Browsing by Author "Simuyemba, Moses C."

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    An evaluation of the consequences of Covid-19 on immunisation programme financing and service delivery in a lower middle income country: the case of Zambia
    (Medical Journal of Zambia, 2024-06-14) Simuyemba, Moses C.; Chompola, Abson; Asiimwe, Gilbert; Masiye, Felix
    The COVID-19 pandemic has disrupted health systems globally, affecting various services, including immunization programs. This study evaluates the impact of COVID-19 on immunization program financing and service delivery in Zambia, a lower-middle-income country, to understand how such disruptions could reshape future healthcare priorities and funding. The study employed a mixed-methods approach, integrating both qualitative and quantitative data collection. Data were gathered at national and sub-national levels, including in-depth interviews with 36 healthcare workers and an online survey completed by 44 staff members. The evaluation focused on the changes in government funding, the effect on static and outreach immunization activities, vaccine supply distribution, and the impact on human resources within the Expanded Programme on Immunisation (EPI). Findings indicated that while regular disbursements to districts improved in 2020, there was heightened competition for limited resources due to COVID-19, leading to a redirection of funds from routine immunization to pandemic-related activities. The study revealed a significant decline in immunization coverage, attributed to reduced health facility visits and outreach sessions. Additionally, financial constraints heightened by the pandemic made it challenging for districts to accommodate the extra costs associated with implementing COVID-19-compliant immunization services. Human resources for immunization were also impacted, with staff being reallocated to COVID-19 response activities, thus increasing workload and stress levels among remaining personnel. COVID-19 has substantially affected the funding, delivery, and human resource components of Zambia's immunization program. Despite an increase in regular funding disbursements, the redirection of funds to COVID-19 activities has strained routine immunization services. The pandemic has highlighted the need for robust health systems that can withstand global health crises without compromising essential services like immunization. Recommendations include closer monitoring of immunization service delivery impacts, assessment of COVID-19's financial implications on immunization, development of clear protocols for service delivery under pandemic conditions, and a re-investment in community engagement and education post-pandemic.
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    An evaluation of the cost of human papilloma virus (HPV) vaccine delivery in Zambia
    (BMC Infectious Diseases, 2024-04-02) Simuyemba, Moses C.; Sinyangwe, Aaron; Asiimwe, Gilbert; Masiye,
    Human papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health Week to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine as well as for full immunisation of two doses. This work was part of a broader study on assessing HPV programme implementation in Zambia. For HPV costing aspect of the study, with a healthcare provider perspective and reference year of 2020, both top-down and micro-costing approaches were used for financial costing, depending on the cost data source, and economic costs were gathered as secondary data from Expanded Programme for Immunisation Costing and Financing Project (EPIC), except human resource costs which were gathered as primary data using existing Ministry of Health salary scales and reported time spent by different health cadres on activities related to HPV vaccination. Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, provincial, district and health facility levels. Administrative coverage rates were obtained for each district. Findings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest economic cost at USD13.2 per dose and USD 28.1 per fully immunised child (FIC). Overall financial costs for school based delivery were US$6.0 per dose and US$12.4 per FIC. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$47.6 per FIC. The main financial cost drivers were microplanning, supplies, service delivery/outreach and vaccine co-financing; while the main economic cost drivers were human resources, building overhead and vehicles. Nurses, environmental health technicians and community-based volunteers spent the most time on HPV related vaccination activities compared to other cadres and represented the greatest human resource costs. The financial cost of HPV vaccination in Zambia aligns favourably with similar studies conducted in other countries. However, the economic costs appear significantly higher than those observed in most international studies. This discrepancy underscores the substantial strain placed on healthcare resources by the program, a burden that often remains obscured. While the vaccine costs are currently subsidized through the generous support of Gavi, the Vaccine Alliance, it’s crucial to recognize that these expenses pose a considerable threat to long-term sustainability. Consequently, countries such as Zambia must proactively devise strategies to address this challenge.
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    Evaluating the functionality and effectiveness of ZITAG and related expanded programme on immunisation technical committees in Zambia
    (Vaccine: X, 2022-12-16) Simuyemba, Moses C.; Chompola, Abson; Asiimwe,Gilbert; Masiye, Felix
    The Zambia Immunisation Technical Advisory Group (ZITAG) was established in 2016 as an advisory body to provide evidence-based recommendations on vaccine policy. As part of the Gave Full Country Evaluation, we evaluated the functionality and effectiveness of ZITAG and related EPI committees through an online stakeholder survey of Interagnecy Coordinating Committee (ICC), ZITAG and Extended programme on Immunisation Technical Working Group (EPI-TWG) members, document review and key informant interviews. The survey was sent out via SurveyMonkey between May and July 2020 to 69 members of ZITAG, ICC or the EPI TWG. A total of 52 individuals responded (75%). Eight key informant interviews were also carried out at the national and global level in September 2020 to elaborate further on some of the quantitative findings and for triangulation. Findingsrevealed that the EPI committees were reasonably functional and effective entities, each with its unique role, though some overlaps occurred. Functionality was shown by having a broad membership with wide expertise and long-serving members; sub-committees existed and meetings were occurring regularly. Leadership and coordination structures also existed and were largely felt to be working well. Funding challenges however persisted, in particular for ZITAG operations and functionality of its subcommittees. Effectiveness and value addition fo the committees to the EPI was illustrated through decision-making processes and evidence use as well as relatively good country ownership in terms of commitment, legitimacy, capacity and accountability. Full independence and ownership may however be compromised by funding challenges. Recent changes to ICC terms of reference and focus beyond immunisation side-lined the EPI and weakened the linkage between ICC and ZITAG with many ZITAG recommendations not having been followed through by ICC as the ultimate endorsing entity.