Tracking financial flows for immunization in Honduras

Valdés, Werner; Janusz, Cara Bess; Aguilera, Ida Berenice Molina; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen

doi:10.1016/j.vaccine.2015.01.012

Cited by 9 publications

(3 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22,32 Expenditure tracking is useful for policy and program management to ensure the most costeffective allocations of resources. 32,33 For the Global Vaccine Action Plan, it is important to have regular estimates of immunization expenditures. Full resource tracking down to the service provider level may be expensive and time consuming, and an alternative financial flow analysis may be less costly to implement on a regular basis.…”

Section: Discussionmentioning

confidence: 99%

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

Brenzel

Schütte²,

Goguadze

et al. 2016

Health Affairs

View full text Add to dashboard Cite

Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27-95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking.

show abstract

Section: Discussionmentioning

confidence: 99%

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

Brenzel

Schütte²,

Goguadze

et al. 2016

Health Affairs

View full text Add to dashboard Cite

show abstract

“…The Expanded Program on Immunization Costing and Financing (EPIC) Project was designed to fill this knowledge gap, providing detailed data on routine immunization costs and financing in a large, representative sample of immunization sites in six countries (Benin, Ghana, Honduras, Moldova, Uganda, and Zambia) [ 7 ]. Information from these studies has already been used to improve information on unit costs [ 8 – 11 ], cost trends [ 12 , 13 ], and financing [ 14 , 15 ] within individual countries. We synthesized data from these country studies to create a unique pooled dataset of 316 sites to explore cross-country determinants of costs.…”

Section: Introductionmentioning

confidence: 99%

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

Menzies¹,

Suharlim²,

Geng³

et al. 2017

BMC Med

View full text Add to dashboard Cite

BackgroundEvidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia.MethodsWe developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume.ResultsAcross countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely—on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0–32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training/seniority, distance to vaccine collection, additional days open per week, greater vaccination schedule completion, and per capita gross domestic product.ConclusionsWe identified multiple features of sites and their operating environment that were associated with differences in average unit costs, with service volume being the most influential. These findings can inform efforts to improve the efficiency of service delivery and better understand resource needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0942-1) contains supplementary material, which is available to authorized users.

show abstract

“…Rooted in new public management theory, improving the quality of and access to monitoring and evaluation data has been a key focus in improving the performance of public sector programmes (Blackman, 2001; Stansfield et al , 2006; Wickremasinghe et al , 2016). Donors, researchers and international agencies have made significant investments in the collection of high-quality data on routine immunization costs with aims to understand cost trends, predict future costs, inform financing strategies and thereby improve the efficiency and sustainability of immunization services within specific countries (Ahanhanzo et al , 2015; Goguadze et al , 2015; Guthrie et al , 2015; Janusz et al , 2015; Le Gargasson et al , 2015; Maceira et al , 2015; Schütte et al , 2015; Valdés et al , 2015; Menzies et al , 2017). However, dissemination of results to district- and service-level managers often does not occur.…”

Section: Introductionmentioning

confidence: 99%

Incorporating costing study results into district and service planning to enhance immunization programme performance: a Zambian case study

Feldhaus

Schütte

Mwansa

et al. 2019

Health Policy and Planning

View full text Add to dashboard Cite

Donors, researchers and international agencies have made significant investments in collection of high-quality data on immunization costs, aiming to improve the efficiency and sustainability of services. However, improved quality and routine dissemination of costing information to local managers may not lead to enhanced programme performance. This study explored how district- and service-level managers can use costing information to enhance planning and management to increase immunization outputs and coverage. Data on the use of costing information in the planning and management of Zambia’s immunization programme was obtained through individual and group semi-structured interviews with planners and managers at national, provincial and district levels. Document review revealed the organizational context within which managers operated. Qualitative results described managers’ ability to use costing information to generate cost and efficiency indicators not provided by existing systems. These, in turn, would allow them to understand the relative cost of vaccines and other resources, increase awareness of resource use and management, benchmark against other facilities and districts, and modify strategies to improve performance. Managers indicated that costing information highlighted priorities for more efficient use of human resources, vaccines and outreach for immunization programming. Despite decentralization, there were limitations on managers’ decision-making to improve programme efficiency in practice: major resource allocation decisions were made centrally and planning tools did not focus on vaccine costs. Unreliable budgets and disbursements also undermined managers’ ability to use systems and information. Routine generation and use of immunization cost information may have limited impact on managing efficiency in many Zambian districts, but opportunities were evident for using existing capacity and systems to improve efficiency. Simpler approaches, such as improving reliability and use of routine immunization and staffing indicators, drawing on general insights from periodic costing studies, and focusing on maximizing coverage with available resources, may be more feasible in the short-term.

show abstract

Tracking financial flows for immunization in Honduras

Cited by 9 publications

References 2 publications

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies

Incorporating costing study results into district and service planning to enhance immunization programme performance: a Zambian case study

Contact Info

Product

Resources

About