Academic journal article Bulletin of the World Health Organization

Cost-Effectiveness of Routine and Campaign Vaccination Strategies in Ecuador

Academic journal article Bulletin of the World Health Organization

Cost-Effectiveness of Routine and Campaign Vaccination Strategies in Ecuador

Article excerpt

Cost-effectiveness of routine and campaign vaccination strategies in Ecuador


The first major national immunization campaign in Ecuador, launched in October 1985, was coordinated and directed by the PREMI project (Programma de Reduccion de Enfermedad Materno y Infantil), a child survival programme focusing on immunization, oral rehydration therapy, and growth monitoring. The campaign was actively promoted by the National Institute for Children and the Family (INNFA), and supported by the U.S. Agency for International Development (USAID), UNICEF, and the Pan American Health Organization (PAHO). The campaign, which mobilized health workers, as well as the national army and the Ministry of Education, used the mass media, including television and radio, to emphasize the importance and timing of vaccinations and other health activities. During the first year (October 1985 to June 1986), three rounds of the PREMI campaign were held, each one initially lasting three days. In the next year three more rounds were held, and in 1988 the country switched to two rounds per year synchronized with the campaigns of other Andean nations.

Campaigns are a controversial approach to vaccinations. Proponents contend that they successfully mobilize the political, human, and financial resources, strengthen the country's interest and capacity to deliver vaccinations, and substantially boost coverage. Critics counter that the gains may be short-lived and the campaigns may divert resources and trust away from routine health programmes.

Directed by PREMI, the immunizations (BCG, polio, tetanus, diphtheria, pertussis, and measles vaccines to children less than five years of age, and tetanus toxoid for pregnant women) were provided in a variety of health facilities (hospitals, health centres, subcentres and health posts) and other locations such as schools. The third and later rounds of the campaign also included other child survival activities, especially the promotion of growth monitoring and use of oral rehydration therapy (ORT). The PREMI campaign was intended to complement rather than replace the routine immunization services which continued to be performed at most Ministry of Public Health (MOPH) facilities. The MOPH had used limited campaigns (here described as pre-PREMI) from 1981 to 1985 to strengthen the routine services. Each lasted only one day, lacked coordinated publicity, and involved only health institutions.

Cost-effectiveness studies of routine and campaign strategies can help policy-makers from village to national levels to evaluate both approaches [14]. Many studies report the costs [9] or cost-effectiveness of an overall vaccination programme [1, 6, 19, 20, 23). Only a few studies, however, have compared the cost-effectiveness of alternative delivery strategies within a single country [2, 4, 7]. (a1) The popularity of the campaign approach makes studies of its cost-effectiveness critical. In the Americas, Brazil, Colombia, El Salvador, Jamaica, and other countries have recently held vaccination campaigns. In other regions of the world, Burkina Faso, Cameroon, Mauritania, Nigeria, Senegal, and Turkey are countries pursuing the campaign strategy.

In the present study, the value of conducting a campaign to supplement routine vaccinations was examined in order to determine (1) the cost, level of coverage, and number of deaths averted by the routine programme alone, (2) increases in cost, coverage, and deaths averted from the campaign, (3) the cost-effectiveness of the routine vaccination programme, and (4) the incremental cost-effectiveness of the campaign. A project report describes the methods, data, results, and sensitivity analyses in detail. (b2)

Costs of vaccinations

Routine services (fixed sites)

Methods. The total and average costs of routine immunizations were derived in part from a 1986 study of the costs of primary health services in health subcentres and similar facilities of the MOPH, the rural social security programme, and certain nonprofit private organizations in Ecuador [8]. …

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