Cost of delivering child immunization services in urban Bangladesh: a study based on facility-level surveys.
This study surveyed 25% of all EPI delivery sites in Dhaka, Bangladesh, during 1999. The EPI services in urban Bangladesh are delivered through a partnership of government (GoB) and non-government (NGO) organizations, although the exact level of involvement of the NGOs in EPI delivery is not known. The survey found that 77% of the sites were under NGO management and they provided 62% of all vaccinations carried out in urban Dhaka (508,188). The average cost per Measles Vaccinated Children (MVC) was found to be $11.57. The outreach facilities both GoB and NGO were able to provide immunization services at a much lower cost than the static facilities. If there was no mistargeting at all, the hypothetical cost per fully vaccinated child should have been $6.88. The wide gap between the cost per MVC and the hypothetical cost implies that the cost of immunizing children can be reduced significantly through a better management of the delivery structure. The incremental cost of adding services with EPI was also found to be quite low, not significantly higher than the actual cost of new vaccines or drugs to be added. The NGOs in Dhaka have generated about US$15,000 from local community resources. Clearly, even the poor communities of the city can potentially support some of the EPI activities. Involving the local community with the EPI activities not only will improve the sustainability of the programme but also will help increase the immunization coverage through higher level of community participation.
Khan, M.; Khan, S.; Walker, D.; Fox-Rushby, J.; Cutts, F.; Akramuzzaman, S. Cost of delivering child immunization services in urban Bangladesh: a study based on facility-level surveys. Journal of Health, Population and Nutrition (2004) 22 (4) 404-412.