Costing and financing analyses of routine immunization in Uganda

This study formed part of the multi-country EPIC initiative, supported by the Bill & Melinda Gates Foundation, GAVI and WHO. The EPIC studies aim to develop updated estimates of routine immunization program costs in six pilot countries, map their funding flows, cost introduction of new vaccines, and develop standardized methodologies to produce comparable results.

Several main conclusions arose from the costing in relation to contributors to costs.

• The bulk of routine program costs (80%) were incurred at facility level (when
  including the vaccine costs at the facility level), followed by the national level
  (11.5%) and then district level (8.4%).
• HCII and HCIII each contributed an estimated 30% and 36% of all facility level immunization costs respectively, and they represent 60% and 32% of total facility numbers in the country respectively. HCIV represent 5% of facilities and 12% of costs, and hospitals 3% of facilities and 21% of costs.
• The total weighted average facility total spending on immunization by type ranged from US$ 4,309 for HC II, US$ 9,957 for HC III, US$ 21,160 for HCIV and US$ 52,793 for hospitals. However there is wide variation around these means.
• Vaccines and vaccines supplies (38% together) were the largest cost item in the total national immunization costs, followed by salaries at 31%. They also contributed the bulk of facility and outreach service costs, which are the immunization activities with the highest costs. Transport was the next largest recurrent cost (5%).
• Outreach accounted for around 40% of immunizations and can have substantial extra costs of staff time and transport, particularly in remote populations, for which it is a particularly important delivery model.
• Program management costs amounted to a relatively high 19% of non-vaccine costs at facility level, and 5.5% of district and 29% national levels.
• Capital costs made up 18% of economic costs, with vehicles contributing the largest part (11%). The cold chain contributed only 2% to routine economic costs, although it is a critical operational necessity and fiscal costs of purchasing capital equipment may pose budget challenges.
• Differences between economic and financial costs were small. Hidden resource use by the immunization program is thus not a major issue for planning