1Family, Womens’s and Children’s Health (FWC)

DEPARTMENT OF IMMUNIZATION,VACCINES AND BIOLOGICALS

Flutool plusWHO Seasonal Influenza Immunization Costing Tool (SIICT)

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Flutool plus: WHO Seasonal Influenza Immunization Costing Tool (SIICT). Pilot version 1.0

ISBN 978-92-4-000403-0 (electronic version)ISBN 978-92-4-000404-7 (print version)

© World Health Organization 2020

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Suggested citation. Flutool plus: WHO Seasonal Influenza Immunization Costing Tool (SIICT). Pilot version 1.0. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

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Printed in English

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Preface

This manual was previously issued under the title “WHO Flutool for plan-ning and costing maternal influenza vaccination, pilot version 1.0” (WHO/IVB/16.07), which was restricted to costing influenza immunization specifi-cally for the influenza risk group of pregnant women. Following validation through pilots, the Flutool was updated to the Flutool Plus which allows for cost estimation for influenza target groups.

Acknowledgements

This manual and the related tool was developed by Ann Levin, Winthrop Morgan, Raymond Hutubessy, Philipp Lambach and Marc Perut.

Financial contributions: Financial support for the development and pilot-testing of this manual is provided through the Centers for Disease Control and Prevention (CDC), which provides financial support to the World Health Organization Initiative for Vaccine Research (U50 CK000431).

Recommended citation: Flutool plus – WHO Seasonal Influenza Immuniza-tion Costing Tool (SIICT). Geneva: World Health Organization; 2019.

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Contents

1.  Introduction 1

2.  What the Flu Costing Tool is costing out for influenza vaccine introduction 2

Cost components of influenza vaccination 2

Recurrent costs 3

Capital costs: introduction costs, supplemental cold chain and other equipment 3

Financial and economic costs 4

3.  The SIICT structure 6

Colour-coding in the SIICT 7

Cover Page 8

Home Page 8

Table of Contents 9

Software requirements for SIICT 9

Reports and Charts 10

4.  Gathering and entering data for the SIICT: SETUP 11

Setup Worksheets 11

5.  Detailed Costing Assumptions Worksheets (Optional) 17

Appendices 20

Appendix 1. Glossary of terms 21

Appendix 2. List of data requirements 22

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1.  INTRODUCTION

Seasonal influenza causes considerable morbidity and mortality worldwide. Three pathogens – influenza A, B and C viruses – cause outbreaks, usually during the winter. Seasonal influenza is particularly dangerous for several target populations:

1

Pregnantwomen

2

Healthworkers

3

Childrenunder five

Adults aged 65and above

4 5

People withchronic healthconditions

The expanded FLUTOOL focuses on planning and costing of influenza vaccination programs to include all of these target populations.

Vaccines have been developed against influenza A and B viruses and are a useful form of preven-tion against seasonal influenza in pregnant women.

Governments are considering different approaches to reducing the incidence of seasonal influenza among the target populations in the expanded FLUTOOL

Vaccination year-round or seasonal vaccination during five months

Vaccination with supplementary immunization activities (SIAs)

In order to facilitate decision-making on these interventions, programme managers and policy-makers need information on the projected costs of introducing influenza vaccine to pregnant women, health workers, children under five, adults 65 and over and persons with chronic health conditions. The Seasonal Influenza Immunization Costing Tool (SIICT) has been developed to assist governments to estimate the costs of influenza vaccine introduction for these populations and is described in detail in this user guide.

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2.  WHAT THE FLU COSTING TOOL IS COSTING OUT FOR INFLUENZA VACCINE INTRODUCTION

The costing tool enables the user to estimate the value of incremental (additional) resources required to add the influenza vaccine to an existing vaccination programme. That is, it estimates only the value of new resources needed and does not include the cost of other goods and services (e.g. transport) already being used for other vaccines. For example, the tool does not estimate the cost of transporting influenza vaccine if this is part of the same transport used to deliver other vaccines from the central warehouse to the periphery in the country.

