Determinants of cost of routine immunization programme in India

Susmita Chatterjee, Arpita Ghosh, Palash Das, Nicolas A. Menzies, Ramanan Laxminarayan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


The costs of delivering routine immunization services in India vary widely across facilities, districts and states. Understanding the factors influencing this cost variation could help predict future immunization costs and suggest approaches for improving the efficiency of service provision. We examined determinants of facility cost for immunization services based on a nationally representative sample of sub-centres and primary health centres (99 and 89 facilities, respectively) by regressing logged total facility costs, both including and excluding vaccine cost, against several explanatory variables. We used a multi-level regression model to account for the multi-stage sampling design, including state- and district-level random effects. We found that facility costs were significantly associated with total doses administered, type of facility, salary of the main vaccinator, number of immunization sessions, and the distance of the facility from the nearest cold chain point. Use of pentavalent vaccine by the state was an important determinant of total facility cost including vaccine cost. India is introducing several new vaccines including some supported by Gavi. Therefore, the government will have to ensure that additional resources will be made available after the support from Gavi ceases.

Original languageEnglish (US)
Pages (from-to)3836-3841
Number of pages6
Issue number26
StatePublished - Jun 18 2018

All Science Journal Classification (ASJC) codes

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


  • Cost
  • Determinant
  • India
  • Routine immunization


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