Cost of immunization coverage surveys in low- and middle-income countries.

Introduction: Immunization coverage surveys are one of the best ways to assess program performance. However, surveys can be costly endeavors, and their costs are not well-documented, particularly in low- and middle-income countries (LMICs). Methods: This research brought together a scoping review of the literature on survey methods and costs in LMICs; qualitative interviews from a range of funders of health and immunization coverage survey; and a quantitative analysis of costs from 33 surveys. We collected and systematically categorized survey design and cost information for a range of immunization coverage surveys conducted in low- and middle-income countries between 2013 and 2025. Total and unit costs were compared across regions, survey type, survey method, and conflict setting. Results: The median total survey cost was $300,000, ranging from $28,000 to $2.87 m depending upon survey method and geographic scope. Lot Quality Assurance Sampling (LQAS) surveys had lower median total costs. The cost per household was highest in Latin American countries and lowest for East African countries. Post-campaign coverage surveys (PCCS) had the highest cost per person surveyed. Major cost drivers included personnel, transportation, and field work costs. Technical support can account for an average of 30% of survey costs. Discussion: Adequate planning and budgeting of immunization coverage surveys are essential for ensuring sufficient financing and quality implementation. Findings from this study can provide benchmarks for better budgeting and financing of immunization coverage surveys, leading to improved quality. Survey cost and budget information should be regularly analyzed and reported to enhance our ongoing knowledge.