Optimizing immunization services: A Data Envelopment Analysis (DEA) of child immunization facilities in Pakistan

Area of Science:

• Public Health
• Health Services Research
• Vaccinology

Background:

• Child immunization is cost-beneficial but faces variable costs due to facility-level factors.
• Optimizing resources and enhancing vaccination services requires efficient methods to measure facility performance.
• Assessing the impact of COVID-19 on immunization facility efficiency is critical.

Purpose of the Study:

• To develop and apply a method for measuring child immunization facility efficiency in Pakistan using existing data.
• To examine the impact of the COVID-19 pandemic on facility efficiency.
• To provide insights for optimizing resource utilization in immunization programs.

Main Methods:

• Data Envelopment Analysis (DEA) was used to compute facility efficiency across two models: Model 1 (doses administered) and Model 2 (total doses used).
• Inputs included stock availability, staff, cold chain equipment, vaccine carriers, and vaccine sessions.
• Tobit and Simar-Wilson regression models explored the influence of COVID-19 and external factors on efficiency.

Main Results:

• Model 1 revealed an average efficiency of 59%, while Model 2 showed 70%, suggesting significant vaccine overstocking (36-43% reduction needed).
• The COVID-19 pandemic reduced efficiency by 10% in Model 1, with no significant impact in Model 2.
• 466 facilities in Punjab and Sindh were assessed across four survey rounds from May 2018 to December 2020.

Conclusions:

• DEA is a valuable tool for improving resource utilization and efficiency in immunization facilities.
• Model 1, focusing on doses administered, is more pertinent for efficiency analysis, highlighting low average efficiency (59%).
• Overstocking is a major issue impacting efficiency; redistribution of excess vaccine stock is essential for optimization.