How countries can finance their immunization programs

1. Overview of domestic immunization financing
arrangements
Dr. Michael McQuestion
Dr. Cliff Kamara
Ms. Dana Silver
Sustainable Immunization Financing Program
Anglophone African Peer review workshop
Nairobi, Kenya
26 October 2015

2. Routine immunization
costs
Country Facility annual costs Cost/infant Cost/FIC % Vaccines
Benin 14,994 19 25 65
Uganda 23,470 20 44 34
Ghana 16,460 36 51 19
Zambia 28,286 60 66 32
Honduras 12,069 113 128 38
Moldova 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.

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.

4. N
Mean
(Std Dev) N
Mean
(Std Dev) N
Mean
(Std Dev) N
Mean
(Std Dev) N
Mean
(Std Dev)
AFR 31/47
15
(34) 29/47
12
(27) 28/47
5
(7) 33/47
8
(16) 34/47
10
(12)
AMR 27/35
167
(81) 27/35
132
(76) 25/35
138
(75) 25/35
133
(48) 15/35
229
(91)
EMR 10/21
12
(19) 9/21
20
(27) 9/21
12
(18) 9/21
13
(14) 8/21
29
(25)
EUR 13/52
159
(222) 11/52
192
(302) 10/52
160
(104) 9/52
132
(148) 9/52
139
(229)
SEAR 8/11
4
(4) 6/11
6
(5) 6/11
6
(4) 8/11
7
(4) 9/11
9
(8)
WPR 12/27
29
(30) 8/27
53
(62) 12/27
34
(143) 11/27
47
(159) 11/27
58
(197)
Global 101/193
39
(84) 90/193
43
(97) 90/193
31
(97) 95/193
36
(101) 86/193
44
(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

5. Improving JRF reporting
Government R.I. expenditures per surviving infant (US$), SIF
Country 2010 2011 2012 2013 2014
Armenia 15 25 86
Cambodia 1 1 3 6 24
Cameroon 7 8 4 5 6
Congo 1 5 9 10 16
DR Congo 0 1 2 2 1
Ethiopia 17 2 13
Georgia 41 88 21 46 68
Indonesia 2 15 4 10
Kenya 4 4 4 3
Liberia 3 2
Madagascar 1 1 2 3
Mali 9 3 0 8
Moldova 16 52 47
Mongolia 0 24 21 41 36
Nepal 1 4 26 6 3
Nigeria 4 7
Senegal 4 17 2 7
Sierra Leone 0 2 6
Sri Lanka 32 35 15
Uganda 3 10
Uzbekistan 1 16 15
Vietnam 6 7 8 7 9
Mean 9 13 11 13 19
Weighted
mean 5 10 6 6 10
Sources: WHO/UNICEF Indicator 6730; UN Population Division
Note: mid-year exchange rates used

6. 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)

7. 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)

8. 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

9. Thank You!!!

10. 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