Mvundura Mercy, Lorenson Kristina, Chweya Amos, Kigadye Rosemary, Bartholomew Kathryn, Makame Mohammed, Lennon T Patrick, Mwangi Steven, Kirika Lydia, Kamau Peter, Otieno Abner, Murunga Peninah, Omurwa Tom, Dafrossa Lyimo, Kristensen Debra
PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
Vaccine. 2015 May 28;33(23):2697-703. doi: 10.1016/j.vaccine.2015.03.084. Epub 2015 Apr 9.
Having data on the costs of the immunization system can provide decision-makers with information to benchmark the costs when evaluating the impact of new technologies or programmatic innovations. This paper estimated the supply chain and immunization service delivery costs and cost per dose in selected districts in Kenya and Tanzania. We also present operational data describing the supply chain and service delivery points (SDPs). To estimate the supply chain costs, we collected resource-use data for the cold chain, distribution system, and health worker time and per diems paid. We also estimated the service delivery costs, which included the time cost of health workers to provide immunization services, and per diems and transport costs for outreach sessions. Data on the annual quantities of vaccines distributed to each facility, and the occurrence and duration of stockouts were collected from stock registers. These data were collected from the national store, 2 regional and 4 district stores, and 12 SDPs in each country for 2012. Cost per dose for the supply chain and immunization service delivery were estimated. The average annual costs per dose at the SDPs were $0.34 (standard deviation (s.d.) $0.18) for Kenya when including only the vaccine supply chain costs, and $1.33 (s.d. $0.82) when including immunization service delivery costs. In Tanzania, these costs were $0.67 (s.d. $0.35) and $2.82 (s.d. $1.64), respectively. Both countries experienced vaccine stockouts in 2012, bacillus Calmette-Guérin vaccine being more likely to be stocked out in Kenya, and oral poliovirus vaccine in Tanzania. When stockouts happened, they usually lasted for at least one month. Tanzania made investments in 2011 in preparation for planned vaccine introductions, and their supply chain cost per dose is expected to decline with the new vaccine introductions. Immunization service delivery costs are a significant portion of the total costs at the SDPs.
掌握免疫接种系统的成本数据可为决策者在评估新技术或项目创新的影响时提供成本基准信息。本文估算了肯尼亚和坦桑尼亚部分地区的供应链及免疫接种服务提供成本和每剂成本。我们还展示了描述供应链和服务提供点（SDP）的运营数据。为估算供应链成本，我们收集了冷链、配送系统、卫生工作者时间以及支付的每日津贴等资源使用数据。我们还估算了服务提供成本，其中包括卫生工作者提供免疫接种服务的时间成本以及外展活动的每日津贴和运输成本。从库存登记册收集了分发给每个机构的年度疫苗数量以及缺货情况和持续时间的数据。这些数据于2012年从每个国家的国家仓库、2个区域仓库和4个地区仓库以及12个服务提供点收集。估算了供应链和免疫接种服务提供的每剂成本。在肯尼亚，仅包括疫苗供应链成本时，服务提供点的平均每剂年度成本为0.34美元（标准差（s.d.）0.18美元），包括免疫接种服务提供成本时为1.33美元（s.d. 0.82美元）。在坦桑尼亚，这些成本分别为0.67美元（s.d. 0.35美元）和2.82美元（s.d. 1.64美元）。两国在2012年都出现了疫苗缺货情况，肯尼亚卡介苗更易缺货，坦桑尼亚口服脊髓灰质炎疫苗更易缺货。缺货发生时，通常至少持续一个月。坦桑尼亚在2011年进行了投资以准备计划引入的疫苗，随着新疫苗的引入，其每剂供应链成本预计会下降。免疫接种服务提供成本在服务提供点的总成本中占很大一部分。
