Publication: The Pakistan Expanded Program on Immunization and the National Immunization Support Project: An Economic Analysis
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2016-11
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2017-01-17
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Pakistan faces a formidable challenge in eliminating the polio virus from the country. With transmission of the polio virus substantially slowing in the Africa region, the only two countries worldwide with ongoing endemic polio transmission may soon be Pakistan and Afghanistan. A substantial number of the polio cases or infant paralysis occurring in Afghanistan is linked to cross-border transmission from Pakistan. The ongoing cycle of polio infection is not just a tragedy for the children of Pakistan, it is a global public health emergency constituting one of the final barriers to permanently eradicating polio. This paper demonstrates clear economic benefits and efficacy of the National Immunization Support Project (NISP), which is financing interventions in terms of DALYs saved, and establishes that this approach is affordable and economically effective with a high rate of return. In addition to increased investment, the effectiveness of the Expanded Program on Immunization can be enhanced by improving the capacity building of health professionals, as well as by improving logistics of program interventions to reach marginalized populations, remote areas, and pockets of resistance. An increased financial investment alone will be insufficient to address the root causes of persistent under-coverage of immunization in Pakistan. It is imperative that ample attention and resources be diverted to strengthen the procurement systems, local and provincial management capacity, and reporting mechanisms, among other capacity improvements.
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“Haque, Minhaj Ul; Waheed, Muhammad; Masud, Tayyeb; Malick, Wasim Shahid; Yunus, Hammad; Rekhi, Rahul; Oelrichs, Robert; Kucheryavenko, Oleg. 2016. The Pakistan Expanded Program on Immunization and the National Immunization Support Project: An Economic Analysis. Health, Nutrition and Population Discussion Paper;. © World Bank. http://hdl.handle.net/10986/25864 License: CC BY 3.0 IGO.”
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Evidence suggests that underachievement of the EPI is due to a combination of factors including; inadequate performance in the areas of service delivery, program management, monitoring and evaluation, logistics control, human resources management and financing, as well as community health-seeking behaviors and other demand-side issues. 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The purpose of the study is to compare the cost-effectiveness and financial implications of introducing pneumococcal (PCV-10), rotavirus (Rota-Teq), and Homophiles influenza type B (Hib) vaccines in Pakistan. The cost-effectiveness analysis was conducted using the Tri-Vac model, which is a static model that estimates the burden of disease and the costs of treatment and for the immunization program of children up to five years old in ten annual birth cohorts (2010 to 2019). Sensitivity analyses were conducted testing key assumptions related to disease burden, vaccine efficacy, and vaccine cost. The analysis of financial implications included a projection of cold chain needs and costs associated with the introduction of each new vaccine, as well as the financial outlays required by the government. Sensitivity testing was also conducted on major assumptions. All three vaccines were found to be cost-effective, with Hib vaccine the most cost-effective option at $22 per disability-adjusted-life-year (DALY). The cost-effectiveness figures for PCV and rotavirus vaccines were $225/DALY and $201/DALY, respectively. Sensitivity testing did not significantly alter the results. The combined financial requirement for the three new vaccines would peak in 2017 if GAVI assistance reduced to five rather than eight years ($213m). This cost would account for 40 percent of national immunization expenditures, and 15 percent of government health expenditures. Required cold chain investments would be small relative to the expenditure on vaccines, and represents a good return on investment. While the investment would be worthwhile from an economic perspective, introducing all three vaccines in Pakistan will present financial challenges unless overall health spending increases. 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New and innovative financing mechanisms to support immunization and the health sector have been developed and the types and costs of vaccines have changed. In addition, policy---makers and development partners have become much more knowledgeable about health financing.Publication Benchmarking Immunization Program Performance in the Africa Region(Washington, DC, 2005-05)The report intends to help shape the Africa Region's engagement in immunization, and, its major findings both validate conventional wisdom on immunization, and challenge the development community to explore new interventions. According to the study, the majority of countries in Sub-Saharan Africa have well-performing, or improved immunization programs reflecting the high priority governments and development partners attach to this basic health service. The overriding message is that robust implementation was essential to sustained success in the countries profiled in the case studies, and, countries found their own solutions, and pursued different strategies. The report also raises some provocative questions about the relationship between different programmatic instruments, and immunization program performance. Finally, some of the case studies highlight how programs are adapting to the rapidly changing environment in which development interventions are taking place. This new application of the benchmarking methodology may be of interest to immunization program managers, whose process can be used to analyze performance variation among districts, and to develop action plans for addressing major bottlenecks in the periphery. The report further emphasizes the importance of remaining vigilant, as performance can rapidly deteriorate with mounting fiscal pressures, and competing public health priorities. Ultimately, enhancing and sustaining immunization program performance will help ensure a healthy start to life for each new generation of children.
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