In October 2016, ThinkWell and John Snow, Inc. (JSI) kicked off a 3-year project focused on increasing the visibility, availability, understanding, and use of evidence on immunization delivery cost. Funded by The Bill & Melinda Gates Foundation, the Immunization Costing Action Network (ICAN) aims to build country capacity around generation and use of cost evidence to work towards sustainable and predictable financing for vaccine delivery.
The countries included in this project are India, Indonesia, Tanzania, and Vietnam. To ensure program and policy relevance, ThinkWell and JSI are working in each country with research institutes and the Expanded Program on Immunization (EPI) to generate costs that address challenges that are at the top of the domestic health and immunization financing agendas.
To kick off the collaboration among the research teams, ThinkWell and JSI brought together researchers from the National Institute of Health Research and Development (NIHRD) and Universitas Indonesia (Indonesia), Ifakara Health Institute (Tanzania), and Hanoi University of Public Health (Vietnam) for a virtual cross-country call in June. The research teams shared their research questions and study designs and discussed methodological challenges that each team will likely face related to shared health system costs, labor costs, and population and coverage data.
While each country will be estimating the cost of different vaccine delivery strategies, the focus of the research depends on the cost needs and policy priorities of the country. The Indonesia research team will analyze the costs associated with routine facility delivery and two outreach strategies, while also looking at delivery costs in relation to coverage and district-level financing. The Tanzania research team will estimate the cost of a fully-immunized child, with a special look at urban/rural differences and cost to reach nomads. The Vietnam research team will examine the costs of switching from TT vaccine delivery to women of childbearing age to Td vaccine delivery to 7-14-year-old children. Each research team is working on their research protocol, with data collection expected to begin this fall.
Several documented challenges countries often face with population and coverage data were presented on the call, with some best practices recommended. For example, current census data can be used to validate or correct inaccurate catchment populations. Setting criteria during sampling for selection of facilities based on an assessment of their population statistics can prevent problems with population data. Reviews of monthly facility records of doses administered can identify gaps and improve the accuracy of numerator data. Diagnosis of coverage percentages is also helpful, accompanied by discussions with district EPI managers who can provide valuable insights on whether coverage is truly low or appears low due to poor reporting.
For more information, contact Michaela Mallow at mmallow@ThinkWell.global
Photo credit: USAID