the PRIME model after updates to the model inputs for demography, disability weights and cervical cancer burden. The vaccination scenario of 50% coverage for routine vaccination of 9-year old girls for the birth cohorts of 2011-2020 (vaccination years of 2020-2029) was compared to the counterfactual scenario of no vaccination in 177 countries. The base settings are based of demography using WHO life tables, disability weights of GBD 2001 study and cervical cancer burden estimates from GLOBOCAN 2012. The demography is updated to UNWPP (United Nations World Population Prospects) 2017 population estimates, disability weights from the GBD (Global Burden of Disease) 2017 study and GLOBOCAN 2018 (Global Cancer Incidence, Mortality and Prevalence from the International Agency for Research on Cancer). The updated estimates for vaccination impact are 16.63 cases averted, 12.45 deaths averted, and 266.06 DALYs averted per 1000 vaccinated girls. Since PRIME is based on a static cohort model, the health impact estimates of HPV vaccination per vaccinated girl will be uniform at different levels of vaccination coverage.


Estimating the costs of strengthening a Second Year of Life (2YL) healthy child visit in Namibia and Cape Verde

Presenter: Alex Adjagba

Twitter: '@UNICEF

Co-authors: Imran Mirza, Ulla Griffiths

Poster file: [download]
Abstract: Estimating Costs of Implementing a Second Year of Life (2YL) Healthy Child Visit in Namibia and Cape Verde. Alex Adjagba, Imran Mirza, Ulla Griffiths Background and Objectives The WHO recommends that immunization programs widen routine vaccination beyond the first year of life. The second year of life (2YL) platform is a critical step in extending immunization beyond infancy. In addition, the 2YL platform is an opportunity to integrate vaccination with other critical health interventions, such as malaria prevention, micronutrients, growth monitoring, and deworming. Both Namibia and Cape Verde already have existing 2YL activities, but also wanted to add new interventions to the existing ones, thus they wanted to generate evidence about total costs, costs per child and an aggregated figure that includes all costs, especially for operational and training costs cumulatively for 5 years. Such evidence will be used for advocacy discussion as part of their future strategic plans in the MoH. Methodology An Excel-based costing tool to standardize data collection and analysis for estimating the costs of introducing a 2YL healthy child visit was developed. The tool was populated with demographic data, chosen interventions, vaccine and commodity parameters, including prices, health personnel salaries, as well as training and communication costs. A series of meetings were with the national focal points for nutrition, malaria, immunization and supply, to identify the most relevant country information sources for each area. In Namibia, data were retrieved from various sources such as the national census data on the National Statistics Institute website for population data; MoH annual reports for malaria and nutrition data, complemented by WUENIC for immunization data, as well as UNICEF supply division and the National Vaccine procurement (CMS) for vaccine prices and presentation data. Similarly, in Cape Verde, data was retrieved from equivalent sources before the mission, by the department of maternal and new born health of the MoH. In both countries, salary and training cost information was received by government and predicted coverage for each intervention was based on expert opinion and existing national strategic plans. Results In Namibia, the total costs estimate with annualized startup costs over 5 years is US$ 2,453,358; with an average cost per child reached is US$8.24. In Cape Verde, the total costs estimate with annualized startup costs over 5 years is US$ 431,353, for an average cost of US$23.02. In both countries, vaccines and nutrition commodities costs represent the largest share of costs, while training and staff time were the less expensive components. Conclusion The use of the costing tool in the 2 countries tackled 2 different requests and allowed to establish evidence that can be used for advocacy and planning at country-level. Reducing vaccines procurement costs will significantly decrease the cost of establishing such platform, especially in middle income countries.


From Data to Metrics: Multi-Country Vaccine Supply Chain Cost and Performance Benchmarking

