Estimating the cost of reaching zero-dose children in hard-to-reach areas of Ethiopia: the case of periodic intensification of routine immunization strategy

This peer-reviewed article estimates the cost of reaching zero-dose children through Periodic Intensification of Routine Immunization (PIRI) in hard-to-reach areas of Ethiopia, using an activity-based, bottom-up micro-costing approach from the health system perspective. 

Key findings 

• The study used retrospective data from six districts in Afar and Somali regions and assessed the most recent PIRI sessions implemented between December 2023 and November 2024.
• Across the assessed sessions, 21,184 vaccine doses were delivered, including 2,263 Penta1 doses; 1,449 of those Penta1 doses were given to zero-dose children.
• The financial cost per vaccine dose delivered was $0.29, and the economic cost per dose was $0.46.
• The financial cost per zero-dose child reached was $4.22, and the economic cost per zero-dose child reached was $6.65.
• Costs varied substantially by region: the economic cost per zero-dose child reached was $13.06 in Afar versus $4.82 in Somali.
• Districts in Somali delivered higher vaccine volumes, suggesting that economies of scale are contributing to lower unit costs.
• Per diem and travel allowances were the main cost drivers, accounting for 54% of average session costs in Afar and 51% in Somali.
• Service delivery represented the largest share of average economic cost per session in both regions, while Afar allocated a larger share to program management and social mobilization than Somali.

Thumbnail image credit: authors