REQUEST FOR PROPOSAL. Analyses of the Costs and Financing of Routine Immunization Programs and New Vaccine Introduction

Transcription

1 REQUEST FOR PROPOSAL Analyses of the Costs and Financing of Routine Immunization Programs and New Vaccine Introduction DEADLINE: FRIDAY, APRIL 6, 2012; 17:00 PST DAMIAN WALKER, SENIOR PROGRAM OFFICER GLOBAL HEALTH DEPARTMENT 1

2 Analyses of the Costs and Financing of Routine Immunization Programs and New Vaccine Introduction Document Purpose OVERVIEW The purpose of this Request for Proposal (RFP) is to solicit consultant information, services information, and cost quotations in order for the Bill & Melinda Gates Foundation (the Foundation ) to identify several consultants ( Consultant ) to undertake two to three (2-3) analyses each of the costs and financing of routine immunization programs in countries that have introduced new vaccines in 2011, or that plan to introduce in early 2012; and to examine the costs of vaccine introduction, unit costs, and productivity as well. This would result in a total of six to eight (6-8) country studies total under this activity. Please note that consultant may refer to the potential provider of services which may, in this case, be a for-profit, not-for-profit, or academic institution. This RFP is intended to solicit proposals from organizations and researchers based in lower and middle-income countries and/or regions, in order to facilitate South-South learning and build capacity in undertaking cost and financing analyses. As one of the deliverables of this assessment, we would expect that there would be one, or more articles prepared for, and submitted to peer-reviewed journals. About the Bill & Melinda Gates Foundation Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people s health 2

3 and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people especially those with the fewest resources have access to the opportunities they need to succeed in school and life. Based in Seattle, the foundation is led by CEO Jeff Raikes and co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett. Project Background The cost and financing of national immunization programs have been evaluated since the early 1980s, particularly as part of Universal Childhood Immunization (UCI) by Early estimates suggested that the cost per child fully immunized against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles was $20 on average (Brenzel and Claquin, 1994). This average figure was confirmed in subsequent studies (Levin A and Kaddar M, 2000). However, around the time of the development of the GAVI Alliance Financial Sustainability Plan (FSP) and the subsequent comprehensive multi-year plan (cmyp) that evaluates current and future costs and financing of national immunization programs, the number of stand alone costing exercises of immunization service delivery has dwindled or the focus has shifted. This occurred at the same time as countries introduced new vaccines, and in many cases, multiple new vaccines. With the cmyp, countries estimate and plan for the national program resource requirements and financing. Estimates made in the baseline year are currently the most reliable source of information on program costs, and several papers have been written summarizing the results of analyses (WHO, Immnization Financing However, there is variability in how these figures are constructed, and whether they are based on input costing (economic costs) or reflect a summary of program expenditures (financial costs). Further, the results of the cmyps provide limited information on the delivery cost per dose or per 3

4 infant by type of vaccine (traditional or specific new vaccine). As such, it is challenging to raise resources to support ongoing routine program delivery costs without this information. In addition, the ability to understand the costs associated with introduction of new vaccines is limited, as the cmyp tool does not set aside a specific analysis of vaccine introduction costs. While the GAVI Alliance New Vaccine application does include a worksheet on the costs of new vaccine introduction (GAVI Alliance, it is generally believed that these under-estimate the true costs of new vaccine introduction. Therefore, despite various potential data sources on costs of routine immunization programs and vaccine introduction, reliability and validity of these data needs strengthening. There are few published articles on the costs of new vaccine introduction. Griffiths, et al (2009) estimated the cost of Hib vaccine introduction in Ethiopia as part of a Post-Introduction Evaluation (PIE) conducted with WHO. There is currently a set of new studies (unpublished at the time of this writing) on the introduction costs associated with Human Papiloma Virus (HPV) vaccine. Information regarding the financing of immunization programs also needs updating. One study (Lydon et al, 2008) found that governments contribute 42% of total financing for routine programs, and there is some recent unpublished evidence that government financing as a proportion of total financing may be increasing. However, there is limited information regarding government financing of vaccines. The main data sources are the WHO-UNICEF Joint Reporting Form and the cmyps. The GAVI Alliance Co-Financing Policy was adopted by the Board in 2006, implemented beginning in 2008, and subsequently revised in The current policy requires countries to co-procure between $010 and $0.30 per dose of their new vaccines depending upon their level of GNI/capita (GAVI Alliance 2011). Countries with a GNI/capita greater than $1500 that are graduating from GAVI Alliance must increase the amount paid per dose of vaccine by 20% per year in 4

