The large-scale introduction of MenAfriVacTM, the meningococcal meningitis A (Men A) conjugate vaccine, in the African Meningitis Belt will substantially modify the epidemiology of epidemic meningitis in the region and impose new challenges to surveillance systems. Whereas the baseline surveillance system for meningitis, so-called enhanced surveillance, aims mainly at outbreak detection to implement appropriate control measures, new questions will need to be addressed, such as vaccine effectiveness, the impact of the vaccine, the detection of serogroup replacement, the dynamics of outbreaks due to other serogroups, etc.
To address these questions, countries introducing MenAfriVacTM will need to upgrade their surveillance systems. The choice of the most suitable system is not straightforward. As of today, no reliable data on the costs of various surveillance strategies are available, although this information is critical to make an informed decision.
In this context, AMP is collaborating on a project to estimate the total and incremental costs of various surveillance strategies within specific countries, so as inform the choice of the most appropriate and sustainable surveillance system. As the coordinator and principal investigator, AMP is implementing the project in Niger. The London School of Hygiene and Tropical Medicine (LSHTM) is co-principal investigator and is implementing the project in Chad. The World Health Organization (WHO) is the project technical advisor, and funding is provided by the Bill & Melinda Gates Foundation.
The study is expected to provide an economic breakdown of the cost implications of existing surveillance mechanisms in Niger and Chad and the costs of upgrading them. It aims to contribute to strengthening surveillance systems to respond to existing and emerging needs, based on what arrangements are plausible in different contexts and their associated costs. The comparison of Niger and Chad country studies is expected to offer further insights to facilitate the extrapolation to other interested countries.
In terms of methodology, a micro-costing approach was adopted. Cost and performance data of meningitis surveillance systems were collected in Chad and Niger in 2013 for the year 2012. The investigation included several levels of the public health system: primary health care facilities, district level, regional level, and central level. The sample included health delivery facilities, laboratories, administration offices, sentinel pediatric hospitals, and partners. Data were collected, based on questionnaires designed specifically for this project.
The study provides the costs of existing surveillance systems in Niger and Chad overall as well as disaggregated by:
- administrative level (national, regional, and district level)
- geographical context (rural or urban)
- resources used (personnel, transport, laboratory and office)
- surveillance system (enhanced vs. case-based)
- capital vs. recurrent costs
- core vs. support surveillance functions
- variable vs. fixed costs
- sources of funding
The research also presents estimations of the expected costs of upgrading current systems into more comprehensive ones.