Financial cost analysis of a strategy to improve the quality of administrative vaccination data in Uganda.

Autor: Ward K; Global Immunization Division, U.S Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA, United States; School of Public Health and Community Medicine, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW 2033, Australia. Electronic address: wvk8@cdc.gov., Mugenyi K; African Field Epidemiology Network (AFENET) Secretariat, Lugogo House, Plot 42, Lugogo By-Pass, Kampala, Uganda. Electronic address: kmugenyi@afenet.net., MacNeil A; Global Immunization Division, U.S Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA, United States. Electronic address: aho3@cdc.gov., Luzze H; Republic of Uganda Ministry of Health, Uganda National Expanded Program on Immunization, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda. Electronic address: luzzehenry@hotmail.com., Kyozira C; Republic of Uganda Ministry of Health Division of Health Information Management, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda. Electronic address: ckyozira@gmail.com., Kisakye A; World Health Organization, Uganda, Plot 60 Prince Charles Avenue, Kololo, Kampala, Uganda. Electronic address: kisakyean@who.int., Matseketse D; United Nations Children's Fund (UNICEF), Plot 9, George Street, Kampala, Uganda. Electronic address: dmatseketse@unicef.org., Newall AT; School of Public Health and Community Medicine, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW 2033, Australia. Electronic address: a.newall@unsw.edu.au., Heywood AE; School of Public Health and Community Medicine, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW 2033, Australia. Electronic address: a.heywood@unsw.edu.au., Bloland P; Global Immunization Division, U.S Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA, United States. Electronic address: pbb1@cdc.gov., Pallas SW; Global Immunization Division, U.S Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-2, Atlanta, GA, United States. Electronic address: xgx4@cdc.gov.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2020 Jan 29; Vol. 38 (5), pp. 1105-1113. Date of Electronic Publication: 2019 Nov 22.
DOI: 10.1016/j.vaccine.2019.11.030
Abstrakt: Background: High-quality vaccination data are critical to planning, implementation and evaluation of immunization programs. However, sub-optimal administrative vaccination data quality in low- and middle-income countries persist for heterogeneous reasons, though most relate to organizational factors and human behavior. The nationwide Data Improvement Team (DIT) strategy in Uganda aimed to strengthen human resource capacity to generate quality administrative vaccination data at the health facility.
Methods: A financial cost analysis of the Uganda DIT strategy (2014-2016) was conducted from the program funder perspective. Activity-based micro-costing from funder financial and program monitoring records was used to estimate total and unit costs by program area (in 2016 US dollars). Hypothetical scenarios were developed to illustrate potential approaches to reducing costs.
Results: Over 25 months the DIT strategy was implemented in all 116 operational districts and 3443 (89%) health facilities in Uganda at a total financial cost of US $575 275. Training and deployment of DITs accounted for the highest proportion of expenditure across program areas (69%). Transport, per diems, lodging, and honoraria for DIT members and national supervisors were the main cost drivers of the strategy. Deployment of 557 DIT members cost US $839 per DIT member, US $4 030 per district, and US $136 per health facility. The estimated opportunity cost of government staff time wasn't a major cost driver (2.5%) of total cost.
Conclusion: The results provide the first estimates of the magnitude and drivers of cost to implement a national workforce capacity building strategy to improve administrative vaccination data quality in a low- or middle-income country. Financial costs are a critical input to combine with future outcome data to describe the cost of strategies relative to performance outcomes. The operational costs of the strategy were modest (0.5-1.6%) relative to the estimated operational costs of Uganda's national immunization program.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AEH has received grant support from GlaxoSmithKline for investigator-driven research unrelated to the work presented in this manuscript. All other authors have no competing interests to declare.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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