Cost effectiveness and sustainability of immunization.

Sustainability of EPI in Bangladesh is based on capital recurring costs and unit costs. These costs sources of financing the capacity of the domestic economy to finance the cost of maintaining the program and nonfinancial aspects of sustaining EPI are discussed. The capital costs for construction of buildings machinery and equipment and skill development and training has been reduced in 1988-89 to 9.15% of the budget. Recurring costs which will increase as coverage increases constitute 90.85% and pay for wages fuel rents and vaccines. The unit cost is low at 5.79/child compared with the world average of 13. WHOs standard formula of dividing total annual EPI costs by children immunized for measles times 90% is used. However this figure assumes full immunization which is estimated at an additional cost of 4.21/child. Over the long term costs will come down. Now funding comes from the government multilateral UN agencies (UNICEF at 57% including other sources and WHO) international NGOs and bilateral donors [USAID SIDA Swiss Development Corporation (SDC) and Canadian International Development Agency (CIDA)]. Government funding covers salaries transport fuel travel allowances and TT vaccines. Contributions from UNICEF provide capital expenses training stipends and communication materials. USAID channels money through an urban funding organization also providing technical assistance which is also given by WHO. TT vaccines are produced within the country and there are plans to produce other antigens. Of the 5.6% health and family planning budget EPI finances account for only 3.56% . If all external funding were curtailed and since EPI has increased access to the government health care delivery system and decreased morbidity EPI would be absorbed within the present allocation albeit at the expense of other programs. Local governments also share the costs and volunteers contribute. Social sustainability relies on popular demand and political commitment. Although the Health and Family Welfare Ministry has operational responsibility the Deputy Ministers involvement is crucial as well as the Presidents support. Managerial sustainability at the local level requires the same sense of ownership as at the national level. EPI was the 1st community service effort to reach large numbers of people and be appreciated.