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The Center For Disease Dynamics, Economics & Policy

Variation in Cost and Performance of Routine Immunisation Service Delivery in India

Variation in Cost and Performance of Routine Immunisation Service Delivery in India

The Question: India’s Universal Immunization Program is the largest public vaccination program in the world, aiming to immunize 26 million newborn children per year. However, the current cost to vaccinate a child fully and the cost of delivering a dose of a vaccine under the program is not known. The study, published in June 2018 in British Medical Journal Global Health, estimates the cost of delivering routine childhood vaccines in seven Indian states.

What We Found: In 2014 and 2015, we visited 255 public health facilities in 24 districts across seven states – Bihar, Gujarat, Kerala, Meghalaya, Punjab, Uttar Pradesh, and West Bengal. We collected cost data using standardized, pre-tested questionnaires. The sample consisted of 99 primary health sub-centers, 89 primary health centers, 44 community health centers, and 23 postpartum units. The main cost categories were staff, vaccines and supplies, transport, training, maintenance and overhead, incentives, and the annual value of capital expenditures.

The main findings were:

  • There was a large range in the cost per dose delivered across states, from US$1.38 to US$2.93
  • Cost per DPT3 child ranged from US$20.08 to US$34.81 across states*
  • Personnel cost (57%) was the largest component of total cost.
  • The weighted average national cost per dose delivered was US$2.29, including the cost of the vaccine itself
  • The weighted average national cost per child vaccinated with the third dose of diphtheria–pertussis–tetanus (DPT3) was $31.67

All costs are in 2017 US$.  *DTP3 is a well-regarded performance indicator of national immunization programs.

Why It Matters: India currently budgets about $25 per child for vaccines and operational costs. Until we carried out this study, the actual cost per dose or per child for vaccination was not known. This study provides essential data for planning, budgeting, and sustaining India’s large immunization program.