Overview of domestic immunization financing arrangements

Dr. Michael McQuestion Dr. Cliff KamaraMs. Dana Silver

Sustainable Immunization Financing ProgramAnglophone African Peer review workshop

Nairobi, Kenya26 October 2015

Routine immunization costs

Country Facility annual costs Cost/infant Cost/FIC % VaccinesBenin 14,994 19 25 65Uganda 23,470 20 44 34Ghana 16,460 36 51 19Zambia 28,286 60 66 32Honduras 12,069 113 128 38Moldova 11,943 317 332 14

Mean routine immunization program costs, 2013,EPIC study countries (2011 US$)

Source: Brenzel, Young and Walker (2015), Table 5, Fig. 3.

Source: UNICEF contract prices as of May 8, 2014. Calculations based on lowest available price. Abbreviations: RV=rotavirus; PCV=pneumococcal conjugate vaccine; Penta=pentavalent vaccine containing diphtheria-tetanus-pertussis-Haemophilus influenza type b (Hib)-Hepatitis B; DTP=diphtheria-tetanus-pertussis; MCV=measles-containing vaccine; MR=measles-rubella; OPV=oral polio vaccine; BCG=Bacillus Calmette-Guerin; HPV=human papillomavirus vaccine. Costs in current (2014) dollars. *Note: Adding a 3-dose course of HPV (4.50/dose) increases the 2014 vaccine cost to $35 for girls ages 9-13.

NMean

(Std Dev) NMean

(Std Dev) NMean

(Std Dev) NMean

(Std Dev) NMean

(Std Dev)

AFR 31/4715

(34) 29/4712

(27) 28/475

(7) 33/478

(16) 34/4710

(12)

AMR 27/35167(81) 27/35

132(76) 25/35

138(75) 25/35

133(48) 15/35

229(91)

EMR 10/2112

(19) 9/2120

(27) 9/2112

(18) 9/2113

(14) 8/2129

(25)

EUR 13/52159

(222) 11/52192

(302) 10/52160

(104) 9/52132

(148) 9/52139

(229)

SEAR 8/114

(4) 6/116

(5) 6/116

(4) 8/117

(4) 9/119

(8)

WPR 12/2729

(30) 8/2753

(62) 12/2734

(143) 11/2747

(159) 11/2758

(197)

Global 101/19339

(84) 90/19343

(97) 90/19331

(97) 95/19336

(101) 86/19344

(128)Notes: Population weighted means; Brazil 2012, Uganda 2011 excluded; Mid-year exchange rates used.Sources: WHO/UNICEF JRF (Indicator 6730); UN Population Division; OANDA

Government R. I. expenditures per surviving infant (US$)2012 2013 201420112010

Increasing country investments

Improving JRF reportingGovernment R.I. expenditures per surviving infant (US$), SIF

Country 2010 2011 2012 2013 2014 Armenia 15 25 86Cambodia 1 1 3 6 24Cameroon 7 8 4 5 6Congo 1 5 9 10 16DR Congo 0 1 2 2 1Ethiopia 17 2 13Georgia 41 88 21 46 68Indonesia 2 15 4 10Kenya 4 4 4 3Liberia 3 2Madagascar 1 1 2 3 Mali 9 3 0 8Moldova 16 52 47Mongolia 0 24 21 41 36Nepal 1 4 26 6 3Nigeria 4 7Senegal 4 17 2 7Sierra Leone 0 2 6Sri Lanka 32 35 15Uganda 3 10Uzbekistan 1 16 15Vietnam 6 7 8 7 9Mean 9 13 11 13 19

Weighted mean 5 10 6 6 10Sources: WHO/UNICEF Indicator 6730; UN Population DivisionNote: mid-year exchange rates used

Sources of immunization financing

• Domestic– Public revenues, royalties

• earmarked government funds– Private sector donations– Out-of-pocket (households)

• External– Foreign aid, loans– Gifts – Remittances (households)

Domestic financing mechanisms

• Public (governments)– Regular health budget

• federal• sub-national

– Social insurance programs– Special (ring-fenced) funds

• Private– Special funds (corporations)– Employment, private insurance (households)

Domestic financing mechanisms

– Public-private financing• public ring-fenced fund + private trust fund• proposed: Kenya, Nepal, Nigeria, Senegal, Uganda

– National immunization fund• actual: Mongolia, Senegal• proposed: Cameroon, Kenya, Uganda

– Shared federal and provincial financing• actual: DRC• proposed: Sri Lanka

Thank You!!!

PEFA standards• Credibility of the budget - The budget is realistic and is implemented as

intended• 2. Comprehensiveness and transparency - The budget and the fiscal risk

oversight are comprehensive, and fiscal and budget information is accessible to the public.

• 3. Policy-based budgeting - The budget is prepared with due regard to government policy.

• 4. Predictability and control in budget execution - The budget is implemented in an orderly and predictable manner and there are arrangements for the exercise of control and stewardship in the use of public funds.

• 5. Accounting, recording and reporting – Adequate records and information are produced, maintained and disseminated to meet decision-making control, management and reporting purposes.

• 6. External scrutiny and audit - Arrangements for scrutiny of public finances and follow up by executive are operating