The Pakistan Expanded Program on Immunization and the National Immunization Support Project: an economic analysis

Type Report
Title The Pakistan Expanded Program on Immunization and the National Immunization Support Project: an economic analysis
Publication (Day/Month/Year) 2016
Publisher The International Bank for Reconstruction and Development / The World Bank
City NW Washington
Pakistan faces a formidable challenge in eliminating the polio virus from the
country. With transmission of the polio virus substantially slowing in the Africa region, the
only two countries worldwide with ongoing endemic polio transmission may soon be
Pakistan and Afghanistan. A substantial number of the polio cases or infant paralysis
occurring in Afghanistan is linked to cross-border transmission from Pakistan. The ongoing
cycle of polio infection is not just a tragedy for the children of Pakistan, it is a global public
health emergency constituting one of the final barriers to permanently eradicating polio.
The outbreaks of vaccine-preventable diseases in Pakistan result in significant costs to
individuals and to society. These include costs associated with visits to health care
providers, hospitalizations, disability, and premature deaths. Despite a slow decline over
the past 10 years, the under-five mortality rate in Pakistan remains high, with more than
400,000 deaths annually in this demographic over the past twenty years. Pakistan is
lagging behind other South Asian countries in improving this indicator.
This paper demonstrates clear economic benefits and efficacy of the National
Immunization Support Project (NISP), which is financing interventions in terms of DALYs
saved, and establishes that this approach is affordable and economically effective with a
high rate of return. In addition to increased investment, the effectiveness of the Expanded
Program on Immunization can be enhanced by improving the capacity building of health
professionals, as well as by improving logistics of program interventions to reach
marginalized populations, remote areas, and pockets of resistance. An increased financial
investment alone will be insufficient to address the root causes of persistent undercoverage
of immunization in Pakistan. It is imperative that ample attention and resources
be diverted to strengthen the procurement systems, local and provincial management
capacity, and reporting mechanisms, among other capacity improvements.

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