Executive Summary
The Uganda National Expanded Program on Immunization (UNEPI) in collaboration with National Medical Stores (NMS), and with funding from GAVI commissioned an 18 month pilot study in 3 districts (Nakaseke, Nakasongola and Wakiso). The pilot tested the feasibility and effect of the distribution of vaccines to the last mile through an outsourced logistics service provider (LSP). The pilot commenced in May 2018 and was implemented by UPS in partnership with Freight in Time. Clinton Health Access Initiative (CHAI) was contracted to conduct a financial costing (i.e., monetary outlays or expenditures) of the pilot. An incremental costing approach/only additional costs of the last mile distribution process was adopted using a health sector – perspective. Costs were categorized as indirect and direct costs. Direct costs included costs for labor, vehicles, additional cold chain equipment, software and electronic reporting devices, fuel and per diems. Indirect costs included costs for preparatory meetings, trainings and supervision visits. The costing excluded economic costs, patient expenses, vaccines and related supply costs. A costing tool was developed and updated with data from key informants and from accounting records on a monthly basis. The pilot was costed for the 18- month period. The total cost of the pilot was valued at ~814,000USD with direct distribution costs contributing 28% of the total and indirect costs accounting for the largest proportion at 72%. This was attributed to contract management fees on warehousing and fleet management, and supplementary activities such as supportive supervisions. Labour costs accounted for the largest driver of direct distribution costs at 52% followed by capital costs at 32%. This was attributed to additional expertise to run the eLMIS, improve data quality and conduct stock counting during deliveries. The cost per kilometer was valued at 6USD. For future scale up considerations, building capacity of existing district staff to take on additional roles and exploring innovative transportation options such as solar powered active boxes could potentially lower direct distribution costs.
You can also read the endline assessment report from this study.
Any organization or individual working in the field of immunization economics can submit findings, opportunities, calls to action, or other relevant work below to be shared with our community.