Government financing for health and specific national budget lines: The case of vaccines and immunization

Immunization Vaccines and Biologicals Department (IVB), Expanded Programme on Immunization (EPI), World Health Organization (WHO), Office: M235, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
Vaccine (Impact Factor: 3.62). 08/2008; 26(51):6727-34. DOI: 10.1016/j.vaccine.2008.06.090
Source: PubMed


A long standing question related to immunization financing and sustainability has been whether the existence of a specific line item for vaccines purchasing within the national health budget can contribute significantly to increasing national government financing of vaccines and routine immunizations. Based on immunization financing indicators from 185 countries collected through the joint WHO and UNICEF monitoring system, this paper attempts to answer this policy question. The study will present findings related to the status of countries that have such specific budget lines for purchasing vaccines and the levels of national budgetary allocation to the financing of vaccines and immunizations, particularly in low-income countries. The analysis shows evidence that the existence ofa specific line in the national budget is associated with increased governmental budget allocations for vaccines and routine immunization financing.

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    ABSTRACT: This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    • "estimated at 94% in the Americas, 92% in Europe, 84% in the West Pacific, 79% in the Eastern Mediterranean, 53% in Africa, and 49% in South East Asia. Having a specific line item for vaccines in the national health budget, as was the case for 86% of countries in 2006, was associated with increased governmental budget allocations for vaccines and routine immunization financing (Lydon et al., 2008 "
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