Costing and financing analyses of routine immunization in Zambia

This study is part of a multi-country EPI costing project to tackle that challenge. The overall purpose of the multi-country project is to generate accurate costing and financing information for the EPI in each country, including consideration of cost implications of new vaccines. This particular study sought to develop an updated, detailed evidence-base around routine immunization program costs to inform planning, management and funding in Zambia.

Analysis of the total national programme cost by functional area and line item revealed that:

•  Most routine programme costs (82%) were incurred at facility level. District level costs (14%) were also substantial, while province and national levels added 2%.
• Total program costs had a similar profile to facility level, although vaccine costs were a smaller proportion of national costs as total program costs add district, provincial and national costs to facility costs, but vaccine costs remain constant.
• The most significant single cost item was labour, which contributed an estimated 49% of total EPI costs. Vaccines contributed 16% while travel and allowances contributed 12%. Together these items comprised 77% of the total national EPI cost. Transport and fuel added a further 6%.
• The most significant functional costs related to facility-based and outreach service provision. Together they contributed 51.8% to total costs and include mainly the cost of salaries, vaccines and travel allowances. 
• Total supervision and program management costs amounted to a relatively high 18.6% of the total EPI cost. Significant expansions of the EPI or introduction of new vaccines, should thus carefully consider indirect supervisory and program management capacity requirements.
• Other activities with substantial contributions to total costs included social mobilization and advocacy (10%), and vaccine collection and distribution (9%).
• Recurrent costs contributed by far the largest portion of economic costs. Annualized capital costs contributed 11% of total program costs. Vehicles were the largest capital costs, contributing 5.3%, mainly at district level. Interestingly, the economic cost of cold chain equipment is less than for vehicles and buildings.
• The economic and financial costs of the program generally differed by only 2-4%, so unrecognised economic costs are unlikely to be a major consideration in planning.