Vaccine storage and distribution between expanded program on immunization and medical store department in Tanzania: a cost-minimization analysis

Abstract

In 2016, the Tanzanian government shifted the vaccine supply chain responsibilities from the Medical Store Department (MSD) to the Expanded Program on Immunization (EPI) to reduce costs. However, cost estimates that informed the decision were based on invoice value of vaccines and related supplies, rather than a proper economic evaluation study. Therefore, this study aims to compare the actual storage and distribution costs of vaccines and related supplies between MSD to EPI. Micro-costing approach was used to estimate resource use at MSD and EPI for the year 2018. Data were collected through a review of documents, warehouse databases, and interviews with key staff at MSD and EPI. We included both capital and recurrent costs. Microsoft Excel® was used for analysis with input data from the UNICEF forecasting tool, WHOs vaccine volume and capacity estimation tool, diesel generator calculator, and supply chain service fee estimator version 1.02. The total vaccine storage and distribution costs were estimated to be USD 1,996,286 at MSD and USD 543,648 at EPI. Distribution and program management costs represented 41% (USD 819,288) and 38% (USD 762,968) of the total costs at MSD, while storage and distribution costs represented 43% (USD 234,423) and 34% (USD 184,620) of the total costs at EPI, respectively. The cost drivers at MSD were fuel and transport (21%), receiving and dispatch (19%) and, program management personnel cost (14%), while at EPI were storage space (20%), program management personnel cost (18%) and fuel and transport (15%). The storage and distribution of vaccines in Tanzania via the EPI reduced the vaccine supply chain cost to about 27% of the program costs at MSD.