5 order to be close to the expected market price at the time of graduation. Despite the relatively low unit prices required by countries under the Co-Financing Policy, some countries face challenges in meeting their requirements year after year, particularly when introducing more than one new vaccine. In addition, there is ad hoc evidence that countries may be paying for co-financing requirements at the expense of being able to fully finance traditional vaccines or other parts of their routine immunization program. Understanding the flow of financing for new vaccines will be critical for the sustainability of programs. Therefore, there is limited up-to-date knowledge on the full economic costs and financing of routine immunization, as well as the financial cost and financing of new vaccine introduction. The policy implications of having accurate cost and financing information are several. For instance, these data can be to improve planning of resource requirements and financing needs at the country level. Understanding the delivery costs associated with new vaccine introduction will be important for updating GAVI Alliance policies on new vaccine introduction support, and for domestic and external resource mobilization for routine programs. Documented information on financial flows for new vaccines and routine programs, particularly from government sources, will be useful inputs into policy dialogue on sustainability and co-financing of new vaccines. It is anticipated that these analyses will help shed light on areas where the cmyp costing and financing tool could be strengthened and also on how costing and financing analyses might be linked with the Post-Introduction Evaluations (PIEs) conducted in countries usually six months after new vaccine introduction ( This exercise will encompass 6-8 countries overall, with successful respondents to this RFP undertaking 2-3 country analyses each, either at national or sub-national levels as appropriate. Facilitation in working at the country level will come from partners, such as the WHO and UNICEF. 5

6 The purpose of this exercise will be to provide detailed estimates of routine program costs and financing primarily for routine programs that have introduced a new vaccine in 2011, and to provide estimates of the delivery costs of new vaccine introduction, unit costs and productivity as well. This exercise will examine recurrent inputs such as personnel, vaccines, injectables and other supplies, training and per diem, supervision, cold chain maintenance, maintenance of other equipment, social mobilization-advocacy, surveillance, program management, other operating costs; and capital inputs, such as cold chain, vehicles, and other associated capital costs. Analyses will be conducted in countries that have introduced one or more new vaccines in the previous year, particularly pneumococcal, rotavirus, meningitis A, and pentavalent vaccines. Because there are several ongoing efforts to estimate the introduction costs of HPV vaccines, these will not be included at this time. In addition to building the evidence-base on costing and financing of routine programs and new vaccine introduction, this exercise will also strengthen collaboration between in-country institutions, researchers, and international experts to build capacity to conduct cost and financing analyses of the NIP. The aim is to catalyze a longer-term process and investment on collecting and analyzing routine immunization program cost and financing information. The main questions to be addressed in these analyses are the following: 1. What is the total cost of the routine immunization program in countries that have introduced new vaccines (pentavalent, pneumococcal, rotavirus, and HPV)? 2. What is the cost structure (cost by line item) of total costs generated above, particularly cold chain recurrent and capital costs? 3. What are the delivery costs associated with the routine immunization program (delivery costs per dose, per infant) variation by level of output 6

7 4. What is the cost of vaccine introduction by major line item in countries that have introduced new vaccines? 5. What are the unit costs of the routine program and what are factors that drive this variation? 6. How do the costs of vaccine introduction compare with budgets for introduction? 7. What are the main sources of financing of the routine immunization program, and what are the sources of financing of vaccines as compared to operating costs and capital investments? 8. Are there any funding gaps or areas of the program that remain under-funded or unfunded? 9. How does productivity (doses/fte or other measure) of the routine program vary within the country, and what is the relationship between costs and levels of output? Project Scope Respondents to this RFP are expected to propose their approach for collecting and analyzing: 1) full economic and financial costs of the routine immunization program; 2) incremental costs and financing of new vaccine introduction; and, 3) financing of the routine immunization program in up to three selected countries that have introduced a new vaccine in 2011, or that plan to introduce in early 2012; and to examine the costs of vaccine introduction, unit costs, and productivity as well. Respondents may consider conducting a prospective analysis of new vaccine introduction in one country, either introducing a single new vaccine, or multiple new vaccines in the early part of Respondents should rely on internationally accepted and standard approaches for costing health and immunization services, such as the Guidelines for standardization of economic evaluations in the field of vaccine-preventable diseases (WHO/IVB/08.14); Immunization costing and financing: A tool and user guide for comprehensive Multi- 7

