Cost of a human papillomavirus vaccination project, Zimbabwe

Objective To determine the cost of Zimbabwe's human papillomavirus (HPV) vaccination demonstration project. Methods The government of Zimbabwe conducted the project from 2014­2015, delivering two doses of HPV vaccine to 10-year-old girls in two districts. School delivery was the primary vaccination strategy, with health facilities and outreach as secondary strategies. A retrospective cost analysis was conducted from the provider perspective. Financial costs (government expenditure) and economic costs (financial plus the value of existing or donated resources including vaccines) were calculated by activity, per dose and per fully immunized girl. Results The project delivered 11 599 vaccine doses, resulting in 5724 fully immunized girls (5540 at schools, 168 at health facilities and 16 at outreach points). The financial cost for service delivery per fully immunized girl was United States dollars (US$) 5.34 in schools, US$ 34.90 at health facilities and US$ 288.63 at outreach; the economic costs were US$ 17.39, US$ 41.25 and US$ 635.84, respectively. The mean financial cost per dose was US$ 19.76 and per fully immunized girl was US$ 40.03 (economic costs were US$ 45.00 and US$ 91.19, respectively).The largest number of doses delivered (5788) occurred during the second vaccination round (the second group's first dose concurrently delivered with the first group's second dose), resulting in the lowest financial and economic service delivery costs per dose: US$ 1.97 and US$ 6.79, respectively. Conclusion The mean service delivery cost was lower in schools (primary strategy) and when more girls were vaccinated in each round, demonstrating scale efficiency

Early Evidence from Results-Based Financing in Rural Zimbabwe

Results-based financing (RBF) is an innovative approach to health system financing which pays providers for verified outputs. In July 2011; through a World Bank grant; Zimbabwe commenced an RBF project to improve utilization of quality maternal; neonatal and child health (MNCH) services. This article discusses its early results. A statistical analysis of intervention districts and control districts shows that RBF districts demonstrate higher increases in utilization levels for the MNCH services than control districts. Month-on-month growth rates for antenatal care; perinatal referrals and growth monitoring are statistically significant after the intervention; whilst they were not before the intervention and no significant trend was found in control districts. Qualitative study provides insight in the mechanisms through which RBF contributed to better performance: the use of contracts; increased autonomy of health facilities; increased community involvement; intrinsic motivation of health-care workers; existence of a reliable health information system; abolishment of user fees; improved supervision of health facilities; separation of functions; and the Government of Zimbabwe's results-based management (RBM) policy