The challenge

Delivering COVID-19 vaccines has posed unprecedented challenges in terms of delivery volume, reaching new target populations, diversity of delivery strategies, and sometimes complex product profiles—elements which must all be managed rapidly in order to achieve effective coverage.

Countries have had to adapt delivery strategies due to the gaps in vaccine supply and reach different priority target populations. In order to plan and budget for future phases of vaccine delivery for COVID-19 or a potential future pandemic vaccine, an accurate understanding of the costs and operational considerations associated with the vaccination program so far is urgently needed.

The approach

ThinkWell is conducting costing studies of COVID-19 vaccine delivery in Bangladesh, Côte d’Ivoire, DRC, Mozambique, the Philippines, Uganda, and Vietnam to generate economic evidence to the support the sustainable rollout of COVID-19 vaccines and help governments plan for future vaccine delivery.

In each country, bottom-up ingredients-based costing studies are being conducted in collaboration with local research institutions to estimate the cost of delivering COVID-19 vaccines through various delivery strategies, reaching different target populations, and using products with varying cold chain requirements. The studies are also mapping out the service delivery process and funding flows, and capturing the source and use of different types of paid and volunteer health workers mobilized to deliver COVID-19 vaccines. Semi-structured interviews are being conducted with stakeholders to assess the rollout and its challenges.

ThinkWell has developed a general research protocol for the country studies to describe the generalized approach, scope, methods, and expected outputs. While recognizing that the diverse range of vaccine rollout modalities will require tailored research approaches in each of the countries, this general research protocol is aimed at ensuring comparability across countries and facilitating cross-country learnings. Preliminary results were presented at the IHEA 2023 Immunization Economics Pre-Congress in July 2023, and you can see below for more information and findings from each country when available.

Côte d’Ivoire

In Côte d’Ivoire, Genesis Analytics and ThinkWell implemented the costing study, with a team from Université Felix Houphouet Boigny collecting data on the cost of delivering COVID-19 vaccines from March to May 2022. The study found a relatively low financial cost for delivering vaccines in 2022 (US$0.67 per dose delivered) which likely reflected a lack of funding rather than low financial requirements to support vaccination. The higher economic cost (US$3.16 per dose delivered) highlights the important role of both existing paid staff as well as volunteers. Read the full study report here and see the poster presented at the IHEA 2023 Immunization Economics Pre-Congress.

Vietnam

ThinkWell worked with the Hanoi University of Public Health in Vietnam to estimate the cost of delivering COVID-19 vaccines in 2021. The financial cost was found to be low at US$0.59 per dose delivered, though this masked shortages in staffing and other resources that the vaccination program had to work around. Limited investments to expand capacity for the rollout meant that a significant burden was placed on the existing health system resources. Read the full study report here and see the poster presented at the IHEA 2023 Immunization Economics Pre-Congress.

Project Summary

Global cervical cancer elimination is achievable by 2030 if sufficient resources can be mobilized, and effectively and equitably used to accelerate implementation and uptake of national programs. The Union for International Cancer Control (UICC) engaged ThinkWell to conduct an assessment and stakeholder interviews to examine the status of health financing for cervical cancer elimination in four project countries: Guatemala, Philippines, Burkina Faso, and Côte d’Ivoire. This work was done within the context of the Scale-Up Cervical Cancer Elimination with Secondary Prevention Strategy (SUCCESS) project, funded by Unitaid, led by Expertise France and implemented together with UICC and Jhpiego.

ThinkWell brings knowledge to the CCE advocacy community on the health financing ecosystem for each of the project countries and how it applies to cervical cancer, including comprehensive and realistic perspectives on what it will take to advocate for sustainable financing approaches for CCE. The profiles outline policy actions for advocates and stakeholders to utilize in addressing the need for CCE financing.

Country Context

Why does financing for cervical cancer elimination matter?

Cervical cancer is a leading diagnosis among women in each country profiled. For example, cervical cancer is the second leading cancer diagnosis in Burkina Faso and takes the lives of over 2,000 Burkinabe women each year, but fewer than 1 in 10 Burkinabe women have been screened for cervical cancer, and the HPV vaccine is not currently included in the national immunization program (WHO 2021). Financing cervical cancer services is a vital step to ending these preventable deaths.

Taking Actionable Steps

By reviewing the current health system structures of each country, ThinkWell found that there is ample opportunity to take health financing-related actions towards the elimination of cervical cancer. As shown in the figure below, these actions are part of a continuum that spans the macro and micro contexts of any given country. Additionally, each country assessment includes policy action suggestions tailored to each country’s context.

Summary

With support from the WHO, ThinkWell conducted a study to develop a primary care competency certification framework and a corresponding tool to certify primary care health workers. As part of the study, we mapped the current state of primary care delivery in the Philippines, developed options for primary care provider models for the Philippines based on global best practices, created and piloted primary care provider competency assessment tools, and designed a primary care provider certification framework. Our study helped ensure that the Department of Health is prepared to certify primary care providers to deliver services in primary care facilities, as mandated under the country’s Universal Health Care (UHC) Law.

Breaking New Ground

Our work consolidated and aligned initiatives that the Health Human Resource Development Bureau of the Philippine Department of Health has led to clarify and re-shape the traditional roles of health care workers in front-line health facilities, particularly in the public sector. More importantly, this work paved the way to ensure that primary health care services be prioritized and institutionalized.

Challenge

ThinkWell helped to ensure that when the UHC Law was implemented in 2020, the Philippines had a certification tool to help identify and certify primary care providers who are equipped to deliver an expanded primary care benefit package for all Filipinos.

Approach

ThinkWell reviewed existing studies and documents that articulate important health care worker competencies. Our work aligned with the goal for primary health care services in the Philippines to be high-quality, efficient, and accessible to all.

Results

Our research uncovered primary care delivery models that are potentially applicable in various settings in the Philippines. In addition, we identified and validated essential competencies for primary care health workers. Finally, we proposed a certification framework and tool that was pilot tested in selected primary care facilities. For a summary of the rationale and proposed design of the certification process of primary care providers, please visit the SP4PHC Philippines page.