The quantity of resources required to introduce influenza vaccine to national immunization pro-grams (NIPs) will differ from other vaccines since it targets some non-traditional populations – i.e. health workers, adults 65 and over, and people with chronic diseases. Service delivery strategies could range from vaccination at fixed clinics or routine outreach to supplementary immunization activities. The SIICT enables the user to estimate the additional resource requirements based on the specific strategy that will be used for vaccinating the target populations in the country.

The SIICT provides estimates of several cost measures

Total costs of adding the influenza vaccine for each target population to specific regions/provinces or at the national level

Cost per immunized child, person or health worker

It differentiates recurrent (operational) and capital costs as well as financial and economic costs. It also present expenditures required for initial investments required for the influenza vaccine introduction.

Cost components of influenza vaccination

The SIICT allows the user to estimate the costs of activities that take place during the introduc-tion of influenza vaccination into a national immunization programme. These activities include the following: procurement of vaccines and injection supplies, micro-planning, training, social mobilization and IEC (information, education, communication), purchase of cold chain equip-ment, service delivery of vaccines to target population, monitoring and evaluation, supervision, and waste management.

In the following section, the differences between types of costs are discussed.

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What the Flu Costing Tool is costing out for influenza vaccine introduction

Recurrent costs

Recurrent costs are the value of resources that last less than one year (Table 1). These include programme costs such as the value of personnel time, transport, maintenance, monitoring and evaluation, and supervision, as well as the costs of short-term training activities that last less than a year (i.e. do not include material development and initial training).

Table 1. Vaccination activities and associated recurrent costs

Vaccination activity Recurrent costs

Vaccine procurement and storage Vaccines, injection supplies, freight, clearance, insurance and taxes

IECHealth personnel time, printing, production of leaflets, posters, radio and television spots

Service delivery Health personnel time, per diem expenses, transport

Supervision Supervisor time, driver time, per diem expenses, transport

Monitoring and evaluation Vaccination cards, tally sheets, surveillance, AEFI

Waste management Fuel for incinerators

Capital costs: introduction costs, supplemental cold chain and other equipment

Capital costs are the value of resources that last longer than one year, such as cold chain equip-ment and vehicles. The capital goods and services used in influenza vaccination include initial investments such as introduction costs (micro-planning, initial training and social mobilization/IEC material development) as well as additional cold chain equipment, vehicle requirements, and incinerators (Table 2). Capital costs in the SIICT are found under the worksheets:

a. Introduction Costs,b. Supplemental Cold Chain,c. Other.

Table 2. Vaccination activities and associated capital costs

Vaccination activity Costs

Vaccine procurement and storage Additional cold chain equipment requirements

IntroductionMicro-planning, initial training, curriculum development, IEC material development/sensitization meetings

Waste management Additional incinerators

Other transport Additional vehicles, motorcycles, boats, bicycles, etc.

Calculation of capital costs differs from calculation of recurrent ones since these are annualized and/or discounted depending on the purpose of the analysis and whether financial or economic costs are preferred.

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What the Flu Costing Tool is costing out for influenza vaccine introduction

Financial and economic costs

Both financial and economic costs are calculated in the SIICT. Financial costs are resources purchased by the buyer (e.g. government) for influenza introduction. Resources purchased for the influenza vaccine introduction include injection supplies, outreach allowances and per diem, and resources used in training, developing new communication materials,,and supervision and monitoring. Financial costs do not include donated items and in-kind resources.

Economic costs comprise the value of all outlays for the vaccine introduction: i.e. financial costs as well as the value of in-kind resources used for the intervention. In-kind resources include those already paid for by the Ministry of Health, donated goods, and other sources of financing (e.g. the salaries of health personnel, vaccines paid for by partners, and time of volunteers). This analysis gives a more complete picture of resources that are tied up in the provision of the new vaccine, and their opportunity costs and should be used if a cost-effectiveness or cost-benefit analysis is to be conducted. This analysis is useful if users are interested in evaluating the share of different sources of finance for the vaccine introduction. For example, users may want to know the share of total costs financed by the Ministry of Health, external partners, clients and the community.

