Schütte Carl, Chansa Collins, Marinda Edmore, Guthrie Teresa A, Banda Stanley, Nombewu Zipozihle, Motlogelwa Katlego, Lervik Marita, Brenzel Logan, Kinghorn Anthony
Strategic Development Consultants, South Africa.
World Bank, Zambia Country Office, Zambia.
Vaccine. 2015 May 7;33 Suppl 1:A47-52. doi: 10.1016/j.vaccine.2014.12.040.
This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million.
The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels.
The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type.
Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses.
本研究旨在通过提供赞比亚常规免疫（RI）总成本和单位成本的最新详细信息，为规划和资金筹集提供依据。赞比亚是一个符合全球疫苗免疫联盟（GAVI）资助条件的中低收入国家，人口达1300万。
该活动是一项关于常规免疫成本与筹资的多国研究（EPIC）的一部分，采用了一种基于成分的通用成本核算方法。2012年12月至2013年3月期间，使用预先测试的问卷，在九个区的51个设施中进行分层随机抽样，收集投入、价格和产出数据。根据为该研究制定的追踪因素，将共享投入分配到RI成本中。分析了一套全面的成本，以获取设施及设施以上层面的总成本和单位成本。
RI的年度总经济成本为3816万美元，约占政府卫生支出的10%。政府提供了83%的资金。劳动力占总成本的最大份额（49%），其次是疫苗（16%）和差旅津贴（12%）。对特定活动成本的分析表明，外展服务和基于设施的服务占总经济成本的一半。地区、省级和国家级（设施以上层面）的项目管理成本占总成本的24%。平均单位成本为每剂7.18美元、每名婴儿59.32美元以及每名接种三联疫苗（DPT3）的儿童65.89美元，农村设施的单位成本明显更高。分析表明，更高的效率与更高的利用率和城市设施类型相关。
总成本和单位成本以及政府的贡献均大大高于赞比亚先前的估计和国际基准。这些发现对规划者、效率提升和可持续筹资具有重大影响，尤其是在引入新疫苗时。设施层面免疫成本的差异值得进一步进行统计分析。
