Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan
Introduction With limited resources, attaining maximal average health service coverage can be at odds with maximising equity which attempts to promote greater reach among underserved populations. In this study, we examined the trade-offs in immunisation coverage levels and equity for children under...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/7/10/e009000.full |
| _version_ | 1797990912133955584 |
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| author | David Wilson Nick Scott Robert Oelrichs Farah Houdroge Hammad Yunus Dominic Delport Erin Stearns Anna Palmer Amber Naim Aliya Kashif Hnin Hnin Pyne |
| author_facet | David Wilson Nick Scott Robert Oelrichs Farah Houdroge Hammad Yunus Dominic Delport Erin Stearns Anna Palmer Amber Naim Aliya Kashif Hnin Hnin Pyne |
| author_sort | David Wilson |
| collection | DOAJ |
| description | Introduction With limited resources, attaining maximal average health service coverage can be at odds with maximising equity which attempts to promote greater reach among underserved populations. In this study, we examined the trade-offs in immunisation coverage levels and equity for children under 5 years of age in Pakistan across various subpopulations who can be targeted with different combinations of immunisation service modalities.Methods We conducted a detailed costing exercise across 16 geographically and demographically diverse districts in Pakistan. These data were the basis for (a) technical efficiency benchmarking via Data Envelopment Analysis to identify potential efficiency gains by location, delivery model and cost ingredient; (b) allocative efficiency optimisation modelling to understand how resource allocations could be optimised and to devise recommended budget allocations and operational metrics. Finally, the hypothetical overall efficiency gains attainable were estimated if available resources were allocated with the optimal emphases, and if service delivery models operated at productivity levels at the benchmarked frontier of efficiency.Results Benchmarking suggests that ~44% of delivery models are running efficiently and 37% are highly inefficient. While coverage and equity are usually at odds, surprisingly, the optimisation modelling revealed that substantial improvements in equity between subpopulations does not necessarily cost very much in overall immunisation coverage: theoretically, equity can be achieved while still attaining close to maximal immunisation coverage. Overall, analyses suggest greater emphases should be placed on outreach delivery models which particularly target rural areas and slum populations.Conclusion The unit cost differentials within districts are not sufficiently large for there to be a large reduction in potential Fully Immunised Children coverage if one focuses on maximising equity. However, reallocations of programme budgets can have a significant impact on equity outcomes, particularly at current low spending amounts. Therefore, it is recommended to address equity as the key objective in national immunisation programming. |
| first_indexed | 2024-04-11T08:43:08Z |
| format | Article |
| id | doaj.art-6652a3b17cf044b7afb903cea53d12d0 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-04-11T08:43:08Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-6652a3b17cf044b7afb903cea53d12d02022-12-22T04:34:02ZengBMJ Publishing GroupBMJ Global Health2059-79082022-10-0171010.1136/bmjgh-2022-009000Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in PakistanDavid Wilson0Nick Scott1Robert Oelrichs2Farah Houdroge3Hammad Yunus4Dominic Delport5Erin Stearns6Anna Palmer7Amber Naim8Aliya Kashif9Hnin Hnin Pyne10Burnet Institute, Melbourne, Victoria, AustraliaBurnet Institute, Melbourne, Victoria, AustraliaWorld Bank Group, Washington, DC, USABurnet Institute, Melbourne, Victoria, AustraliaPFM Solutions, Islamabad, PakistanBurnet Institute, Melbourne, Victoria, AustraliaBill and Melinda Gates Foundation, Seattle, Washington, USABurnet Institute, Melbourne, Victoria, AustraliaPFM Solutions, Islamabad, PakistanWorld Bank Group, Washington, DC, USAWorld Bank Group, Washington, DC, USAIntroduction With limited resources, attaining maximal average health service coverage can be at odds with maximising equity which attempts to promote greater reach among underserved populations. In this study, we examined the trade-offs in immunisation coverage levels and equity for children under 5 years of age in Pakistan across various subpopulations who can be targeted with different combinations of immunisation service modalities.Methods We conducted a detailed costing exercise across 16 geographically and demographically diverse districts in Pakistan. These data were the basis for (a) technical efficiency benchmarking via Data Envelopment Analysis to identify potential efficiency gains by location, delivery model and cost ingredient; (b) allocative efficiency optimisation modelling to understand how resource allocations could be optimised and to devise recommended budget allocations and operational metrics. Finally, the hypothetical overall efficiency gains attainable were estimated if available resources were allocated with the optimal emphases, and if service delivery models operated at productivity levels at the benchmarked frontier of efficiency.Results Benchmarking suggests that ~44% of delivery models are running efficiently and 37% are highly inefficient. While coverage and equity are usually at odds, surprisingly, the optimisation modelling revealed that substantial improvements in equity between subpopulations does not necessarily cost very much in overall immunisation coverage: theoretically, equity can be achieved while still attaining close to maximal immunisation coverage. Overall, analyses suggest greater emphases should be placed on outreach delivery models which particularly target rural areas and slum populations.Conclusion The unit cost differentials within districts are not sufficiently large for there to be a large reduction in potential Fully Immunised Children coverage if one focuses on maximising equity. However, reallocations of programme budgets can have a significant impact on equity outcomes, particularly at current low spending amounts. Therefore, it is recommended to address equity as the key objective in national immunisation programming.https://gh.bmj.com/content/7/10/e009000.full |
| spellingShingle | David Wilson Nick Scott Robert Oelrichs Farah Houdroge Hammad Yunus Dominic Delport Erin Stearns Anna Palmer Amber Naim Aliya Kashif Hnin Hnin Pyne Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan BMJ Global Health |
| title | Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan |
| title_full | Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan |
| title_fullStr | Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan |
| title_full_unstemmed | Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan |
| title_short | Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan |
| title_sort | cost optimisation analysis of the expanded programme for immunisation balancing equity and coverage in pakistan |
| url | https://gh.bmj.com/content/7/10/e009000.full |
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