Cost analysis of vaccine-preventable diseases surveillance in Ethiopia

BACKGROUND: This study evaluated the cost of the vaccine-preventable diseases (VPD) surveillance system in Ethiopia to inform budgeting for disease detection, prevention, and control, and planning for transitions from donor funding. METHODS: This cross-sectional retrospective, bottom-up micro-costing study collected data on resource utilization to conduct VPD surveillance during one fiscal year (2018-2019) in Ethiopia. The study covered 16 VPDs and costs from the government and partners perspective. RESULTS: The estimated economic costs of VPD surveillance in Ethiopia were US$69.11 million or US$0.70 per capita, while financial costs were US$26.83 million or US$0.27 per capita. The largest economic cost was for labor (41.0%) and the largest financial cost was for supplies (36.9%). Resources were mostly allocated to integrated, general disease surveillance (economic: 54.6%; financial: 50.7%), followed by surveillance for measles and rubella (economic: 15.9%; financial: 22.5%) and polio (economic: 12.4%; financial: 15.7%). The main funder was the Ethiopian Ministry of Health (economic: 78.8%; financial 62.6%), including donor resources channeled through the ministry. CONCLUSIONS: Human resources were primary drivers of economic costs. Although the Ethiopian VPD surveillance system uses shared resources across multiple VPDs, resulting in scale efficiencies, and the Ethiopian government covers most of its economic costs, a substantial portion relies on direct external donor support.