2016年-世界发展银行全球_The_Pakistan_Expanded_Program_on_Immunization_and_the_National_Immunization_Support_Project___An_Economic_Analysis_66页_1mb

Summary of The Pakistan Expanded Program on Immunization and the National Immunization Support Project: An Economic Analysis

Core Content

This document presents an economic analysis of the Pakistan Expanded Program on Immunization (EPI) and the National Immunization Support Project (NISP), focusing on the cost-effectiveness and financial sustainability of immunization programs in the country. It highlights the challenges Pakistan faces in achieving high immunization coverage and the potential benefits of expanding immunization to reduce the burden of vaccine-preventable diseases (VPDs) and child mortality.

Main Points

1. Immunization and Public Health Impact

• Immunization is one of the most cost-effective public health interventions, saving more lives globally than any other health intervention.
• Every dollar invested in childhood immunization saves approximately $16 in health care costs, wages, and productivity.
• The return on investment rises to $44 when considering the long-term benefits of healthier, longer lives.
• Immunization programs contribute to the eradication, elimination, and control of infectious diseases, and the WHO estimates that immunization averts two to three million deaths annually.

2. Challenges in Pakistan's Immunization Coverage

• Pakistan continues to experience outbreaks of VPDs due to low immunization coverage.
• The under-five mortality rate (U5MR) in Pakistan remains high, with over 400,000 deaths annually in children under five over the past twenty years.
• Immunization coverage is below the regional median, with only 43 to 62 percent of children estimated to be fully vaccinated.
• There are significant disparities in immunization rates across provinces, districts, and genders, with boys being more likely to be immunized than girls.

3. Root Causes of Low Coverage

• Supply Side Issues:

  • Inconsistent prioritization and funding for EPI compared to other public health campaigns.
  • Weak capacity in human resources, logistics, and monitoring at the local level.
  • Political interference and lack of motivation among health workers due to low remuneration.
  • Underutilization of vaccinators and Lady Health Workers (LHWs).
  • Reduced opportunities for capacity building in immunization programs.

• Demand Side Issues:

  • Cultural and social resistance to immunization in certain communities.
  • Lack of immunization knowledge among the general population.
  • Recent attacks on immunization workers and opposition to vaccination campaigns in some areas, creating new barriers to coverage.

4. Economic Analysis of NISP and EPI

• The National Immunization Support Project (NISP) is proposed as a financing mechanism for the Comprehensive Multi-Year Plan (CMYP) to enhance immunization coverage.
• NISP aims to coordinate results-based financial support from Gavi, the World Bank, and the Bill & Melinda Gates Foundation.
• The study estimates the unit cost of immunization and calculates cost-effectiveness ratios based on different coverage scenarios.
• The findings demonstrate clear economic benefits in terms of Disability-Adjusted Life Years (DALYs) saved due to expanded immunization.
• The proposed intervention is deemed affordable and economically effective, with a high rate of return on investment.

5. Recommendations

• Increased investment in immunization is necessary to address the current low coverage.
• Capacity building of health professionals and improving logistics to reach marginalized populations and remote areas is critical.
• Strengthening procurement systems, local and provincial management, and reporting mechanisms is essential for program effectiveness.
• The government must prioritize immunization as part of its strategy for Universal Health Coverage (UHC) and inclusive development.

Key Information

• Gavi and the Bill & Melinda Gates Foundation are key financiers of the NISP.
• The World Bank supports the analysis and publication of the report.
• The 18th Amendment to the Constitution has increased provincial autonomy but left the federal government's role in health planning unclear.
• The Pakistan Demographic and Health Survey (PDHS) and Pakistan Social and Living Standards Measurement Survey (PSLMS) provide data for the analysis.
• The study emphasizes the need for strong leadership, good governance, and effective management at the provincial and district levels.

Conclusion

The economic analysis underscores the importance of immunization as a public health intervention and highlights the need for a more robust and coordinated approach to improve immunization coverage in Pakistan. The NISP is proposed as a viable and cost-effective mechanism to achieve this goal, with potential long-term benefits for both public health and the economy.