Presenter: Gabriella Ailstock

Twitter: '@VillageReach

Co-authors: Tapiwa Mukwashi, Joseph Roussel, Dorothy Thomas

Poster file: [download]
VillageReach is committed to socializing the lessons learned from our experience establishing the first-of-its-kind, multi-country, routine childhood immunization supply chain (iSC) cost and performance benchmarking database for the context of low- and middle-income countries. A challenge faced by public health supply chains is a lack of referential cost and performance metrics. To address this gap, VillageReach is creating the iSC cost and performance benchmarking database that enables stakeholders to use standardized references to evaluating supply chain cost and performance against comparable peer groups. This information will allow users to gain a deeper understanding of supply chain costs, identify performance gaps, establish aspirational performance goals and identify specific strategies for improvement. Cost and performance metrics incorporated into the benchmarking database have been computed from data collected at the sub-national (e.g., Province, state or similar unit) level as well as the supply chain levels beneath it. National-level iSC costs that are used to support the sub-national level are also considered in this evaluation. In this presentation, VillageReach will share experiences from the development of the iSC benchmarking database and early stage findings from phase one participants. Phase one results will include methodological lessons learned from four supply chains; two regions in Ethiopia and one region from Nigeria and one from Mozambique. Additionally, we will share progress in database design and challenges in the data landscape. More specifically, we will highlight our experiences applying a total system cost lens to define cost measures and metrics and, ultimately, compare immunization supply chain cost and performance across comparable groups.

Additional Files:
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Knowledge, attitudes, and practices concerning cervical cancer prevention in Uganda: a review of literature and critical appraisal

Presenter: Pamela Bakkabulindi

Poster file: [download]
Background Cervical cancer is the leading cause of preventable deaths in women in Uganda where it accounts for 80% of all female cancers in the country. The human papillomavirus (HPV) is the primary cause of cervical cancer but uptake of HPV vaccination remains low in Uganda. The aim of this literature review was to assess the knowledge, attitudes, beliefs and practices regarding cervical cancer and its prevention, with an emphasis on HPV vaccination, the reasons for use and non-use. Methodology We conducted an electronic search of databases including PubMed, Medline, Scopus, Cochrane library, Science Direct, Embase, Google scholar between January – February 2018, using the key words; knowledge, attitudes, practices, beliefs, cervical cancer, HPV vaccination, Uganda. Duplicates were removed and content analysis was used to analyse the narratives in each article. Results The initial search yielded 210 articles, but the final review included 67 full articles after removing duplicates and screening by title and abstract. The age standardized rate of cervical cancer had doubled between the 1960’s and 2015 (19.7 vs. 47.5/100,000). Baseline cervical screening rates were low (4.8% in rural; 30% in urban areas); knowledge on cervical cancer screening and HPV vaccination was low (as low as 41% and 8.3% respectively) but acceptance rates for HPV vaccination were high (96.6%) in demonstration projects. Cited barriers to cervical cancer screening included; limited knowledge and awareness; inadequate screening; misconceptions; fear of embarrassment; stigma; poor health worker attitude and inadequate screening supplies at the health facilities. Others included community misconceptions that HPV vaccination was associated with infertility; death; harm to the body; disability of injected arm; birth of twins; cause of cervical cancer; weakened intellect; abdominal cramps; heavy bleeding; and child birth complications. Discussion The rollout of the HPV vaccine in Uganda provides an immense opportunity to curb the burden of cervical cancer. One of the significant short fall of the nationwide HPV vaccination roll out in 2015 was a lack of involvement of key stakeholders like the national and district education officials including head and class teachers. The high levels of willingness for HPV vaccination of 96.6% as demonstrated one of the studies despite the low levels of knowledge of 17.6% as shown in another study presents an opportunity for communication strategies aimed at increasing education and awareness on HPV vaccination. Evidence shows that massive sensitisation involving all key players (school girls, parents, health workers, teachers, district leaders, community leaders) through targeted education is critical in improving the vaccine coverage. Mobilisation activities that focus on creating awareness while providing accurate information builds acceptability, sustains demand for HPV vaccination, and counters rumours/misinformation.


The impact of vaccination on gender equity: conceptual framework and human papillomavirus (HPV) vaccine case study

Presenter: Samantha Clark

Co-authors: Allison Portnoy, Sachiko Ozawa, Mark Jit

Poster file: [download]
Background: Although the beneficial effects of vaccines by socioeconomic status and geography are increasingly well-documented, little has been done to extend these analyses to examine the linkage between vaccination and gender equity. In this study, evidence from the published literature is used to develop a conceptual framework demonstrating the potential impact of vaccination on measures of gender equity. This framework is then applied to the example of HPV vaccine introduction in three countries with different economic and disease burden profiles to establish proof of concept in a variety of contexts. Methods: An initial literature review was conducted to inform development of the conceptual framework. Output from the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model was then used to generate cervical cancer cases and deaths due to HPV types 16/18 by age in each country. We estimated labor force participation and fertility effects from improvements in health and converted these into inputs consistent with those used to calculate the United Nations Gender Inequality Index (GII) (0-1 scale with lower scores associated with greater gender equity) to assess gender equity impact. Findings: Overall, HPV vaccination is expected to decrease cervical cancer cases and deaths by approximately 80% in Tanzania, India, and the United Kingdom based on PRIME projections. This mortality reduction is associated with labor force participation improvements corresponding to 10,600 years of employment gained and an additional $46.7 million dollars (in US$2015) in economic productivity. These cases and deaths averted were also associated with a decrease in maternal mortality and GII score. Interpretation: This proof of concept model is a starting point to inform future health and economic analyses that might incorporate gender equity considerations as an additional impact of vaccination in improving the health and well-being of populations under study.