Capital costs are calculated differently depending on whether financial or economic costs are being estimated. When calculating financial costs, straight-line depreciation is used in the cal-culation of capital costs. That means that the cost of the item is annualized by dividing it by the useful life-years of the item. For example, if cold chain equipment could be expected to last for 10 years, the total cost would be divided by 10. Straight-line depreciation assumes that capital goods are used up equally over the useful time period of the item. For economic costs, capital goods are discounted as well as annualized. This type of depreciation assumes that people prefer to use goods and services now rather than in the future.

Table 3 presents a comparison of resources included in cost estimation based on whether financial or economic costs are being calculated. For micro-planning, for instance, the value of personnel time spent in meetings is included in economic costs but not in financial costs.

The main differences between financial and economic costing are threefold

The time spent by health personnel and volunteers is valued in economic costing since there is an opportunity cost to this time – i.e. the workers are unable to spend time on other activities when they are occupied with influenza vaccination – but it is not included in financial costs since these are already paid for with government salaries.

The value of donated goods and services is included in economic costs but not in financial costs since there is an opportunity cost to their use.

Capital costs are calculated differently for financial and economist costs.

A glossary of terms used in the cost analyses in the Expanded FLU tool is found in Appendix 1.

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What the Flu Costing Tool is costing out for influenza vaccine introduction

Table 3. Resources by vaccination activity for financial and economic costs

Vaccination activity Financial costs Economic costs

Procurement of vaccines and injec-tion supplies

� Cost of vaccines and injection sup-plies to government

� Cost of freight, clearance, insurance and taxes

� Cost of vaccines and injection supplies regardless of source of financing

� Cost of freight, clearance, insurance and taxes

Micro-planning

� Per diems and travel allowances

� Venue rental

� Transport

� Personnel time spent in meetings

� Per diems and travel allowances

� Venue rental

� Transport

Training

� Development of training materials

� Per diems and travel allowances

� Venue rental

� Transport

� Training materials

� Stationery

� Value of personnel time spent on training

� Development of training materials

� Per diems and travel allowances

� Venue rental

� Transport

� Training materials

� Stationery

IEC/social mobilization

� Facilitator time in meetings

� Per diems and travel allowances

� Stationery

� Printing of materials

� Production of TV and/or radio spots

� Value of personnel, and volunteer time spent on material development and other activities

� Facilitator time in meetings

� Per diems and travel allowances

� Stationery

� Printing of posters and leaflets

� Production of TV and/or radio spots

Service delivery

� Transport fuel

� Personnel per diems to travel to vaccination sites

� Supplies – e.g. cotton

� Value of personnel time spent on vaccination

� Transport fuel

� Personnel per diems to travel to vaccination sites

� Supplies – e.g. cotton

Monitoring and evaluation

� Tally sheets or registers

� Pens and pencils

� Vaccination cards

� Materials for surveillance

� Tally sheets or registers

� Pens and pencils

� Vaccination cards

� Materials for surveillance

Supervision

� Travel allowances

� Transport fuel and maintenance

� Stationery

� Value of personnel time spent on supervision

� Travel allowances

� Transport fuel and maintenance

� Stationery

Waste management

� Purchase of incinerators (annualized)

� Fuel

� Transport

� Purchase of incinerators (annualized/discounted)

� Fuel

� Transport

Cold chaine quipment

Cold chain equipment (annualized)Cold chain equipment (annualized and discounted)

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3.  THE SIICT STRUCTURE

The SIICT has a cover page, a home page, and a table of contents. The tool contains four sections:

1  REPORTS AND CHARTS

2  SETUP (Required)

3  DETAILED COSTING ASSUMPTIONS WORKSHEETS (Optional)

4  APPENDICES

In the Reports and Charts section, there are four worksheets:

