Policy Simulation of Measles Immunization Programs for Children in Borno State

This study conducts a policy simulation exercise on two measles immunization programs for children of age 9-23 months to determine the effectiveness and success of measles vaccination coverage in Borno State, Northern Nigeria.

Author: Eberechukwu Uneze, Sabastine Akongwale & Ibrahim Tajudeen

Publication Date: June, 2011

Document Size: 52 pages

Despite the efforts made by the Nigerian government, policy makers and other stakeholder to increase children vaccination against infections, measles vaccination coverage remains very low. While this problem is more profound in the northern part of Nigeria, its present form in Borno State even requires urgent attention. This study is an attempt to expose the issue. It conducts a policy simulation exercise on two measles immunization programs for children of age 9-23 months – free immunization against measles with media awareness campaign (Policy A) and free immunization against measles with house to house campaign (Policy B) to boost children measles immunization coverage. The study estimates the relative cost and the effectiveness measure such as the health benefits – morbidity avoided and mortality averted. In what follows, it compares the cost per child covered and the cost-effectiveness ratios of the policy alternatives. The cost per child indicates that policy A has a lower cost and lower level of coverage, while policy B has a higher cost and a higher level of immunization coverage. In terms of cost of treating measles and the value of statistical life (VSL), the results of the costeffectiveness analysis show that both policies are efficient. However, policy A has a lower costeffectiveness ratio than policy B.

In terms of paying for the policy alternatives, two funding scenarios as well as the equity distribution were analysed. The equity aspect of the exercise is to ensure that the policies are pro-poor. The findings of sensitivity analysis performed to determine the stability of the results show that the results are not sensitive to changes in the values of the parameters. Overall, since both programs can be implemented (as shown by their cost-effectiveness ratios), the recommendation is that policy B be introduced in the rural areas characterized with high level of illiteracy, uneven distribution of government hospitals, and poor electronic and print media coverage which often discourage or keep parent out of touch of the next vaccination date. However, policy A can be deployed in urban areas where there is reasonable distribution and accessibility of government hospitals, organized electronic and print media coverage and high level of literacy. Lastly, in semi urban areas with moderate literacy, and electronic and media coverage, the best option will be for the government to implement both policies as complements, depending on resource availability.