Sharma Abhishek, Kaplan Warren A, Chokshi Maulik, Zodpey Sanjay P
Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA Precision for Value, Boston, MA, USA
Department of Global Health, Boston University School of Public Health, Boston, MA, USA Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
Health Policy Plan. 2016 Sep;31(7):884-96. doi: 10.1093/heapol/czw008. Epub 2016 Mar 14.
India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP.
We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status.
Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services.
In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state.
印度的通用免疫计划（UIP）在公共部门免费提供基本疫苗，但全国疫苗接种覆盖率较低。印度政府已敦促扩大私营部门的作用，以帮助实现全面免疫覆盖。我们对私营部门在为印度儿童接种印度UIP涵盖的六种主要儿童疾病疫苗方面的作用进行了逐州分析。
我们分析了艾美仕市场研究公司（IMS Health）关于印度私营部门疫苗销售的数据、2011年印度人口普查数据和全国家庭调查（2005 - 2006年的 DHS/NFHS以及2009年的联合国儿童基金会CES），以估计在2009 - 2012年出生队列中，在印度16个邦的私营部门接种特定疫苗的儿童百分比。我们还分析了估计的私营部门疫苗份额与各邦特定社会经济状况的关系。
总体而言，在16个邦中，私营部门对结核病（卡介苗（BCG））的总体（公共和私营部门）疫苗接种覆盖率贡献为4.7%，对麻疹为3.5%，对白喉 - 百日咳 - 破伤风（DPT3）为2.3%，对脊髓灰质炎（OPV3）为7.6%。某些低收入邦（北方邦、拉贾斯坦邦、中央邦、奥里萨邦、阿萨姆邦和比哈尔邦）的私营部门和公共部门疫苗接种覆盖率都较低。私营部门的作用主要限于高收入邦，而不是大多数印度儿童居住的这些低收入邦。能够方便地接触到私营部门且有支付能力的城市地区，增加了印度人口使用私营部门疫苗接种服务的意愿。
在印度，公共部门为大多数人口提供疫苗接种服务，但私营部门不应被忽视，因为它有可能提高总体疫苗接种覆盖率。政府可以培训并激励更广泛的私营部门卫生专业人员来帮助提供疫苗，特别是在出生队列最大的低收入邦。我们建议未来的研究确定印度每个邦公共和私营卫生部门的优势和局限性。