Early stakeholder engagement in economic evaluation in Uganda

Presenter: Gatien de Broucker

Twitter: g_debroucker

Co-authors: Anthony Ssebagereka, Aloysius Mutebi, Rebecca Apolot, Elizabeth Ekirapa-Kiracho, Dagna Constenla, Bryan Patenaude

Poster file: [download]
Collecting cost and utilization data from caregivers and healthcare facilities proves challenging. Researchers face the threat of inaccessible or unreliable/inaccurate data. Economic evaluations hardly seem relevant to the practice of physicians and nurses, and inaccessible for district health officers and agents who could see use for it. We look at the different stakeholders in our cost of illness study in Uganda and highlight the key roles that they played, after overcoming notable challenges. We documented our initiatives for stakeholder engagement: a newsletter and open access coursework.


Ghana Beyond Aid: Implications for Funding Early Immunizations and Inequalities in Immunization Coverage

Presenter: Ama Fenny

Twitter: '@ama_fenny

Co-authors: Derek Asuman

Poster file: [download]
Introduction Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant barriers in achieving universal coverage of child vaccination among and within countries. Donor support through GAVI is a central source of funding for Ghana’s immunization program. Ghana Beyond Aid refers to a commitment of the government to finance development without recourse to external assistance. Ghana is expected to fully transition from GAVI support in 2020, with funding for immunization services relying on domestic resources. Increasing financial obligations raises concerns for the sustainability of immunization financing and universal coverage of immunizations in Ghana. Objectives This study examines the trends between sources of healthcare financing and the coverage of childhood immunizations in Ghana. In addition, the paper assess the determinants and sources of rural-urban inequalities in Ghana. Method The study uses data from the WHO Global Health Expenditure database to examine the trends between healthcare financing sources and coverage in childhood immunization programs in Ghana. To assess the sources and determinants of rural-urban inequalities in Ghana, we employ data from the two recent rounds of the Ghana Demographic and Health Surveys conducted in 2008 and 2014. A logit estimation is estimated to examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas; using the Oaxaca-Blinder decomposition technique. Results We find that domestic sources has been the main source of healthcare financing in Ghana, with the external sources playing a crucial complementary role. Coverage of childhood immunizations for measles and DPT-Hep B-Hib has been increasing, reaching 92 and 98 percent in 2014 respectively. In 2015 however, coverage for DPT-Hep B-Hib fell to 88 percent whiles vaccinations for measles dropped to 89 percent. The drop in immunization coverage in 2015 coincided with a decline in domestic financing of healthcare. In 2015, domestic sources accounted for 75 percent of the current healthcare spending. This suggest that a reliance on domestic resource mobilisation to fund immunization may be detrimental to efforts to achieve universal coverage of childhood immunizations in Ghana. The findings of the paper reveal significant rural-urban differentials in the probability of a child receiving the required immunization. Specifically, children in rural households are more likely to have completed the required immunizations compared to children in urban areas in both 2008 and 2014. The decomposition analysis of the rural-urban inequalities in child immunization coverage reveals the existence of significant disparities in the probability of a child receiving the full immunization. The direction of the disparities, however, differs in 2008 and 2014. In 2008, there exist a rural disadvantage in child immunization coverage. The gap in immunization coverage is dominated by endowment or explained effect. In 2014, there exist an urban disadvantage in child immunization. The emerging urban disadvantage may reflect the neglect of primary healthcare delivery in fast growing slums and informal settlements in urban areas. Implications The results of this study fits into the workshop’s aim of advancing the use of information on financing of immunisation to improve coverage. To sustain the gains made in extending the coverage of childhood immunization, countries need to bridge the gap in healthcare financing. Improving methodology that produces the required information to policymakers is critical for the health sector. Beyond this, our findings show a change in rural and urban dynamics, as urban population become more informal and slums develop rapidly. We need to begin looking at methods that engage the use of community resources to finance immunizations? There is a lot to reflect improving community level engagement in the broader impact of immunisation. Increasingly, funding from the National Health Insurance Scheme has supplemented budgetary allocations. However, funding from NHIS may decline as the scheme’s financial commitments to other obligation grows and the scheme becomes a major source of funding for investments in the health sector. To reduce the risks posed by the changing mix of immunization financing, alternative financing options should be explored. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas.

