Albania's immunization costing and financing situation
Macroeconomic and health system context
While economic growth in Albania has fluctuated during the last five years, it is now on a positive track for growth. In 2002, growth fell due to the effects of the election campaign, energy crises and political uncertainty, but the government is now projecting that economic growth will increase to 6% from 2003 onwards.
The Government is implementing reforms, the most important of which is decentralization of key government functions. The Government also plans to increase the salaries of all public service personnel, with larger increases for staff working in the health sector (since remuneration has been lower in this sector than others).
The Health Insurance Fund (HIF) administers two sets of programs:
- contributor-financed benefits covering mainly general practitioner services and subsidies for prescribed drugs; and
- health financing reform initiatives for which finance is channeled from the Budget through the HIF. Some pilot health financing reform initiatives are now being evaluated and the results will shape the future development of the health insurance system.
In 2001, per capita expenditures on health were $85.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 99%. The Albania immunization programme objectives are to:
- achieve and maintain 90% or higher vaccination coverage rates for each EPI antigen at all administrative units;
- introduce new antigens to the national schedule, specifically mumps and Hib vaccines;
- develop and implement immunization policies for high-risk groups;
- strengthen epidemiological surveillance and monitoring of targeted diseases;
- maintain effective cold chain system;
- reduce vaccine wastage rates to operationally possible levels;
- introduce presentation mix analysis for the vaccines supplies to ensure most efficient vaccine prices and combinations;
- strengthen political commitment for immunization;
- strengthen management and coordination of the national immunization programme; and
- ensure immunization safety and safe injection practices during immunization.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Albania spent $0.8 million on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $15.2 per DTP3 vaccinated child or $0.26 per capita. Programme-specific spending on routine immunization decreased slightly by 16% in 2003, the first year of GAVI Fund support, due to a reduction in vaccine wastage.
The government’s expenditures on the immunization programme increased from $0.29 million in 2001 to $0.35 million in 2003. The percent of total expenditures paid by national and regional governments increased from to 51% in 2003. The government pays mainly for salaries, transport, social mobilization and maintenance and overhead, while donors pay for vaccines, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund and UNICEF.
Routine immunization financing by source - 2003
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with increasing expenditures on vaccines, capital costs and other operational costs. The average annual resource requirements during 2004-2006 for the NIP are estimated to be $1.5 million. Over 40% of the funding is considered secured. If funding classified as probable is included as well, approximately 88% of requirements are covered during the remaining years with GAVI Fund support.
During 2004-2006, the gap in funding for the NIP is on average $0.8 million each year if probable funding are not included, and $0.2 million a year if probable funding is included. The average annual gap in the post-GAVI Fund period during 2007-2013 with secure and probable funding stays at approximately the same level as during the remaining GAVI Fund years. In other words, 5% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve the financial sustainability of the national immunization programme. The strategies are to:
- increase the government’s contribution for vaccine purchase;
- increase government contribution for programme operational costs;
- increase government’s contribution for capital costs;
- reduce vaccine wastage;
- increase attendance at vaccine sessions; and
- optimize vaccine combinations.