Expanded national immunization proposal and malaria control program for Outer Islands, Republic of Indonesia; economic analyses of proposal

Study is based on site visits, interviews with Indonesian Ministry of Health officials, and research by the contractor, the American Public Health Association. Economic analysis shows that an expanded immunization program for diptheria, whooping cough, tetanus, and tuberculosis can be cost-effective compared to treatment of the diseases; can provide significant economic benefits for the target population; and can markedly reduce mortality and morbidity. While it is not possible to quantify most of the expected benefits, the program is nonetheless justifiable purely on economic grounds. Employment effects are modest (3-4,000 people) and geographically dispersed; distributional effects are desirable in that most benefits will accrue in rural areas and among low-income groups. A separate analysis shows that the DPT, TFT, and BCG components -- and possibly polio and measles vaccinations as well -- are not cost-effective by themselves but may be economically justifiable as part of a larger immunization program. The proposed Outer Islands malaria control program is only marginally viable when evaluated in terms of quantifiable economic benefits. Assuming the most plausible operating conditions, the benefit/cost ratio is still only 1.07 and the internal rate of return 17% due to the high cost of program operations. This leaves little room for administrative inefficiency or deviation from population targets. Offsetting these economic conclusions are the program"s substantial but unmeasured humanitarian benefits as well as the unquantifiable benefits of encouraging transmigration and reducing the cost of malaria control on Java-Bali-Madura; the importance of these benefits is judgemental but potentially decisive. The program would have large employment effects, providing directly for the training of 20,000 workers. Both employment and benefits would be dispersed regionally and would have desirable effects on income distribution.