Additional Files:
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WHO Economic Analysis Value Chain of Seasonal Flu Vaccination Programme

Presenter: Heather Fraser

Twitter: '@heatherfraser10

Co-authors: Ijeoma Edoka, Ciaran Kohli-Lynch, Winfrida Mdewa, Cheryl Cohen, Karen Hofman & Raymond Hutubessy

Poster file: [download]
Background: Influenza accounts for a significant number of deaths annually in South Africa. The burden of seasonal influenza is further exacerbated by a high prevalence of HIV and tuberculosis. To address this burden of disease, the South African National Department of Health introduced an influenza vaccination programme in 2010. However, due to budget constraints and competing priorities in other disease areas, coverage remains low among high-risk population groups including children, pregnant women, the elderly, HIV positive individuals and those with other underlying medical conditions. This study aimed to assess the costs and health outcomes associated with the seasonal influenza vaccination programme in South Africa. Methods: This study assesses the costs and cost-effectiveness of the seasonal influenza vaccination programme using two standardised tools recently developed by the WHO – the Seasonal Influenza Immunization Costing Tool, an ingredient-based costing tool; and the Cost-Effectiveness Tool for Seasonal Influenza, a worksheet-based static decision analytic modelling tool, respectively. In addition, this study pilot-tested the two new WHO tools in combination – assessing their flexibility and ease of application in different settings. We estimated total cost (USD 2018) and incremental cost per quality-adjusted life year (QALY) for each high-risk group, and for the overall high-risk population compared to no vaccination, from a health system perspective, employing a 1-year time horizon. Preliminary Results: Minor adaptations to the model structure and target populations were required. Preliminary results show that cost-effectiveness of the South African vaccination programme in the overall population was approximately $4,400/QALY. Preliminary results show that cost-effectiveness varies in the sub-groups from $3,500/QALY (children) to $6,600/QALY (elderly). Discussion: The pilot-testing exercise provides a framework for adaptation and use of the WHO economic analysis value chain toolkit in different healthcare settings. This study provides cost-effectiveness evidence for the seasonal influenza vaccination programme in South Africa, highlighting potential target populations for scale-up.


Immunization Financing: Mobilization of resources and effective use allocated resources in immunization program Georgia’s Experience

Presenter: Vladimer Getia

Co-authors: Gia kobalia, Eka Adamia, Lia Jabidze, Irina Javakhadze

Poster file: [download]
Background and Aims: Georgia’s immunization program was heavily supported by Gavi, the Vaccine Alliance (Gavi), which co-finances immunization programs in low- and middle-income countries. However, as Georgia’s economy grew, the country gradually transitioned off Gavi support, assuming a greater and greater share of its immunization costs. After the donor support from the main supporter of the state immunization program, GAVI-Alliance, was completed, the progress achieved can only be sustained through achieving stable financing. The country will now need to seek domestic reserves in order to incur costs for any newly introduced vaccines. A strict decision-making process, including the requirement to secure financing, allows Georgia to take a strong position in the face of these new challenges. Methods: In order to ensure financial sustainability of the program, it is necessary to mobilization of resources and effective use allocated resources in immunization programm. Ways to improve efficiency are: implement effective procurement system, planning and forecasting system, immunization Infrastructure, raise awareness of parents - by UNICEF unified Procurement Mechanism; increase in quantity through multi-year purchases; legislation that provides opportunities to ensure transparency and free competitive environment, through the electronic system of international procurement; the use of the mechanism for the abolition of registration of those vaccines that are registered in countries with a high level of control and also prequalified by WHO; use tools and methods to assess the capacity and performance of country vaccine procurement system, Improve immunization informations systems by making use of e-health applications, home-based records and using data for action system of monitoring and tracking Immunization Infrastructure upgraded Cold chain system and increased capacities, mobile application for parents Results: 3 new vaccines have been introduced since 2012, including an ongoing demo project for one new vaccine, cold chain infrastructure was renewed at central and regional levels, an unified electronic vaccination recording system was introduced, an unscheduled measles vaccination is underway, international financial obligations have been handed over completely, immunization budget has increased fivefold in the years 2012-2019. Conclusion: The foundation of the success behind stable financing of immunization in Georgia is the transparency of financial resource consumption, active usage of international recommendations and mechanisms and Government’s political support.


