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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
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.
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.
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