Estimating the cost of the integrated measles-rubella campaign in Sierra Leone

In June 2019, the government of Sierra Leone, with support from partners, conducted a seven-day integrated measles-rubella (MR) campaign. Alongside MR, oral polio vaccines (OPV) were delivered nationwide, and vitamin A supplements and deworming tablets (albendazole) in half of the country’s districts.

The cost of delivering immunization through campaigns is not well understood, and evidence on campaigns that co-deliver multiple vaccines or other interventions is virtually non-existent. To address this gap, ThinkWell in collaboration with Sierra Leone’s Ministry of Health and Sanitation, conducted the first comprehensive estimation of immunization campaign delivery costs in Sierra Leone, and of co-delivery campaigns globally.

The study estimated the full financial and economic costs of the campaign from the payer perspective, including costs incurred by health service providers, the Ministry of Health and Sanitation at all levels, and development partners. The study’s key findings include:

• The total financial cost of the campaign was US $3,943,200 (SLL 35,529,101,566), and the delivery cost (excluding the cost of vaccines and nutrition supplements) was estimated at US $1,566,596 (SLL 14,115,375,656).

• Service delivery was the key cost driver of the campaign, followed by training and social mobilization.

• Per dose delivered, the financial delivery cost was US $0.31, mainly driven by per diems and travel allowances.

• The opportunity cost of delivery was estimated at US $0.38 per dose delivered, of which 94% consisted of the value of paid and unpaid labor, and only a small share of capital costs. The total economic delivery cost was thus US $0.69 per dose.

• The study found that financial cost efficiencies could be achieved through integration, although opportunity costs were higher in districts that co-delivered both vaccines and nutrition interventions.