Budgeting for Immunization in nine Eastern and Central European countries

Presenter: Ulla Griffiths

Twitter: '@ullakou

Co-authors: Svetlana Stefanet, Jennifer Asman

Poster file: [download]
Introduction Existence of a line item in the Ministry of Health (MOH) budget is often seen as an essential, first step to ensure financial sustainability. Budget execution and budget evaluation are the remaining two necessary functions in the public financial management system. In this study, immunization was used as a reference point for cross-country comparison of budgeting methods in nine Eastern European and Central Asian countries; Armenia, Azerbaijan, Bosnia and Herzegovina, Georgia, Kyrgyzstan, Moldova, Romania, Tajikistan and Uzbekistan. Study objectives were to (i) verify the number and types of budget line items for immunization services, (ii) compare budget execution with budgeted amounts, and (iii) compare values with annual immunization expenditures reported to WHO and UNICEF. Methods UNICEF country offices were contacted for obtaining a copy of the pages in the 2016 and 2017 MOH budgets and budget execution reports where immunization expenses were included. Budgets were compared across countries in terms of budget structure and amounts budgeted. Results Bosnia and Herzegovina had nine line items for immunization, Kyrgyzstan seven, and Georgia four. The remaining six countries only had a single line item. Immunization budget per child in the birth cohort ranged from US$ 6 in Kyrgyzstan to US$ 224 in Romania. Immunization budget as percent of the Government health budget ranged from 0.03% in Azerbaijan to 2.14% in Armenia. The difference between budgets and immunization expenditures reported to WHO and UNICEF ranged from 11% in Georgia to 56% in Kyrgyzstan, with a mean of 29% across the countries. Budget execution reports from Georgia and Moldova showed executions rates of 113% and 97%, respectively. Conclusion There were great differences between country indicators and some values seemed implausible. Budget credibility must be questioned. It is concerning that budget execution reports could only be obtained from two countries.


The Costs of Preparation and Delivery of Td Vaccine to 7-Year-Old Children in Vietnam

Presenter: Hoang Van Minh

Twitter: ThinkWellGlobal

Co-authors: Vu Quynh Mai, Carl Schutte

Poster file: [download]
Since Vietnam has eliminated maternal and neonatal tetanus since 2005, the National EPI is likely to follow WHO recommendations to cease delivery of TT vaccine and replace with a booster Td vaccine. This study estimates the budget impact of future cessation of TT vaccination for women of childbearing age (CBAW) and introduction of Td vaccination for 7-year-olds using three delivery strategies. The poster outlines the methods for estimating the budget impact of the replacement, based on both retrospective and prospective ingredients-based costing from a public health care provider perspective. Retrospective costing was done of the delivery of TT for CBAW and Td for diphtheria outbreak control, while prospective costing was done of the replacement (complete cessation of TT vaccination for CBAW, routine implementation of Td vaccination for 7-year-olds at health faiclities, outreach sites and schools, and outbreak control campaigns for Td during a transition period). The budget impact (2018-2025) is based on the assumption that TT for CBAW would be expected to cost $22.2 million based on the retrospective costing. Replacement of Td would mean a savings of $3.2-$7.1 million, with greatest savings achieved using school-based delivery.


Creating the Architecture of Sustainable Immunization Financing, Pakistan Workshops

