Cost of Vaccinating a Child in Iraq (CoVC)

Challenge

As Iraq continues to recover from decades of conflict, the government has made investments to strengthen the health system. While mortality rates and access to care have improved, routine immunization coverage remains stagnant. The 2018 Multiple Indicator Cluster Survey (MICS) found only 49.4% of children 12-23 months in Iraq were fully immunized by age 12 months, lagging behind other countries in the region. Large disparities exist across the Iraqi governorates, among urban and rural communities, conflict recovery zones and by socio-economic status. Despite recovery efforts, coverage in governorates hardest hit by conflict like Anbar (26.3%) remain lower than other parts of the country.

Understanding the barriers to improved immunization coverage are vital for continued investment in the immunization program. Toward this end, UNICEF is undertaking a comprehensive study to tell the story of vaccinations in Iraq by generating evidence on coverage and equity, supply chain management, and cost of the national immunization program. This study, led by UNICEF in partnership with IVAC & the Iraq Ministry of Health (EPI Unit), focuses on estimating the cost of vaccinating a child in Iraq.

Approach

The goals of CoVC are to:

  1. Estimate the annual total and unit cost of the National Childhood Immunization Program in Iraq by program activity category and per fully immunized child
  2. Describe differences in unit costs of vaccine delivery across sites and vaccination strategies for the three sub-national regions: Central and South Zone, Northern Zone, and Conflict Zone
  3. Estimate the out-of-pocket cost for vaccine-seeking, including transportation cost and productivity loss. Assess factors associated with differences in out-of-pocket spending, including geographic and socio-economic differences.

To estimate the cost of vaccinating a child in Iraq in the national immunization program, we are conducting health facility assessments and caregiver exit interviews at primary healthcare centers and vaccine distribution points sampled from the three sub-national regions.