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Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan.

Farah Houdroge1, Hammad Yunus2, Dominic Delport1

  • 1Burnet Institute, Melbourne, Victoria, Australia.

BMJ Global Health
|October 11, 2022
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Summary

Maximizing child immunisation equity in Pakistan is achievable without sacrificing overall coverage. Reallocating budgets to outreach programs can significantly improve equity for underserved populations.

Keywords:
health economicsimmunisation

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Area of Science:

  • Public Health
  • Health Economics
  • Health Services Research

Background:

  • Limited resources often create a conflict between maximizing health service coverage and ensuring equity for underserved populations.
  • Achieving high average health service coverage may not translate to equitable reach across all subpopulations.

Purpose of the Study:

  • To examine the trade-offs between immunisation coverage levels and equity for children under five in Pakistan.
  • To identify optimal resource allocation strategies for improving immunisation equity.

Main Methods:

  • Conducted a detailed costing exercise across 16 diverse districts in Pakistan.
  • Utilized Data Envelopment Analysis for technical efficiency benchmarking.
  • Employed optimization modeling for allocative efficiency and budget recommendations.

Main Results:

  • Approximately 44% of delivery models were found to be efficient, while 37% were highly inefficient.
  • Optimization modeling indicated that substantial equity improvements are possible with minimal impact on overall immunisation coverage.
  • Outreach delivery models were identified as crucial for targeting rural and slum populations.

Conclusions:

  • Focusing on equity does not necessitate a significant reduction in potential Fully Immunised Children coverage.
  • Reallocating program budgets can substantially impact equity outcomes, even at current spending levels.
  • Equity should be prioritized as a key objective in national immunisation programming.