Community Partners International, Yangon, Myanmar.
Department of Policy and Research, Community Partners International, Yangon, Myanmar.
BMJ Glob Health. 2022 Jul;7(7). doi: 10.1136/bmjgh-2021-007800.
Myanmar, a conflict-affected geographically and ethnically diverse lower middle-income country, was in the donor transition phase for health prior to the political unrest of the last year. This study analyses the distribution of benefit and utilisation of basic childhood vaccinations from the highly donor-dependent Expanded Program on Immunization for populations of different socioeconomic status (SES).
We conducted a benefit incidence analysis with decomposition analysis to assess the equity of benefit. We used basic childhood immunisations-BCG, measles, diphtheria, pertussis and tetanus (DPT)/pentavalent, oral polio vaccine (OPV) and full vaccination-as measurements for healthcare use. Childhood immunisation data were collected from Myanmar Demographic and Health Survey. Cost of vaccines was obtained from UNICEF document and 'Immunization Delivery Cost Catalogue' and adjusted with regional cost variations. We reported Concentration Index (CI) and Achievement Index (AI) by SES, including wealth quintiles, maternal education and across geographic areas.
Nationally, better-off households disproportionately used more services from the programme (CI-Wealth Index (CI-WI) for BCG, measles, DPT/pentavalent, OPV and full immunisation: 0.032, 0.051, 0.120, 0.091 and 0.137, respectively). Benefits had a pro-poor distribution for BCG but a less pro-rich distribution than utilisation for all other vaccines (CI-WI: -0.004, 0.019, 0.092, 0.045 and 0.106, respectively). Urban regions had a more pro-rich distribution of benefit than that in rural areas, where BCG and measles had a pro-poor distribution. Subnational analysis found significant heterogeneity: benefit was less equitably distributed, and AI was lower in conflict-affected states than in government-controlled areas. The major contributors to vaccine inequality were SES, antenatal care visits and paternal education.
Donors, national government and regional government should better plan to maintain vaccine coverage while improving equity of vaccine services, especially for children of lower SES, mothers with less antenatal care visits and lower paternal education living in conflicted-affected remote regions.
缅甸是一个受冲突影响、地域和种族多样化的中下等收入国家，在去年政治动荡之前，其卫生领域正处于捐助者过渡阶段。本研究分析了在不同社会经济地位（SES）人群中，高度依赖捐助者的扩大免疫规划为基本儿童疫苗接种带来的受益和利用情况。
我们采用受益发生率分析和分解分析来评估受益的公平性。我们使用基本儿童免疫接种-BCG、麻疹、白喉、百日咳和破伤风（DPT）/五联疫苗、口服脊髓灰质炎疫苗（OPV）和完全免疫接种-来衡量医疗保健的使用情况。儿童免疫接种数据来自缅甸人口与健康调查。疫苗成本来自联合国儿童基金会文件和“免疫接种交付成本目录”，并根据区域成本差异进行了调整。我们按 SES 报告了集中指数（CI）和实现指数（AI），包括财富五分位数、母亲教育和地理区域。
在全国范围内，较富裕家庭不成比例地更多地使用了该计划提供的服务（BCG、麻疹、DPT/五联疫苗、OPV 和完全免疫接种的财富五分位数集中指数（CI-WI）分别为 0.032、0.051、0.120、0.091 和 0.137）。BCG 的受益分配有利于贫困人口，但其他疫苗的受益分配则不如利用情况有利于贫困人口（BCG 的 CI-WI：-0.004、0.019、0.092、0.045 和 0.106）。城市地区的受益分配比农村地区更有利于富人，而 BCG 和麻疹在农村地区的分配则有利于贫困人口。次国家分析发现存在显著的异质性：受益分配的公平性较低，受冲突影响的州的 AI 低于政府控制地区。疫苗不平等的主要原因是 SES、产前保健就诊次数和父亲教育程度。
捐助者、国家政府和地区政府应更好地规划，在维持疫苗覆盖率的同时，改善疫苗服务的公平性，特别是为社会经济地位较低、产前保健就诊次数较少和父亲教育程度较低的儿童以及生活在受冲突影响的偏远地区的儿童提供疫苗服务。
