Despite being operational for about 35 years, India’s universal immunization program could only fully immunize up to 62% of the eligible children in 2015–2016. To increase the coverage to 90% by 2018, Intensified Mission Indradhanush (IMI), the periodic intensification of routine immunization, was implemented by the Indian government in 173 lower-coverage districts and 17 urban areas across 24 states from October 2017 to January 2018.
Researchers from George Institute for Global Health, Harvard University, and BMGF estimated the incremental economic and financial cost of conducting IMI in India from a government provider perspective. Five states—Assam, Bihar, Maharashtra, Rajasthan, and Uttar Pradesh were purposefully selected for the study because of the high concentration of residents and IMI activities. The stratified random sample of 40 districts, 90 sub-districts, and 289 sub-centers was also included in this study. Cost data (economic and financial costs) were retrospectively collected at all levels from administrative records, financial records, and staff interviews involved in IMI. Data then were analyzed to understand the incremental cost of administering IMI.
The study found that the weighted incremental economic cost per dose (including vaccine costs) substantially varied across the study states and districts. The incremental costs were the lowest in Assam (US$0.49 million) and highest in Uttar Pradesh (US$40.08 million). Among all 40 study districts, the lowest incremental economic cost was in Pratapgarh (US$0.02 million) and highest in Jaunpur (US$1.43).
Further, the financial cost for IMI was about 24% of the incremental economic cost of conducting IMI. Vaccines and syringes accounted for the significant share of financial cost (average ranging between 60% and 78%) for the sampled IMI districts in three states: Bihar, Rajasthan, and Uttar Pradesh. In the sampled IMI districts of Assam and Maharashtra, vaccines and syringes represented on average 29% and 25% of financial costs, respectively.
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