1  REPORTS AND CHARTS

d. Dashboard

e. Service Delivery

f. Graphs & Charts

g. Incremental Costing Summary and What-if Tool

In the Setup section, there are thirteen worksheets:

2  SETUP

a. Time Period – Assumptions

b. Financial – Assumptions

c. Labels

d. Target Populations and Coverage Estimates

e. Microplanning

f. Procurement

g. Distribution

h. Training

i. Social Mobilization /IEC

j. Service Delivery

k. Supervision, Monitoring and evaluation

l. Cold Chain Expansion

m. Other Activities

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The SIICT structure

In the section entitled ‘Detailed Costing Assumptions Worksheets,’ there are eight worksheets:

3  DETAILED COSTING ASSUMPTIONS WORKSHEETS

a. Detailed Microplanning Cost Estimate

b. Detailed Distribution Cost Estimates

c. Detailed Preparatory Training Cost estimate

d. Detailed Social Mobilization and Communication Cost Estimate

e. Detailed Supervision Cost Estimate

f. Detailed Routine Vaccination Add-on Cost Estimate

g. Detailed Special Immunization Activities Cost Estimate

h. Detailed other Activities Cost Estimate

The Appendices section includes worksheets on reference data and cost ingredients; a sub-section on Model documentation.

Buttons at the top of each page allow the user to go to each section easily.

Colour-coding in the SIICT

In the SIICT, cells are colour-coded and shaded to indicate their purpose. That is, the colour, shading, or border indicates whether these are for 1) inputting data, 2) linked to another cell in the workbook, 3) calculated, 4) not filled, or 5) for labels, as can be seen in Table 4.

Table 4. Colour-coding in the SIICT

Cell Font colourCell background shading

Cell background pattern

Cell border Symbol

Input number Blue Yellow None Dotted None

Input percentage Blue Yellow None Dotted %

Input dollars Blue Yellow None Dotted $

Linked name Black Light brown None Double blue line None

Linked number Black Light brown Dotted Single black line None

Linked percentage Black Light brown None Double blue line %

Linked dollars Black Light brown None Double blue line $

Calculated number Black Light brown Small dots Double blue line None

Calculated dollars (not totals) Black Light brown Small dots Solid Line $

Calculated dollars (totals) Black Light brown Small dots Solid Line $

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The SIICT structure

Cover Page

The cover page provides information on the sponsor and developers of the SIICT, as can be seen in Figure 1.

Figure 1. Screenshot of Cover Page

Home Page

Figure 2. Screenshot of Home Page

The home page has five columns. The first column shows the summary results for the model version. The second column has links to the worksheets with country characteristics: time period, financial rates, custom labels, and target populations. The third column has links to the

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The SIICT structure

worksheets for cost components such as microplanning and procurement while the fourth column has links to all of the detailed costing worksheets. Note that the latter worksheets in column 4 are used for calculation of costs to enter into the required costing worksheets in column 3. The last column provides links to reports and what-if tools.

Table of Contents

The table of contents is entitled Contents as shown in the screenshot in Figure 3. In this work-sheet, there are links to each of the sections. Each entry in the table of contents has links to the worksheets.

Figure 3. Screenshot of Table of Contents worksheet

Software requirements for SIICT

The SIICT is designed to be used with Microsoft Excel 2010 so that it can make use of the drop-down menu feature. However, it can also be used with Microsoft Excel 2007 although the user must fill in some information manually in a few places where there are dropdown menus.

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The SIICT structure

Reports and Charts

The first section in the SIICT is entitled REPORTS AND CHARTS. It has four worksheets:

a. Dashboard

b. Service Delivery – Analysis and What-if Tool

c. Graphs & Charts

d. Incremental Costing Summary and What-If Tool.

The first worksheet, the Dashboard, summarizes the costs, outputs such as number of persons vac-cinated by target population, and cost per output.

Figure 4. Screenshot of the Dashboard worksheet

The Service Delivery – Analysis and What-if Tool worksheet shows the incremental cost by service delivery type as well as the cost if changes were made to the assumptions such as the proportion of service delivery types. The Graphs worksheet shows graphs of the estimated financial and eocnomic costs. The last worksheet, Incremental Costing Summary and What-If Tool, shows the cost by activity.

