Variation in cost and performance of routine immunisation service delivery in India

Abstract

A comprehensive understanding of the costs of routine vaccine delivery is essential for planning, budgeting and sustaining India’s Universal Immunisation Programme. India currently allocates approximately US$25 per child for vaccines and operational costs. This budget is prepared based on historical expenditure data as information on cost is not available. This study estimated the cost of routine immunisation services based on a stratified, random sample of 255 public health facilities from 24 districts across seven states—Bihar, Gujarat, Kerala, Meghalaya, Punjab, Uttar Pradesh and West Bengal. The economic cost for the fiscal year 2013–2014 was measured by adapting an internationally accepted approach for the Indian context. Programme costs included the value of personnel, vaccines, transport, maintenance, training, cold chain equipment, building and other recurrent costs. The weighted average national level cost per dose delivered was US$2.29 including vaccine costs, and the cost per child vaccinated with the third dose of diphtheria–pertussis–tetanus (DPT) vaccine (a proxy for full immunisation) was US$31.67 (at 2017 prices). There was wide variation in the weighted average state-level cost per dose delivered inclusive of vaccine costs (US$1.38 to US$2.93) and, for the cost per DTP3 vaccinated child (US$20.08 to US$34.81). Lower costs were incurred by facilities and districts that provided the largest number of doses of vaccine. Out of the total cost, the highest amount (57%) was spent on personnel. This costing study, the most comprehensive conducted to date in India, provides evidence, which should help improve planning and budgeting for the national programme. The budget generally considers financial costs, while this study focused on economic costs. For using this study’s results for planning and budgeting, the collected data can be used to extract the relevant financial costs. Variation in cost per dose and doses administered across facilities, districts and states need to be further investigated to understand the drivers of cost and measure the efficiency of service delivery.

Cash‐based maternal health interventions can improve childhood vaccination—Evidence from India

“…These results also report the early effects of the program, whereas our analysis adds more recent data. 4 Finally, a recent work by Chatterjee et al (2018) found a positive impact of JSY on immunization in India, though the data used and methodology are different from this paper.…”

“…Vaccines are inexpensive in India, and the actual cost to families for vaccination is small or zero meaning that institutional and informational barriers are more likely to prevent vaccination than cost barriers. According to one estimate, as of 2017, the cost of each dose of Bacillus Calmette-Guérin (BCG) cost around Rs 3.25 ($0.05), Rs 2.6 ($0.04), and Rs 32.5 ($.5), respectively, whereas the central government allocates approximately US$25 (Rs 1,625) per child for vaccines and operational costs (Chatterjee et al, 2018). Together, we expect a priori that exposure to the JSY will increase vaccination.…”

Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children

“…Funding for India's national immunization program remains inadequate. During 2013–2017, the estimated annual budgetary shortfall for the program increased from $8.6 to $544.2 million (in 2013 US$), primarily because of the introduction of pentavalent and other new vaccines …”

Affordability of Adult Tuberculosis Vaccination in India and China: A Dynamic Transmission Model-Based Analysis

“…We estimated the maximum cost of such a vaccination programme at the lowest WTP threshold to be $21B (UI 16–27) and $15B (UI 12–19) in India and China, respectively, for three vaccination campaigns in 2027, 2037 and 2047. In comparison, annual universal infant vaccination programmes in India and China are estimated to cost approximately $700 million (2013–14 levels, adjusted to 2017 prices) [ 27 ] and $1B (2015 levels) [ 28 ], respectively, while the World Health Organization estimates the total annual budgets available for national strategic plans for tuberculosis in India and China at $583 million and $719 million in 2019, respectively. In this context, targeted vaccination may represent a more affordable approach.…”

“…Our study suggests that an all-age adult and adolescent mass tuberculosis vaccination programme, considered cost-effective at country-specific cost-effectiveness thresholds, would impose a substantial budgetary burden on the health system in India and China. We estimated the maximum cost of such a vaccination programme at the lowest WTP threshold to be $21B (UI [16][17][18][19][20][21][22][23][24][25][26][27] and $15B (UI [12][13][14][15][16][17][18][19] in India and China, respectively, for three vaccination campaigns in 2027, 2037 and 2047. In comparison, annual universal infant vaccination programmes in India and China are estimated to cost approximately $700 million (2013-14 levels, adjusted to 2017 prices) [27] and $1B (2015 levels) [28], respectively, while the World Health Organization estimates the total annual budgets available for national strategic plans for tuberculosis in India and China at $583 million and $719 million in 2019, respectively.…”