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Project Overview

The Economics of Last Mile Delivery Hub (the “Hub”) launched in 2021 to generate high-quality economic evidence on the delivery of essential health services, including COVID-19 vaccines,  to priority groups. ThinkWell leads this project, supported by funding from the Bill & Melinda Gates Foundation, with technical support from the Harvard T.H. Chan School of Public Health and Genesis Analytics. 

The Hub will bring together global and country level institutions to: 

  1. Produce rapid economic evidence to support the sustainable roll-out of COVID-19 vaccines;  
  2. Generate key economic evidence on the delivery and integration of essential health services to reach priority populations;  
  3. Strengthen capacity at local research institutes to generate demand-driven and actionable evidence to inform improvements to the efficiency of essential health service delivery.  

The Hub will be implemented in two phases, with phase one focusing on COVID-19 vaccine delivery costing analysis in multiple countries and phase two focused on generating evidence on the delivery of essential health services (EHS) and capacity in countries to generate such evidence.  

COVID-19 vaccine delivery costing 

During the first year, the project will oversee the implementation of costing studies on COVID-19 vaccine delivery in 4-5 countries to support the sustainable roll-out in low and middle income countries. This will enable the streamlining of approaches, coherence in study design and methods, and facilitate iterative cross-country learnings. The results of the studies will be disseminated through COVAX’s Country Readiness and Delivery (CRD) group, as well as other relevant forums such as immunizationeconomics.org and c19economics.org.  

Generating essential health service costing evidence and local capacity building 

The second phase of the project will seek to bring together research institutes, governments, and partners to generate robust and policy relevant evidence on the economics of delivering essential health services as well as strengthening country level capacity and managing the immunization economics community of practice. 

We will work with countries where there is true demand and interest for the generation of cost evidence on delivery strategies to reach priority population groups with essential health services. Using novel approaches and robust methodologies, we will fill evidence gaps to answer pressing policy questions. 

With each of the research institutions we work with, we’ll help define objectives to strengthen their capacity to generate and translate cost and economic evidence for policy and programmatic decision making. We’ll support junior researchers to develop their skills and networks, and support participation at conferences and meetings.  

The Hub will also be taking over the management of the immunization economics community of practice and website. The community of practice currently has a reach of 20,000 members, of whom almost half are country level practitioners, and has played a vital role in capacity strengthening in the immunization costing and economics community. ThinkWell will continue to grow the community and invigorate the website with a view to making it an engaging one stop shop for immunization economics resources. 

COVID-19 vaccine delivery costing

The challenge 

Low- and middle-income countries are standing at the beginning of an incredibly challenging vaccine roll-out. COVID-19 vaccine delivery poses 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 at rapid speed if effective coverage is to be achieved.  

Countries are considering many different delivery strategies designed to reach different priority target populations, which they have had to adapt to the uncertain influx of supply. These range from delivery at hospitals to reaching certain populations at their workplace, to mass delivery through large ad-hoc campaign sites to small, fixed sites in the community. In order to plan and budget for the roll-out in the most efficient manner possible, a better understanding of the costs and operational considerations associated with each of these delivery strategies is urgently needed.  

The approach 

The project will oversee the implementation of costing studies on COVID-19 vaccine delivery in 4-5 countries to evaluate a range of delivery strategies. In partnership with ThinkWell staff, in-country research institutions will collect and analyze primary data from delivery sites. Within each country, we will use a mixed-methods approach including ingredients-based costing, top-down analysis of financial expenditure reports and budgets, semi-structured interviews with stakeholders to assess the roll-out and its challenges. 

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