Presenter: Maryam Huda

Twitter: Maryam_huda67

Co-authors: Shehla Zaidi, Shreena Malaviya, Farina Abrejo

Poster file: [download]
Relevance and significance of work: The problem is the lack of human resources skilled in financial and economic decision making when critical policies are made that affect the performance of immunization delivery in GAVI countries. There are few opportunities for staff in EPI programs to gain these skills as part of their primary professional training and few resources for them to turn to in mid-career. Local business schools and public health schools in GAVI countries do not offer a curriculum that is tailored to improving decisions related to vaccine economics and financing. If nothing is done, million of dollars will be wasted and lives put at risk because financing priorities are not aligned properly, or because life saving antigens and delivery strategies are not adopted. This work lays out a strategy to improve efficient use of resources by vaccine delivery programs in low- and middle-income countries (LMICs). It focuses on capacity development in applied economics, cost effectiveness, and finance for EPI mangers, NiTAG members, and MOH so they can improve resource allocation and priority setting for vaccine delivery programs. With better skills policy makers can improve vaccination program sustainability, efficiency and financial predictability. Methodology The aim of this project was to develop and deploy training material to address critical capacity needs in vaccine economics, costing and financing for vaccine policy makers in GAVI-eligible countries, develop demand for skills in vaccine economics, financing and decision-making and to develop a community of practice and dialogue supplying a pipeline of peers and mentors and veteran policy makers offering capacity building experiences in a network of vaccine policy makers. There were three phases of the project; Phase 1 was inception from December 2016 to February 2017. Faculty from Gates foundation, Johns Hopkins, Makerere, PHFI and Aga Khan University convened to gather consensus on learning objectives, teaching methods and a work plan for content creation. The list of learning objectives was organized into possible modules of training. Phase 2 was producing and piloting drafts of training material from March 2017 to December 2017. The faculty work groups were assigned to construct various course modules including PowerPoint lectures, case studies, exercises, curated readings and instructors’ manuals. This was followed by regional workshops at Kampala, Karachi, Delhi and South Africa. Phase 3 was developing supply and demand for training from January 2018 to November 2018. This included workshops, Open Course ware, international meetings and conferences, social networks, newsletter and peer influence. Results In the last two years, AKU has organized three workshops and one policy round-table, each spanning over 3 days. The workshops brought together 25 participants from Pakistan and Afghanistan that are currently working in immunization in various aspects. The curriculum was taught by health economics experts from AKU, Johns Hopkins University, WHO, World Bank and Chemonics. The modules taught were; 1. Fundamentals of Vaccine Economics 2. Economic Evaluation for New Vaccines and Programs 3. Costing of Immunization Programs 4. Systems, Logistics and Operations of Immunization Programs 5. Financing & Resource tracking of Immunization Programs

ican / vaughan

Systematic Review Findings on the Cost of Delivering Vaccines in Low- and Middle-Income Countries: Unit Cost Catalogue and Cost Ranges

Presenter: Kelsey Vaughan

Twitter: '@ThinkWellGlobal

Co-authors: Michaela Mallow, Annette Ozaltin, Logan Brenzel

Poster file: [download]
Immunization programs that deliver for all require sustainable and predictable financing to achieve equitable, high-quality coverage of life-saving vaccines. However, use of cost evidence for budgeting, planning, and decision making is challenging. Cost data are fragmented, of variable quality, and can be difficult to translate for policy purposes. This poster outlines the methods and results from a systematic review of immunization delivery costing studies in low- and middle-income countries. The poster provides an overview of findings from the systematic review, which are housed in an online unit cost database data, and some of the cost ranges developed from comparable unit costs. We note that there is high variability in unit costs, even in comparable settings; some variation may be due to differences in study methodologies and reporting. Finally, cost ranges can inform planning and policymaking, but should be used with caution given their width and the few unit costs used in their development.

ivac / garcia

Making Data Matter: Impactful Results Dissemination Through Storytelling and Stakeholder Engagement

Presenter: Cristina Garcia

Co-authors: Katie Gorham, Meeru Gurung, Arun Sharma

Poster file: [download]
Introduction: Economic evidence is particularly useful to decision makers, yet many researchers do not prioritize broad dissemination. Unseen and unused economic evidence does no good; to promote evidence use among important stakeholders, investigators must intentionally and strategically disseminate results beyond peer-reviewed publications. Pairing human interest stories with economic evidence puts a face to the data and can be compelling to decision makers and the public. Here we share resources for using storytelling and stakeholder engagement to make data matter, highlighting the PneumoNepal PCV Impact Economic Data Study (PIES) approach as an example. Methods: Our process involved five key steps: 1) mapping messages and audiences; 2) map the stakeholders and determine the path to engagement; 3) find compelling stories; 4) package stories for priority audiences; 5) implement the engagement strategy. To map out messages and audiences, we developed a Message and Audience Matrix to answer key questions such as: what is the message, what is the corresponding data/evidence, and who is it important to? More details about this process and resources for replicating it are available at pneumonepal.org/storyresources. Results: The PneumoNepal PIES study estimated out-of-pocket costs and catastrophic and medical impoverishment impact of hospitalized pneumonia on Nepali families. We identified five stories of families impacted by pneumonia to pair with study results. Story products include a series of focus videos, a short documentary following one family coping with the repercussions of the pneumonia hospitalization six months later, and a series of short videos for distribution on social media. We also developed photo essays and a photobook telling the stories of the five families, which can be disseminated to stakeholders at meetings and conferences. Conclusion: In a competitive environment for attention, engaging key stakeholders requires effort and resources. Intentional engagement combined with compelling storytelling to supplement quantitative evidence can be an effective way of ensuring research results matter in real life.