A new approach to assess the performance of the Brazilian National Immunization Program (NIP)

The present study develops an alternative measure of efficiency to assess the Brazilian National Immunization Program (NIP) using Data Envelopment Analysis (DEA), an output-oriented variable returns to scale (VRS) model, to combine different homogeneity indicators within a unique composite index and evaluate the socio-demographic differences among states. The new DEA index allows homogeneity indicators to be measured for various vaccines in the same model, which enables the development of a composite index for “the first year of life” immunization cycle. In Brazil 2010, the mean efficiency score for the 26 states was 0.89 (0.14 SD). Eleven states were considered efficient, and eight of them were located in regions with a high Human Development Index (HDI) and small rural population, which reinforces the concept that regional and socioeconomic differences must be considered during immunization planning. To reach the frontier of best practice, each state should have an individual and attainable goal for vaccine homogeneity.