RESUMO
Background: Human papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine well as for full immunisation of two doses. Methods: For HPV costing, both top-down and micro-costing approaches were used, depending on the cost data source, and economic costs were gathered from Expanded Programme for Immunisation Costing and Financing Project (EPIC). Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, district and provincial levels. Results: Findings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest cost economic cost at USD13.2 per dose and USD 26.4 per fully immunised child (FIC). Overall financial costs were US$6.0 per dose and US$11.9 per fully immunised child. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$46.0 per FIC. The main cost drivers were human resources, building overhead and vehicles, microplanning, supplies and service delivery/outreach. were the top cost drivers. Nurses, environmental health technicians and community-based volunteers were the most involved in HPV vaccination. Conclusions: Future planning in Zambia and other African countries conducting HPV vaccination needs to prioritise these cost drivers as well as possibly find strategies to minimise some costs. Although not a challenge now due to Gavi support, vaccine costs are a major threat to sustainability in the long run. Countries like Zambia must find strategies to mitigate against this.
RESUMO
The Zambia Immunisation Technical Advisory Group (ZITAG) was established in 2016 as an advisory body to provide evidence-based recommendations on vaccine policy. As part of the Gave Full Country Evaluation, we evaluated the functionality and effectiveness of ZITAG and related EPI committees through an online stakeholder survey of Interagnecy Coordinating Committee (ICC), ZITAG and Extended programme on Immunisation Technical Working Group (EPI-TWG) members, document review and key informant interviews. The survey was sent out via SurveyMonkey between May and July 2020 to 69 members of ZITAG, ICC or the EPI TWG. A total of 52 individuals responded (75%). Eight key informant interviews were also carried out at the national and global level in September 2020 to elaborate further on some of the quantitative findings and for triangulation. Findingsrevealed that the EPI committees were reasonably functional and effective entities, each with its unique role, though some overlaps occurred. Functionality was shown by having a broad membership with wide expertise and long-serving members; sub-committees existed and meetings were occurring regularly. Leadership and coordination structures also existed and were largely felt to be working well. Funding challenges however persisted, in particular for ZITAG operations and functionality of its subcommittees. Effectiveness and value addition fo the committees to the EPI was illustrated through decision-making processes and evidence use as well as relatively good country ownership in terms of commitment, legitimacy, capacity and accountability. Full independence and ownership may however be compromised by funding challenges. Recent changes to ICC terms of reference and focus beyond immunisation side-lined the EPI and weakened the linkage between ICC and ZITAG with many ZITAG recommendations not having been followed through by ICC as the ultimate endorsing entity.