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4.  GATHERING AND ENTERING DATA FOR THE SIICT: SETUP

The second section is for tool setup or data entry. Before entering data, the user should examine the worksheets under SETUP and determine whether there is consensus on the service delivery strategy to be used – i.e. will the vaccination take place at fixed health clinics and/or supplemen-tary activity immunization, will the vaccination take place over 5 or 12 months? What is the plan for training? Will the vaccine be phased in or delivered nationwide? What other assumptions are required for the influenza vaccination for each target population in their country? Specifying information on the service delivery strategy is a necessary input into the tool.

After the strategy has been defined, the tool can be used to estimate/project the costs of imple-menting one strategy or comparing the costs of implementing two or more strategies. For example, the government may want to compare the costs of introducing influenza vaccine at fixed clinics versus SIAs. In that case, the user should make a copy of the SIICT and fill in the costs for each of the strategies so that these can be compared.

After the user has identified the strategies to be costed in the SIICT, s/he should gather the data required for the analysis. A list of data that need to be collect ed for the tool is given in Appendix 2. Once the user has gathered the data needed for the SIICT, he or she can begin the data entry.

To enter data into the workbook, the user must turn off the worksheet protection. To do this, the user should do the following: go to FILE, press on INFO, and then put in the password to unprotect the worksheet. The password is MYFLUTOOL.

Setup Worksheets

This section has worksheets for filling in data on country labeling and timing of vaccination. The first worksheet is Time Period – Assumptions and has yellow cells where the user can fill in the time periods for the financial year end and model start month. The second worksheet entitled Financial Assumptions is for entering information on currencies, the annual discount rate, and cost types. The third worksheet, Labels, is for entering information on the country labels – i.e. country name, health system infrastructure, service area names, target populations, and venues for vac-cination. After filling in the labels, the names will be automatically copied to other worksheets in the tool. Figure 5 shows a screen shot of the worksheet.

The next worksheet (see Figure 6) is Target Populations and Coverage Estimates and is for entering the populations sizes of the target populations for influenza vaccine by groups and subgroups targeted for vaccination.

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Gathering and entering data for the SIICT: SETUP

Figure 5. Screenshot of Labels

Figure 6. Screenshot of the Target Population and Coverage Estimates Worksheet

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Gathering and entering data for the SIICT: SETUP

Microplanning Estimates

This worksheet (see Figure 7) is for entering data on activities and resource use for microplanning. In the first table, enter the names of microplanning activities and the scope of each activity. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

Figure 7. Screenshot of Micro-planning Estimates

Procurement Estimates

This worksheet is for entering information needed to estimate the costs of procurement. In the first section, the target populations and number of vaccinations to be administered are shown. The user should review the list of target populations and their coverage as well as the total number of vaccines that would be administered to ensure that these are correct. Then they should fill in information on the presentation of the vaccine(s) (e.g. single vaccine dose in vial or single vaccine dose in prefilled auto-destruct syringe) and injection supplies. Next they should enter assump-tions on the estimated wastage (%) and reserve-buffer stock (%).

In the bottom of the worksheet, the user should enter procurement sources and unit costs of the vaccines and injection supplies.

Distribution Estimates

This worksheet is for entering information on distribution costs for the vaccines (see Figure 8). In the first table, the user should list the activities required for influenza vaccine distribution and the scope of each activity. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

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Gathering and entering data for the SIICT: SETUP

Figure 8. Screenshot of Distribution Estimates Worksheet

Training

This worksheet (see Figure 9) is for entering information on training costs. In the first table, the user should list the activities required for training and the scope of each activity. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

Figure 9. Screenshot of Training Worksheet

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Gathering and entering data for the SIICT: SETUP

Social Mobilization/IEC Estimates

This worksheet is for entering information on Social Mobilization/IEC Estimates. In the first table, the user should list the activities required for social mobilization/IEC and the scope of each activity. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

Figure 10. Screenshot of Social Mobilization/IEC Worksheet

Service Delivery – Immunization Activities

This worksheet is for entering information on Service Delivery. In the first table, the user should list the activities required for social mobilization/IEC and the scope of each activity. They should also list the number of activities that will be completed in a day or other time period.

