Cost and effectiveness analysis of immunization service delivery support in Andhra Pradesh, India

Abstract

The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110 630 (US$ 36 877 per round). The performance of health centre and immunization sessions was evaluated using 43-and 28-point checklists, respectively, and demonstrated significant improvement during and following the twoyear implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12 760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit. Diptheria, Pertussis and Tetanus) coverage nationally and at least 80% DPT3 coverage in every district by the year 2005, the "90/80 goal" adopted by the GAVI Alliance.2 Supportive supervision involves on-site training by supervisors, which promotes quality at all levels of the health system by strengthening relationships within the system, focuses on the identification and resolution of problems, and helps to optimize the allocation of resources. The approach also promotes continuous improvements to the quality of care by providing leadership and support and by promoting high standards, teamwork and better two-way communication.3 Different approaches to supportive supervision to strengthen health worker performance and health services have been developed and documented. For instance, an integrated health package to guide essential health service delivery was developed by the United Republic of Tanzania Ministry of Health following health sector reform in 1999. This included a plan to bring a team of supervisors to district health facilities to evaluate how services are being delivered, to provide feedback and to conduct on-site training.4 Since implementation, supervisory visits occur more frequently and have become an opport...

Supervising community health workers in low-income countries – a review of impact and implementation issues

“…In India, the effect of supportive supervision on immunization providers was measured using a before and after design. Performance was measured using a checklist, administered by the supervisor, covering management, practices, and supplies with a 36% ( p <0.01) increase in worker performance scores 18 months after implementation ( 70 ).…”

Costs and effectiveness of the supervision, performance assessment and recognition (SPARS) strategy for medicines management in Uganda

“…To our knowledge, this is the first study to estimate costs and cost effectiveness of a comprehensive supportive supervision strategy to improve medicines management in a health system. A previous study that looked at the cost-effectiveness analysis of a supportive supervision intervention - strengthening immunization service delivery in India found, that it would cost US$3091 to obtain a 1% increase in health facility immunization performance scores [15].…”

Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial

“…In pillar 1 (improved targeting of interventions and better allocation of resources to match disease burden), we are using the LQAS methodology to collect data for use in understanding poorly performing indicators around evidence-based interventions. LQAS has the advantage that it is a programmatic methodology but its data can also be aggregated to look at broader progress in study areas [ 9 ]. The aggregated data from the baseline and endline LQAS surveys will also be used as the primary data for the analysis of the cluster randomized trial.…”