Ethiopia study finds delivery cost per zero-dose child reached as low as $6.65

A new costing analysis from Ethiopia’s Afar and Somali regions shows that reaching zero-dose children, those who have never received the first dose of the DTP-containing vaccine, can be lower than expected. The study compared delivery costs for routine immunization with regular outreach, periodic intensification of routine immunization (PIRI), and Mobile Health and Nutrition Teams (MHNTs) to understand what it really takes to reach the hardest-to-reach children.

Key findings:

• PIRI emerged as lowest cost strategy, delivering vaccines at US $0.46 per dose and reaching each zero-dose child for only US $6.65
• Routine immunization and regular outreach followed, with relatively low costs per dose (US $ $0.55-1.85) but higher costs per zero-dose child reached (US $ $52.44-90.37)
• MHNTs had the highest costs overall, US $2.31 per dose and US $129.26 per zero-dose child, yet when only immunization-specific costs were considered, their efficiency approached that of periodic intensification of routine immunization (US $ 0.14 per dose and US $7.72 per zero-dose child)
• Cost drivers differed across strategies: staff time and cold chain equipment were key drivers for routine immunization and outreach, while staff time, vehicles and fuels accounted for most delivery costs for MHNTs. Key cost drivers for PIRI included per diems and travel allowances

The report found PIRI to be the most cost-efficient strategy for reaching zero-dose children in remote Ethiopia, though its impact is often short-term due to limited integration with routine services. MHNTs, while the most expensive strategy overall, delivered broader health benefits beyond immunization. When considering only vaccination-specific costs, MHNTs approach the cost-efficiency of PIRI for reaching zero-dose children, suggesting that integrating vaccination with other essential services, such as nutrition, can effectively increase coverage at a relatively low cost. The report also found that health posts delivered the highest total volume of doses, underscoring the pivotal role of fixed facilities in sustaining the immunization system.