Estimates of the cost of carrying out an immunization program vary considerably, depending on the geographic region and the type of program established. WHO estimates that during the 1980s the cost per fully immunized child will be more than US$3.00, a figure that includes program development costs.
It is obvious that the cost of carrying out a program in an urban area, with high population density and easy access to health centers, will be lower than that of a program in rural areas. Vaccinations carried out in fixed services or through outreach programs are less costly than those carried out by mobile vaccination teams to reach areas with few health services or very scattered populations.
Taking into consideration the factors needed to decide on the tactics and strategies of immunization activities, operational plans can be made and coverage objectives established in order to set up the most effective system within economic limitations.
Changes in percentage coverage, vaccination schedule and number of antigens to be included will have to be balanced against the amount of resources available. For example, a minimum vaccination schedule may be organized requiring only three contacts between the child and the health worker in order to fully immunize the child. Under this schedule, BCG vaccination is postponed until the child is three months old, and the third dose of DPT and poliomyelitis vaccine is delayed until nine months, when the measles vaccine is also administered.
With fewer contacts, the amount of personnel needed is reduced, and less time is also required from mothers who bring their children for vaccination. If more resources are available, the schedule may be expanded to vaccinate newborn infants with BCG and to administer booster doses of DPT and poliomyelitis vaccine.
Costs must be kept to a minimum, while still meeting the minimum requirements of immunization.
Although cost-benefit and cost-efficiency considerations must be taken into account, greater importance should be given to effectiveness than to cost. For example, a locally manufactured vehicle or refrigerator may be cheaper, but if it breaks down frequently and requires constant repairs, it may reduce the effectiveness of the program.
On the other hand, the same vehicles, although they may break down more often, can be repaired easily locally and may therefore be more effective than imported vehicles that remain out of service for several months while waiting for spare parts.
In reality, there is no general solution to this problem. Everything depends on local conditions and on the availability of materials and personnel. In general, however, in developing countries the rule seems to be valid that what is cheapest is more effective, because it is simpler, and therefore better.
In many areas, effective programs can be established even with limited funds. By using existing health facilities, personnel and equipment, coverage can often be provided simply by adding factors such as better administration and supervision.
The amount of money needed to establish the infrastructure, the cold chain and appropriate services around existing health facilities is very small compared with the benefits of immunization.
Personnel Organization
As with all components of primary healthcare, the proper administration of a sufficient number of properly trained personnel is very important.
Selection of Personnel
The ministry of health must formulate vaccination coverage objectives. On the basis of these objectives, the skills of the personnel needed to achieve them can be determined. The specific tasks to be performed must be known. A description of the work to be carried out is an indispensable step before a training session can be developed. It is necessary to know exactly what is to be done before attempting to prepare teaching materials.
Before training, the recruitment and appointment of the personnel who will carry out the work must be completed. Careful selection of this personnel will greatly facilitate the training process. It may be possible to identify personnel who already possess many of the skills needed to carry out immunization activities.
Unfortunately, it may also not be possible to select the personnel who will perform immunization tasks. They may be personnel already working in health centers whose duties are expanded to include immunization work, or community workers in charge of community-based service delivery projects.
The skills required of immunization personnel depend on each individual’s position or areas of responsibility within the program. They may also depend on each country’s legal regulations. The individual’s capacity must be reflected in their work, whether they administer or preserve vaccines, maintain the cold chain or drive a vehicle.