Figure 11. Screenshot of Service Delivery – Immunization Activities Worksheet

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Gathering and entering data for the SIICT: SETUP

In 1a, the user should enter the % of vaccinations that are provided through each service delivery method. Then the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

Supervision, Monitoring and Evaluation Estimates

This worksheet is for entering information on Supervision, Monitoring and Evaluation Estimates. In the first table, the user should list the activities required for Supervision, Monitoring and Evalu-ation and the sources of information. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

Cold Chain Expansion

This worksheet is for entering information on Cold Chain Expansion. In the first table, the user should list the activities required for Cold Chain Expansion and their scope. In the second part, the user should fill in the estimated cold chain storage required at national, regional and other lev-els. They should fill in the proportion of different types of vaccines to be stored at any time. They should also fill in the availability of cold storage available for influenza vaccines before any expan-sion. The spreadsheet will then calculate the shortfall of cold storage space before expansion.

Figure 12. Screenshot of Cold Chain Expansion Worksheet

Other Activities – Estimates

This worksheet is for entering information on Other Estimates. In the first table, the user should list the activities by whether these are recurrent or for capital acquisition. In the second part, the user should enter estimates of costs of activities. There is a link to detailed costing sheets where the user can enter the list of resources used for the activities, their quantities used, and prices to calculate the costs of activities.

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5.  DETAILED COSTING ASSUMPTIONS WORKSHEETS (Optional)

In this section, the user can enter detailed costing assumptions in order to calculate costs of activities that will be conducted for influenza vaccine introduction. There are eight worksheets for detailed costing: microplanning, distribution, training, social mobilization and communica-tion cost, supervision, routine vaccination, special immunization activities, and other activities.

Detailed Microplanning Cost Estimate Worksheet

This worksheet (see Figure 13) is used to estimate the cost of Microplanning meetings. The user should first list the personnel that take part in microplanning, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

Figure 13. Screenshot of Detailed Microplanning Cost Estimate Worksheet

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Detailed Costing Assumptions Worksheets (Optional)

Detailed Distribution Costs Estimates Worksheet

This worksheet is used to estimate the cost of Distribution of vaccines such as preparing customs releases, planning a distribution plan, planning routes, translation of package insert, and unload-ing refrigerated trucks... The user should first list the personnel that take part in distribution, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

Detailed Preparatory Training Cost Estimate Worksheet

This worksheet is used to estimate the cost of Preparatory Training activities. The user should first list the personnel that take part in training, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering informa-tion on any supplies and materials that will be used as well as other direct costs.

Detailed Social Mobilization and Communization Costs Worksheet

This worksheet is used to estimate the cost of Social Mobilization and Communication activi-ties such as managing press inquiries and appearances and preparing national press releases. The user should first list the personnel that take part in social mobilization and communication, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

Detailed Supervision Cost Estimate Worksheet

This worksheet is used to estimate the cost of Supervision activities. The user should first list the personnel that take part in supervision, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any sup-plies and materials that will be used as well as other direct costs.

Detailed Routine Vaccination Add-On Cost Estimate Worksheet

This worksheet is used to estimate the cost of Routine Vaccination Add-on activities. The user should first list the personnel that take part in Routine Vaccination Add-on, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

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Detailed Costing Assumptions Worksheets (Optional)

Detailed Special Immunization Activities Cost Estimate Worksheet

This worksheet is used to estimate the cost of Detailed Special Immunization activities. The user should first list the personnel that take part in Detailed Special Immunization activities, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

Detailed Other Activities Cost Estimate Worksheet

This worksheet is used to estimate the cost of Detailed Other activities. The user should first list the personnel that take part in Detailed Other activities, their role, and the number of days or hours (specify) that will be spent on this activity. In the second table, the user should list the amount of per diem that will be paid to personnel in these meetings. Other tables are for entering information on any supplies and materials that will be used as well as other direct costs.

