Variation in cost and performance of routine immunisation service delivery in India
Variation in cost and performance of routine immunisation service delivery in India
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DOI：
10.1136/bmjgh-2018-000794
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发表时间：
2018-05-01
影响因子：
8.1
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
--
作者：
Chatterjee, Susmita;Das, Palash;Laxminarayan, Ramanan
全面了解常规疫苗供应的成本对于规划、预算编制和维持印度的普遍免疫规划至关重要。印度目前为每个儿童分配约25美元的疫苗和运营费用。由于没有关于费用的资料，本预算是根据历史支出数据编制的。这项研究估计了常规免疫接种服务的成本，基于一个分层的，随机抽样的255个公共卫生设施，从24个地区在7个邦-比哈尔邦，古吉拉特邦，喀拉拉邦，梅加拉亚，旁遮普，北方邦和西孟加拉。2013-2014财政年度的经济成本是根据印度的情况采用国际公认的方法来衡量的。方案费用包括人员、疫苗、运输、维修、培训、冷链设备、建筑和其他经常性费用的价值。全国加权平均每剂成本为2.29美元（包括疫苗成本），每名儿童接种第三剂白喉-百日咳-破伤风（DPT）疫苗（代表全面免疫）的成本为31.67美元（按2017年价格计算）。每剂疫苗的加权平均州级成本差异很大，包括疫苗成本（1.38美元至2.93美元）和每名三联疫苗接种儿童的成本（20.08美元至34.81美元）。提供最多剂量疫苗的设施和地区的费用较低。在总费用中，最高数额（57%）用于人事。这项成本计算研究是迄今为止在印度进行的最全面的研究，提供了证据，应有助于改进国家方案的规划和预算编制。预算一般考虑财务成本，而本研究则侧重于经济成本。为将本研究结果应用于规划与预算，所搜集之资料可用以萃取相关财务成本。需要进一步调查各设施、地区和州的每剂成本和剂量差异，以了解成本驱动因素并衡量服务提供效率。
A comprehensive understanding of the costs of routine vaccine delivery is essential for planning, budgeting and sustaining India's Universal Immunisation Programme. India currently allocates approximately US$25 per child for vaccines and operational costs. This budget is prepared based on historical expenditure data as information on cost is not available. This study estimated the cost of routine immunisation services based on a stratified, random sample of 255 public health facilities from 24 districts across seven states-Bihar, Gujarat, Kerala, Meghalaya, Punjab, Uttar Pradesh and West Bengal. The economic cost for the fiscal year 2013-2014 was measured by adapting an internationally accepted approach for the Indian context. Programme costs included the value of personnel, vaccines, transport, maintenance, training, cold chain equipment, building and other recurrent costs. The weighted average national level cost per dose delivered was US$2.29 including vaccine costs, and the cost per child vaccinated with the third dose of diphtheria-pertussis-tetanus (DPT) vaccine (a proxy for full immunisation) was US$31.67 (at 2017 prices). There was wide variation in the weighted average state-level cost per dose delivered inclusive of vaccine costs (US$1.38 to US$2.93) and, for the cost per DTP3 vaccinated child (US$20.08 to US$34.81). Lower costs were incurred by facilities and districts that provided the largest number of doses of vaccine. Out of the total cost, the highest amount (57%) was spent on personnel. This costing study, the most comprehensive conducted to date in India, provides evidence, which should help improve planning and budgeting for the national programme. The budget generally considers financial costs, while this study focused on economic costs. For using this study's results for planning and budgeting, the collected data can be used to extract the relevant financial costs. Variation in cost per dose and doses administered across facilities, districts and states need to be further investigated to understand the drivers of cost and measure the efficiency of service delivery.