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Maceira D.,Center for the Study of State and Society | Goguadze K.,Curatio International Foundation CIF | Gotsadze G.,Curatio International Foundation CIF
Vaccine | Year: 2015

ObjectiveThis paper identifies factors that affect the cost and performance of the routine immunization program in Moldova through an analysis of facility-based data collected as part of a multi-country costing and financing study of routine immunization (EPIC). MethodsA nationally representative sample of health care facilities (50) was selected through multi-stage, stratified random sampling. Data on inputs, unit prices and facility outputs were collected during October 3rd 2012-January 14th 2013 using a pre-tested structured questionnaire. Ordinary least square (OLS) regression analysis was performed to determine factors affecting facility outputs (number of doses administered and fully immunized children) and explaining variation in total facility costs. ResultsThe study found that the number of working hours, vaccine wastage rates, and whether or not a doctor worked at a facility (among other factors) were positively and significantly associated with output levels. In addition, the level of output, price of inputs and share of the population with university education were significantly associated with higher facility costs. A 1% increase in fully immunized child would increase total cost by 0.7%. ConclusionsFew costing studies of primary health care services in developing countries evaluate the drivers of performance and cost. This exercise attempted to fill this knowledge gap and helped to identify organizational and managerial factors at a primary care district and national level that could be addressed by improved program management aimed at improved performance. © 2015 Elsevier Ltd. Source


Goguadze K.,Curatio International Foundation CIF | Chikovani I.,Curatio International Foundation CIF | Gaberi C.,Ministry of Health of the Republic of Moldova | Maceira D.,Center for the Study of State and Society | And 3 more authors.
Vaccine | Year: 2015

Objective: Available estimates on how much it costs to provide routine immunization services are out-dated. This study attempts to address gaps in evidence by evaluating the total economic and unit costs of delivering routine immunization (RI) services in Moldova as part of a multi-country study on the costs and financing of routine immunization (EPIC). Methods: This cross-sectional study is based on a multistage stratified random sample of fifty primary health care facilities. Data on inputs, prices, and outputs were collected retrospectively for 2011 and analyzed using an ingredient-based costing approach in Excel and SPSS®. Results: The average total annual facility cost for RI was $11,943 ranging from $565 to $112,548 and labor cost was the main driver of routine immunization costs contributing 65%, followed by capital costs - 16.3% and the cost of vaccines and injection supplies accounting for 9%.The average cost per dose was $18.3, the cost per child was $316.6 and the cost per fully immunized child was $332.3. The results show considerable variation in the costs of routine immunization services across facility type and depending on a facility scale i.e. annual doses administered. Conclusions: The study shows that the cost of fully immunizing a child in a middle-income country is much higher than previous estimates. These results will be used by the government for better planning and financing of routine immunization services, leading to greater sustainability. © 2015 Elsevier Ltd. Source

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