8 Year Plan (WHO/IVB/06.15); Guidelines for Estimating the Costs of Introducing New Vaccines into the National Immunization System ( (WHO, 2002); and, the OneHealth Model (IHP+). The analysis can entail collection of economic and financial costs. The WHO National Health Accounts methodology may be a useful starting point for evaluating funding flows for national programs though a full NHA for immunization programs is not envisioned. The analysis should include a survey of delivery sites as well as an analysis of administrative costs at national and sub-national levels. The aim of having a sample of delivery sites is to be able to explain variation in costs. Respondents should provide a description and rationale of selection of delivery sites and the proposed sampling frame. For budgeting purposes, a minimum of 25 facilities and a maximum of 50 facilities should be selected for data collection in each country. The respondent should provide an explanation as to why fewer or more facilities are required. Respondents are also to describe other information will need to be collected as explanatory factors related to immunization program costs and productivity, and how this information will be obtained and utilized in the analysis. Depending upon the countries selected, sub-national cost studies may be useful to conduct. The focus of this exercise is on routine program costs and financing, and excludes costs and financing of supplementary immunization activities (SIAs). The vaccine schedule associated with the routine program may vary by country. For instance, a relatively new vaccine that has been provided in a country for three years or more may be considered to be part of routine immunization for the purpose of this analysis. Annex 1 provides an initial list of countries that have introduced new vaccines in 2011 or are planning to introduce new vaccines in 2012 (WHO, 2012). The respondent should carefully consider the rationale for country selection. 8

9 Specific Tasks of the Successful Consultant(s): The successful Consultant(s) will be responsible for the following tasks: 1) Participate in all meetings (in-person and remote) convened by the Foundation regarding this exercise, including an initial launch/methodology workshop; a meeting pertaining to updating and reviewing progress; and a workshop to disseminate results. 2) Collaborate and participate in a review of methods developed and used over the years, and the methods proposed by each Consultant to generate a final methodology to be used for all of the country analyses. 3) Select countries and work collaboratively with the Ministry of Health, the National Immunization Program (NIP) management, partner agencies and other relevant stakeholders to successfully implement the exercise in each country. Obtain relevant clearances and IRB approvals to conduct data collection and analysis, as required. 4) Collect cost and financing information from a sample of health facilities and administrative units in 2-3 countries based on a sound sampling strategy developed as part of the initial launch workshop. Ensure highest quality and reliable data through quality control. 5) Undertake data entry and analysis of routine program costs and financing, and the costs and financing of new vaccine introduction in 2-3 selected countries using the final methodology: a) Estimate the total annual cost of the routine immunization program; b) Estimate and compare (across facilities or districts as relevant) unit costs of the routine immunization program, including cost per capita, cost per dose administered, cost per infant vaccinated, and cost per infant receiving the third dose of DTP. c) Estimate the total and unit costs of new vaccine introduction, including cost per infant and per dose of vaccine. 9

10 d) Estimate and compare a range of productivity parameters (across facilities or districts as relevant), such as cost/dose delivered; doses/full-time equivalent; and other possible indicators to be determined; and describe how explanatory factors will be utilized in the analysis. 6) Undertake a flow of funds analysis for the national immunization program, by identifying all sources and amounts of financing and for which aspects of the national (or sub-national) program, including sub-national sources of financing, and financing of cold chain costs. In addition, the source(s) of co-financing payment as well as for financing of traditional vaccines will also be a focus of this analysis. a) Estimate any financing gaps for the routine program (for the period of the analysis, 2011 or 2012). b) Estimate any financing gaps for new vaccine introduction (what the program would have undertaken had financing been available); 7) Conduct a series of comparisons of the cost and financing estimates, such as: a) Compare total costs and financing with country cmyp data to identify similarities and/or gaps, and areas that require further strengthening. b) Compare/contrast cost estimates in the most relevant version of the cmyp with the EPI budget and MOH budget (gazetted) to determine the extent to which estimated resource needs are potentially being financed by national government resources. c) Estimate the non-vaccine delivery costs associated with new vaccine introduction and compare these with the funds received from the GAVI Alliance for new vaccine introduction. d) Compare total and unit costs to government health expenditure and GDP in order to have a better picture of the affordability and sustainability of the program. 10