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APPENDICES

The Appendices in the tool include the following worksheets:

a. Reference Data,

b. Cost Ingredients,

c. Model Documentation.

Other appendices in the user manual include a glossary of term (Appendix 1) and a list of data requirements (Appendix 2).

The worksheet Reference Data is for entering information on prequalified seasonable influenza vaccines and their vaccine packed volume per dose. The second worksheet on Cost Ingredients is for entering cost categories and prices of cost items by type (recurrent and capital).

Model documentation includes two worksheets:

a. About Flutool,

b. About Flu.

The worksheet About Flutool provides information on the purpose of the tool and the uses of the tool. The worksheet About Flu provides information on seasonal influenza.

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Appendix 1.  Glossary of terms

Annualization: Division of total costs by life expectancy of the good, used to WORK the cost of a capital good over its lifetime.

Capital items: Goods that last for longer than one year, such as equipment

Cost-effectiveness analysis: Comparison of the costs and effectiveness of alternative ways of achieving the same objective.

Depreciation: Amount of capital used during one year

Discounting: Accounts for time preference through calculating the present value using the dis-count rate.

Economic costs: Estimates all costs of an intervention, regardless of the source of funding, so that the opportunity cost of all resources is accounted for in the analysis, includes in-kind and donor contributions. Takes into account resources that are tied up for one activity and are not available for other purposes (opportunity cost). Also allows for the fact that people prefer receiving goods and services now rather than later in the future (time preference) and includes discounting for capital items.

Financial costs: Estimates the actual monetary flows of the buyer such as the Ministry of Health. Does not include the value of resources already paid for, such as personnel time.

Introduction costs: Introduction costs are initial one-time programmatic activities and include micro-planning, initial training activities, and initial sensitization/IEC. These are treated as capi-tal costs in economic costing.

Investment costs: Initial expenditures used in preparation for an intervention. These include introduction costs plus purchase of capital goods such as cold chain equipment and transport purchases.

Opportunity costs: The cost of an alternative that must be foregone in order to pursue a certain action.

Present value: The current value of goods or services, usually applied to costs or outcomes expected in the future.

Recurrent items: Goods or items used in the delivery of a service or intervention that last less than a year, e.g. personnel salaries.

Straight-line depreciation: This type of depreciation assumes that all of the benefit from the capital good is work evenly spread throughout its lifetime; it involves annualizing the total costs but not discounting.

Time preference: Preference for receiving goods and services at one time over another, usually expressed as wanting goods and services now rather than later in the future.

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Appendix 2.  List of data requirements

■ COUNTRY CHARACTERISTICS

■ Administrative levels ■ Types of health personnel working in immunization by target population group ■ Types of health facilities where vaccination will take place ■ Names of second-level areas in countries (e.g. regions, provinces or districts)

■ PROGRAMME VARIABLES

■ Immunization coverage goal (%)

■ ECONOMIC VARIABLES

■ Exchange rate ■ Annual discount rate (%)

■ PROCUREMENT VARIABLES

■ Vaccine wastage rate (%) ■ Vaccine buffer/reserve stock (%) ■ Syringe wastage rate (%) ■ Syringe buffer/reserve stock (%) ■ Safety box wastage rate (%) ■ Safety box buffer/reserve stock (%) ■ Safety box capacity (number) ■ Subsidized cost per dose of vaccine (unloaded) ■ Unsubsidized cost per dose of vaccine (unloaded)

■ TRAINING VARIABLES

■ Health workers trained per operational dispensary (number)

