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Bull World Health Organ. 1989;67(2):181-8.

The Thai expanded programme on immunization: role of immunization sessions and their cost-effectiveness.


A cost-effectiveness study of the Thai expanded programme on immunization was carried out in district hospitals and health centres in Thailand during early 1987. The total annual spending on immunization was US $3852 in hospitals and US $813 in health centres. The percentage distribution of annual costs was similar in both facilities. Salaries were the largest component, followed by building and vaccine costs. The frequency of immunization sessions was the most important factor in determining total costs--immunization costs increasing with the frequency of sessions. In hospitals the average number of fully immunized children was 184, compared with 49 in health centres. The cost per fully immunized child varied widely from US $5.30 to US $33.20, and the most cost-effective facilities were those that immunized the greatest number of children. With the present number of health facilities in all areas of the country, which correspond to saturation levels, the most likely way for the Thai programme to reduce costs would be to make better use of staff time by decreasing the frequency of the services offered, thereby increasing the efficiency of each session. Hospitals should adjust the frequency of their immunization sessions according to the number of children being served, but health centres should offer sessions only monthly or once every two months.


A cost-effectiveness study of the extended immunization program in Thailand surveyed data from 4 provinces for the fiscal year of 1986. The study's objective was to better use scarce health resources especially in difficult economic times. The survey assessed the total annual spending for hospitals and health centers in U.S. dollars: $3,582 in hospitals and $813 in health centers. In relation to the number of 1 year old children in their respective area, hospitals showed 100% coverage of immunization and not more than that. The vaccine was administered in predetermined clinics that also continued with supplementary outreach activities. The immunization costs for each child was $13.80 in hospitals and $11.80 in health centers and $8.90 and $10.30, respectively for pregnant women. Higher administrative and construction expenses caused hospitals to have higher immunization costs than health centers. Salary was identified as the major factor in both operating and total costs. The output and coverage in hospitals was better than that of centers. Higher hospital costs could be justified by the frequency of immunization and the service load. The hospital immunization sessions should be organized according to service load with the frequency increasing with the number of children. Potential factors such as a decrease in birth rate and the change-over of users to local care should be considered in future studies of immunization coverage and effective health facility use.

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