Sunday, 15 June 2008
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POST 01280E: COSTING FOR IMMUNIZATION SERVICES FOLLOW-UP ON POSTS: 01265E, 01269E, 01273E 15 JUNE 2008 ******************************************* Rowan Wager delves further into how heath services costs can be offset. Terry Hart poses a question with regard to Anthony Battersby’s ppt on Energy and climate implications of safe injections (POST: 01273E)—whose carbon footprint is the largest and who is bearing the costs? ----------- Terry brings up an important factor of commercialization of the process and products to provide pull mechanisms. There are many examples from the demand creation side of health services and health products (condoms being one the earliest products), and economic development through the use micro credit and the engagement of the base of pyramid in the formal economy. These are all factors that need to be considered in the development or improvement of an immunization delivery system. The example of the tracking packs as a low tech logistics aid to help offset increased costs associated with combined vaccines. This brings up the radical change in perception in the world of development; that even the poor can be engaged as positive commercial viable actors in an economy, basically being moved from a “cost” to and “investment” that can provide a “return?” In this frame of mind; we need to now reinforce that their time is also worth something. So in the case of the introduced tracking packs, “costs” could be offset by the time saved by the target population (which could be used in production of revenue) receiving a combination vaccine or multiple services versus single dose/service over longer period of time or visits, and adding the reduction of delivery equipment (one syringe versus two or more): Especially in Terry’s project. This productivity could be “accounted” by surveying households on the activities done during the day and evening and finding out the patterns of work and times of highest return. With this data, and access of a health facility to energy for light, the health point could better staff the facility to match the low return periods for the target population, or with a good tracking system could actually match focused needs of the target population and needs of the health providers. An example could be providing services in early evenings for day workers and/or their spouses – moving away from traditional set times convenient to the health workers or some abstract government schedule. By allowing the target population to engage in activities that provide them resource to move out of poverty and providing the essential health service, the over all net gain economically and socially would be much greater than the traditional standard health delivery done now. On the staff side, the issue is mostly managerial in terms of scheduling, but may have some costs such as incentives to offset other duties (I have found most health workers to be women who have additional household duties and often a little extra money is enough incentive to get their spouses to contribute more in terms of watching the children or cooking). So when looking at the system many factors need to be considered: costs of the supplies, cost of the staff, and costs of the time of the target population. Anthony brings in another dimension when looking at costs of supplies, and more specifically syringes. In business terms this is product life cycle. Basically the product life cycle is the actual life of and associated costs going from raw material to end used product. This is becoming more important as more countries and companies are moving more towards environmental accounting – looking at all the costs associated with the manufacture of a product or service delivered. So as Anthony pointed out an efficient manufacture could save more than ten times the energy used compared to an inefficient manufacturer. Often the costs are passed onto the consumer, and large buyers (namely governments) should weigh these factors in when purchasing. However, often there is more political incentives to buy from a non efficient producer (who may dump the product as less than cost) than from efficient producers. This is where external oversight in terms of purchasing may help – (using a neutral third party buyer –UNICEF). Also as Anthony points out in his sides is the cost of the waste product in terms of health hazards from the medical waste and disposal costs, which is the reverse side of the supply chain that often does not get looked at. The input like Anthony's is to get people to discuss what the current practice is now and why we need to continue to look at ways to improve how we deliver vaccines - in terms of environmental terms Another point I would add to Anthony’s argument is that you should factor in what is delivered by the syringe. Recent research into adjuvant (The Economist), scientist better understand a bit more about the process and are looking for a better adjuvant than alum. If say the oil-in-water-emulsion adjuvant works with number of traditional vaccines in terms of requiring less than the normal amount antigen to be effective, then this could (as a hypothetical premise) lead to the need of small dose syringes though all studies on dose reduction with adjuvants to date have used the normal volume of injection. Or if a newer adjuvant is developed that is compatible with non-oil base polymer products such as those based on starch from corn silk or other plant material which are more biodegradable, which would have the same qualities in terms of safety in delivery of aqueous formulations. This could lead to reductions in costs associated with the whole life cycle to include the reverse supply chain/disposal side. Rowan Wagner ([[email protected]][email protected][/email]) ----------- Dare I ask Anthony to provide the sums, not that I dispute the numbers, but if they are correct and if the high end numbers are in Annex A countries, there are CDM benefits to be earned in parallel with initiates to rectify such climatic examples of robbing Peter to pay Paul. Terry ([[email protected]][email protected][/email]) Post generated using Mail2Forum (http://www.mail2forum.com)
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