11 8) Conduct a qualitative/descriptive analysis of the planning and budgeting processes for routine immunization programs in selected countries. Describe resource mobilization and efficiency strategies of the national program. 9) Develop a draft report and annexes for review. 10) Prepare a final report for each country study that includes relevant background, objectives, methods, results, discussion, and conclusions/recommendations. 11) Prepare a powerpoint presentation summarizing the final country report. 12) Provide the data and databases generated for each country analysis. Organization of the Exercise and Role of the Foundation The Foundation, with support from the GAVI Alliance Immunization and Financial Sustainability Task Team (IF&S), will have a coordinating role for these studies to ensure that: a) a common methodology is used for all country analyses; b) there is information sharing between the institutions undertaking the work; c) relevant partners are engaged and kept informed of the progress of the work and results in order to facilitate country-level engagement and commitment for the studies; and, d) wide dissemination and sharing of results. A Steering Committee, comprised of members of the IF&S (including WHO Regional Focal persons) and technical experts, will be convened by the Foundation to oversee the selection of successful candidates and to monitor progress in implementing these analyses. In order to successfully conduct these analyses, other partners, such as WHO and UNICEF will need to be engaged in order to facilitate dialogue with 11

12 ministries of health to obtain commitment and to provide input and context. The Foundation will be responsible for synthesizing the country-specific results into a policy relevant document, as well as convening the initial launchmethodology meeting and any subsequent meetings related to sharing progress with data collection and analysis and dissemination of results. Intent and Disclaimer This RFP is made with the intent to identify a consultant to deliver results as described above and in other areas of this RFP. The Foundation will rely on Consultant s representations to be truthful and as described. The Foundation assumes it can be confident in Consultant s ability to deliver the product(s) and/or service(s) proposed in response to this RFP. The response will be incorporated into a future contract should the Foundation wish to purchase the product(s) and/or service(s). This RFP is not an offer to contract. The Foundation assumes no responsibility for Consultant s cost to respond to this RFP. All responses become the property of the Foundation. If the Foundation amends the RFP, copies of any such amendments will be sent to all consultants selected for this RFP. Release Consultant understands that the Foundation has chosen to solicit a RFP for the Analyses of the Costs and Financing of Routine Immunization Programs and New Vaccine Introduction project from a variety of consultants, and that Consultant s response does not guarantee that the Foundation will enter into a new contract with Consultant or continue any current contract(s) with Consultant. Consultant agrees that the Foundation may, in its sole discretion: (1) amend or cancel the RFP, in whole or in part, at any time; (2) extend the deadline for submitting responses; (3) determine whether a response does or does not substantially comply with the requirements of the RFP; (4) waive any minor irregularity, informality or nonconformance with the provisions or procedures of the RFP; (5) 12

13 negotiate with any and all consultants the Foundation deems acceptable; (6) issue multiple awards; (7) share responses generated by this RFP with consultants the Foundation may retain to help it evaluate them; and (8) copy the responses. Consultant also agrees that all responses become the property of the Foundation. In exchange for the opportunity to be awarded a contract, Consultant agrees to not bring a legal challenge of any kind against the Foundation relating to the Foundation s selection and award of this contract, even if Consultant is not awarded a contract. Consultant represents that it has responded to the RFP with complete honesty and accuracy. If facts provided in Consultant s response change, Consultant agrees to supplement its response in writing with any deletions, additions or changes within ten days of the changes. Consultant will do this, as necessary, throughout the selection process. Consultant understands that any material misrepresentation, including omissions, may disqualify it from consideration for a contract award. Consultant understands it may receive proprietary and confidential information from the Foundation during the RFP process ( Confidential Information ). Consultant agrees to not use Confidential Information for any purpose other than its participation in the RFP process and to not reveal Confidential Information directly or indirectly to any other person, entity, or organization without the prior written consent of the Foundation. Consultant further agrees to exercise all reasonable precautions to maintain the proprietary and confidential nature of Confidential Information. 13