■ SOCIAL MOBILIZATION AND IEC VARIABLES

■ Sensitization meetings per health facility (held in new dispensaries only) (number) ■ Personal IEC materials printed per FIC (#) (e.g. brochure, handout) ■ Collateral IEC materials printed per active health facility (# each year) (e.g. posters,

hangers, wall charts) ■ Cost to broadcast one radio public service announcement ■ Local radio public service announcements (PSAs) per year per active region ■ Cost to broadcast one television public service announcement ■ National television public service announcements (PSAs) per year

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■ SERVICE DELIVERY VARIABLES

■ Average number of minutes per visit for influenza vaccine (number) ■ Proportion of vaccinations administered in health facility (%)

■ MONITORING & EVALUATION VARIABLES

■ Allocation of supervision costs to influenza vaccine programme (%) ■ National supervisory trips per year (number) ■ Days per national supervisory trip (number) ■ Regional supervisory trips per year (number) ■ Days per regional supervisory trip (number) ■ District supervisory trips per year (number) ■ Days per district supervisory trip (number) ■ Average cost of fuel per litre (TZS) ■ Fuel allotment for a national supervisory tour (number of litres) ■ Fuel allotment for a regional supervisory tour (number of litres) ■ Fuel allotment for a district supervisory tour (number of litres) ■ Tally sheets per operational dispensary per year (number, includes wastage ) ■ Vaccination cards if required (includes wastage ) ■ Cost of post-introduction evaluation

■ DELIVERY VARIABLES AND ASSUMPTIONS BY REGION

■ Target population defined as the number of eligible vaccinees in target populations by region by year

■ Number of operational health facilities and outreach sites used for influenza vaccination

■ PRICE DATA FOR COSTS OF MICROPLANNING, DISTRIBUTION, TRAINING, SOCIAL MOBILIZATON

AND IEC, SUPERVISION, and ROUTINE VACCINATION/SIAs

Salaries and per diems ■ Salaries by type of staff* (including benefits) ■ Per diems by type of staff*

Vehicle- and transport-related prices ■ Travel allowances ■ Fuel price per litre

Workshops and meeting prices ■ Daily hall rental charges for workshops ■ Daily meals and refreshments (breakfast, lunch and dinner)

* use Table A1 below

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Material design, production and printing prices ■ Printing costs per

– Tally sheets

– Vaccination cards ■ IEC charges for

– Print material development and production

– Radio spot development and production (Develop one set of coordinated radio spots (:60)(:30)(:15))

– Television spot development and production (Develop one set of coordinated television spots (:60)(:30)(:15))

– Printing leaflets (assumes print run of 10 000 or more)

– Printing posters (assumes print run of 10 000 or more)

– Airing radio spots (assumes block purchase of one month of spots)

– Airing television spots (assumes block purchase of one month of spots)

Table A1. Local salaries and per diems in local currencies

Salaries including benefits Per diem

National EPI manager

National administrator

National surveillance officer

National cold chain officer

Other (specify)

National EPI training and communication officer

National data manager

National assistant data officer/manager

National supplies officer

National driver

Second-level (regional/provincial) medical officer

Second-level (regional/provincial) health officer

Second-level (regional/provincial) cold chain/logistician

Second-level (regional/provincial) reproductive and child health coordinator

Second-level (regional/provincial) assistant cold chain officer

Second-level (regional/provincial) cold chain officer

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Salaries including benefits Per diem

Second-level (regional/provincial) secretary

Second-level (regional/provincial) driver

Third-level (e.g. district) medical officer

Third-level (e.g. district) health officer

Third-level (e.g. district) health secretary

Third-level (e.g. district) cold chain/logistics officer

Third-level (e.g. district) reproductive and child health coordinator

Third-level (e.g. district) assistant cold chain officer/technician

Third-level (e.g. district) secretary

Third-level (e.g. district) driver

Health facility clinical officer-in-charge

Health facility nursing officer/nurse midwife

Health facility health officer/health assistant

Health facility laboratory assistant

Health facility driver

Health facility volunteer

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CONTACT INFORMATIONRaymond Hutubessy Philipp LambachImmunization, Vaccines and Biologicals Department World Health OrganizationEmail: influenzavaccine@who.int Website: www.who.int