From 24-28 September 2012, the ProVac Initiative led a planning mission to Honduras to begin preparations for a comprehensive costing study of the routine Expanded Programme on Immunization (EPI). Honduras has introduced rotavirus in 2009 and pneumococcal conjugate vaccines in 2011 with support from the GAVI Alliance. In preparation for its upcoming GAVI-graduation, the country has requested support from the Pan American Health Organization’s (PAHO) ProVac Initiative to explore routine programme costs and financial flows to better inform long-term financial sustainability plans.
Currently, the country has relied on central level cost and expenditure data to estimate the total unit costs of the EPI. With the implementation of the ProVac EPI Costing Tool and the ProVac data collection methodology, developed in collaboration with the Harvard Centre for Health Decision Science and the National University of Colombia, Honduras seeks to explore current programme costs at the different levels of the programme, including service delivery sites, regional programme offices and vaccine distribution sites.
During the first two days of the mission, the ProVac team worked with the national EPI staff to draft key components of the study protocol. In addition, the team visited health facility sites and regional programme offices to determine the level of data availability and quality. With this information, the team developed a sample design that includes eight purposefully-selected sanitary regions and 71 randomly selected health facilities within these regions. The sample includes both rural and urban areas of the country, and is designed to facilitate extensive data collection at all three administrative levels (central, regional and municipal levels). Lastly, the team reviewed the data collection instruments that are companions to the ProVac EPI Costing Tool and incorporated revisions to the surveys to reflect the Honduran health system structure.
The ProVac Initiative will continue to work with the local EPI staff for the next few months to refine the data collection protocol and instruments before a training visit in early January 2012 to launch the data collection phase. This study is part of a multi-country routine immunization programme costing grant funded by the Bill and Melinda Gates Foundation to develop precise estimates on routine programme costs and financial flows.
The final day of the visit also gave the ProVac team and EPI staff an opportunity to discuss plans to perform a cost-effectiveness analysis on strategies to strengthen the cervical cancer programme, including improved screening strategies and an evaluation of the possible introduction of an HPV vaccine. The EPI convened key immunization stakeholders and cervical cancer programme staff to discuss data availability and data collection plans for populating the ProVac CERVIVAC Model, a comprehensive cost-effectiveness model to evaluate HPV vaccine introduction among adolescent girls and strengthened screening strategies among adult women, ineligible for the vaccine.