14 RESPONSE GUIDELINES Response Instructions Please adhere to the following instructions when responding to this RFP: All questions must be answered in order for Consultant to be considered for this RFP. All communication relating to the RFP, with the exception of communications outlined in the RFP Delivery Instructions section below, including questions and clarifications, should be submitted via to: Consultants or their representatives may not contact anyone else within the Foundation regarding this RFP. Any violation of this requirement may result in disqualification from the selection process. Questions submitted by any consultant and associated responses will be distributed to all consultants. Response Contents The Consultant s response should address the purpose and scope of the project as described above. In particular, the Consultant should address the following: A. Describe in detail the methodology you would use to provide the services, including reference methodologies to be used; definitions of costs and cost categories to be evaluated; methods of primary and data collection at facility and administrative levels, including training of enumerators, supervision, and quality control; identification of explanatory variables and methods for data collection; identification of approaches to obtaining detailed information on financing of the routine program; data sources; time period for the analysis; perspective of the analysis; methods for incorporating discounting and annualization, and other methodological details; methods of analysis, including sensitivity analysis; 14

15 B. Identify criteria for country selection and propose the set of countries in which you would implement the analyses. Describe the sampling methodology you would use to select facilities (what types, location, random or purposeful sampling, stratified, etc.); C. Identify in-country and regional stakeholders critical to the successful implementation of the country analyses, and describe how they will be consulted and kept informed of the progress of the analyses, and what role they might have in the implementation of the work; D. Discuss the process for IRB approval for the exercises at country level, including key stakeholders involved, timing, and requirements; E. Identify individuals proposed to undertake the work and describe in detail what aspects of data collection, data entry, analysis and report writing they would be responsible for, and number of days allocated to this activity; F. Provide a sample health facility data collection instrument that could be used to estimate vaccine and personnel costs (not to exceed 2-3 pages in an annex); G. Provide the CVs and a description of the qualifications of the proposed individuals (relevant training, expertise, experience, and familiarity with the countries selected); H. Provide a description of corporate capabilities, including previous relevant experience and clients worked for (including dates of service). Identify the unique capabilities that your firm or institution has that are relevant for successful management and implementation of this project; I. Describe any previous experience working with the Foundation; J. Describe why you are in the best position to take on this project? 15

16 In addition, please provide: A proposed project timeline for each country and overall for the 2-3 countries. It is estimated that this project will begin late April 2012 and be completed (through a dissemination workshop) by 10 December A proposed budget, including details on person-days; a breakdown of professional fees and expenses; details on travel and accommodation; and other relevant costs Three references attesting to the capabilities of the firm or organization, and the lead researchers (names and contact information- and telephone). Response Delivery Instructions The response contents for sections A though E combined should not exceed 10 pages. Submissions can be single spaced and font size should not be smaller than 11 pt. Please an electronic copy of your RFP response in Microsoft Word or Adobe PDF format to: Immunization&VaccineCostAnalysisRFP@gatesfoundation.org Additional materials, such as collateral brochures, white papers and case studies that you reference in your proposal can be mailed to: Bill & Melinda Gates Foundation Attention: Jamie Eckhardt, Global Health Policy & Advocacy PO Box Seattle, WA Foundation Contact Foundation staff will be available to provide clarification on this RFP until the close of business on March 2nd. Please submit any 16

17 questions to: Consultant Contacts Please provide the following primary contact information for the purposes of this RFP: Name: Title: Telephone number: address: Mailing address: Timetable The evaluation and selection process will adhere as closely as possible to the following schedule. However, the Foundation may modify this schedule at its sole discretion. All dates below are COB / 5PM PST. Event Timeframe RFP Launch Date Monday February 27, 2012 Submit Questions about this RFP By Friday March 2, 2012 RFP Questions Answered Friday March 9, 2012 Proposal Due Date Friday April 6, 2012 Notification of Short List of Consultants for Consideration Friday April 20, 2012 Project Start Date On/About Monday May 14, 2012 Selection Criteria Consultant responses will be evaluated against criteria that include: 17

