A new publication in BMC Health Services Research by ThinkWell shows the cost of delivering COVID-19 vaccines in Mozambique during the first year it was introduced. The study covers two time periods: the initial supply constrained period of the rollout in March-April 2021 and a later, higher-volume period from December 2021 to February 2022. The study estimates the financial and economic costs of vaccine delivery using a retrospective, bottom-up costing approach, using primary data from a sample of 27 vaccination sites. Researchers also carried out a qualitative assessment of enabling factors and operational challenges of program implementation which complemented the costing analysis.
Key findings
- For the initial rollout period, when supplies were constrained and delivered solely at health facilities, the volume delivered was low (64 doses/vaccination day on average), the economic cost per dose was $3.56. This decreased considerably to $0.85 when delivery volume increased and the program delivered at scale and volume delivered increased to 225 doses/vaccination day. Mobile brigades were deployed at temporary sites such as offices and nursing homes, and expanded to high-traffic areas in communities and sporting centers at the height of delivery.
- Opportunity costs, including labor, made up a considerable share of the economic cost per dose, 73% and 49% respectively during the initial rollout and when the program delivered at scale. The major financial cost drivers were the vaccine injection and safety supplies. Notably, per diem and allowances were not a cost driver.
- Transport and fuel represented a much larger share of the financial cost during the program at scale period (19% vs. 3% during the initial rollout), because COVID-19 vaccines were mostly delivered at temporary sites during this period, which increased transport and fuel costs.
- A number of challenges which hindered program implementation including significant funding delays due to both disbursement delays as well as the long time necessary to comply with public financial management regulations in Mozambique. Funding shortages meant that per diem and financial incentives available for health workers were insufficient, leading to low morale.
- The cost per dose for the first year of implementation was found to be $1.14 for economic costs and $0.50 for financial costs. This was low compared to other countries, due to heavy reliance on existing resources and little additional investment into the program.
Findings from this study provide valuable evidence for decision-makers in Mozambique and around the world, as they can inform planning, budgeting, and resource allocation decisions for the future of the COVID-19 vaccination program as well as other vaccination campaigns, both in emergency and routine contexts.
This publication complements a study report released in 2023.
