Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Program Group, UNICEF, New York City, New York, USA.
BMJ Open. 2022 Sep 13;12(9):e059566. doi: 10.1136/bmjopen-2021-059566.
In recent years, Iraq has expanded and revised the childhood immunisation schedule, but estimates of the costs of the programme are unavailable. The objective of this study was to estimate the economic costs of delivering childhood vaccines in Iraq from a government perspective.
Health facilities were sampled using multistage probabilistic sampling and stratifying the country into three regions: Central and South, North/Kurdistan Region, and Retaken Areas. Cost data were collected from 97 health facilities and 44 district and regional vaccine stores. Total national costs were extrapolated using sample weight calibration.
Administrators at each health facility and vaccine store were interviewed using a standardised survey.
Total costs of vaccine delivery per year, costs per dose delivered and delivery costs per fully vaccinated child.
An estimated 15.3 million vaccine doses were delivered in 2018, costing US$99.35 million, excluding costs of vaccines and injection material. Nearly 90% of delivery costs were attributed to personnel salaries. Vaccine record-keeping and management (21%) and facility-based vaccine delivery (19%) were the largest cost contributors. Vaccine transport and storage, programme management, and outreach services represented 13%, 12% and 10%, respectively. All other activities represented less than 10% of the total cost. Average costs per dose delivered was US$6.48, ranging from US$9.13 in Retaken Areas to US$5.84 in the Central and South. Vaccine delivery costs per fully vaccinated child totalled US$149.
This study provides baseline evidence of the current programme costs and human resource uses which can be used for annual planning, identifying areas for improvement, and targeting strategies to increase programme efficiency.
近年来，伊拉克扩大并修订了儿童免疫计划，但该计划的成本估算尚不可用。本研究旨在从政府角度估算伊拉克提供儿童疫苗的经济成本。
使用多阶段概率抽样对卫生机构进行抽样，并将该国分为三个区域：中部和南部、北部/库尔德地区以及收复地区。从 97 个卫生机构和 44 个地区和区域疫苗储存库收集成本数据。使用样本权重校准推断全国总成本。
对每个卫生机构和疫苗储存库的管理人员使用标准化调查进行访谈。
每年疫苗接种总成本、每剂接种成本和完全接种儿童的接种成本。
据估计，2018 年共接种了 1530 万剂疫苗，耗资 9935 万美元，不包括疫苗和注射材料成本。近 90%的接种成本归因于人员工资。疫苗记录保存和管理（21%）和基于设施的疫苗接种（19%）是最大的成本贡献者。疫苗运输和储存、方案管理和外展服务分别占 13%、12%和 10%。其他所有活动的成本均低于总成本的 10%。每剂疫苗接种的平均成本为 6.48 美元，从收复地区的 9.13 美元到中部和南部的 5.84 美元不等。每个完全接种儿童的疫苗接种总成本为 149 美元。
本研究提供了当前方案成本和人力资源利用的基准证据，可用于年度规划、确定改进领域以及制定提高方案效率的策略。