18 1. Soundness of the technical approach (40%) including: Quality and rigor of the data collection and analytical methods proposed; Quality of the sampling strategy and criteria for country selection; Strength of proposed comparisons of unit costs and productivity indicators, as well as analysis of explanatory factors; Overall understanding of the purpose and scope of the project. 2. Experience and technical capabilities of the proposed team (30%) Demonstrated expertise and experience of the proposed team in estimating costs and evaluating financing of primary health care and immunization programs; Knowledge of new vaccine introduction, the GAVI Alliance, and immunization systems; Consultant s proven ability to produce high quality, concisely written technical documents suitable for publication 3. Successful collaboration at country level (15%) Demonstrated ability to work collaboratively at the country level with a range of stakeholders, and ability to create teamwork and ownership of the project with relevant NIP and ministry stakeholders; Ability to trouble-shoot and overcome implementation obstacles arising during field work Ability to work effectively as part of a larger network of researchers/consultants related to this project. 4. Cost of services / budget proposal (15%) 18

19 Annex 1: Selected Country Status with Respect to New Vaccine Introduction Region Country Vaccine Presentation Application Intro Intro Year Status Month Intro Status AFRO C Angola Pneumo Introduced EURO Armenia Rota Planned EURO Azerbaijan Hib Liquid 1 dose 2009 Sept Introduced EURO Azerbaijan Pneumo Planned AFRO W Benin Pneumo PCV Sept Introduced AFRO W Benin Rota Not applied?? Planned AFRO C Burundi Pneumo PCV Sept Introduced AFRO C Cameroon Pneumo PCV Sept Introduced AFRO C CAR Pneumo PCV May Introduced AFRO C Congo Pneumo PCV Sept Planned 19

20 EMRO Djibouti Pneumo SEARO DPR Korea Hib Liquid 10 dose? AFRO C DR Congo Pneumo PCV13 AFRO E&S Ethiopia Pneumo PCV10 AFRO E&S Ethiopia Rota EURO Georgia Rota Rotarix Liquid 2 dose AFRO W Ghana Pneumo PCV13 AFRO W Ghana Rota 2 dose AMRO Guyana Pneumo PCV13 AMRO Guyana Rota Liquid pentavalent 3 dose 2008 May 2009 Sept 2007 Oct 2007 Oct Planned Planned Introduced Introduced Planned Planned Planned Planned Introduced Introduced 20

21 AMRO Haiti Hib? AMRO Honduras Pneumo PCV13 SEARO India Hib Liquid 10 dose AFRO E&S Kenya Pneumo PCV10 WPRO Kiribati Pneumo PCV13 AFRO E&S Madagascar Pneumo PCV10 AFRO E&S Malawi Pneumo PCV13 AFRO E&S Malawi Rota Rotarix Liquid 2 dose AFRO W Mali Pneumo PCV13 EURO Moldova Rota SEARO Myanmar Hib N/A 2007 Oct 2009 June 2008 May 2009 Sept 2009 Sept 2009 Sept 2009 June Planned Nov Early Planned Introduced Partial Introduced Planned Planned Introduced Planned Introduced Planned Planned 21

22 AMRO Nicaragua Pneumo PCV13 AFRO W Niger Pneumo AFRO W Nigeria Hib 10 dose lyophilized EMRO Pakistan Pneumo PCV10 AFRO E&S Rwanda Rota AFRO C Sao Tome Pneumo Liquid pentavalent 3 dose AFRO W Sierra Leone Pneumo PCV13 EMRO Sudan Rota AFRO E&S Tanzania Pneumo AFRO E&S Tanzania Rota Rotarix Liquid 2 dose PCV13 or PCV10 Rotarix Liquid 2 dose 2007 Oct 2009 Sept 2009 June 2009 Sept Introduced Planned Planned Planned 2012 May Planned Planned Introduced Introduced Planned Planned 22

23 SEARO Timor Leste Hib WPRO Viet Nam Hib Liquid 10 dose Liquid 1 dose EMRO Yemen Pneumo PCV13 EMRO Yemen Rota Rotarix Liquid 2 dose AFRO E&S Zambia Pneumo PCV10 AFRO E&S Zambia Rota Rotarix Liquid 2 dose 2008 May 2008 Sept June 2011Conditional Planned Introduced Introduced Planned Planned Partial AFRO E&S Zimbabwe Pneumo PCV Planned Source: Extracted from World Health Organization, IVB. January