Armenia's immunization costing and financing situation
Macroeconomic and health system context
During the last ten years, Armenia has faced several economic challenges due to the Spitak earthquake, destruction and closure of the industrial sector and the disruption of the existing economic networks with the republics of the former Soviet Union. Recently, the economy has begun to improve and in 2001 GDP per capita was $619. Economic growth is projected to be 6% or more for the period of 2003-2006.
In 1996 the government adopted a programme of health reforms that included privatization of health institutions, decentralization of management, and financing reforms. The government has now shifted from a centrally-funded programme to one that is funded from local budgets, health insurance, and direct payments. In 2001, per capita expenditures on health were $49.
Immunization programme objectives
Armenia’s immunization coverage has remained at the same level for the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 94%. The national immunization programme’s objectives are to reduce morbidity from vaccine-preventable diseases; eliminate child mortality from vaccine-preventable diseases; maintain the country’s polio-free status; and eliminate mumps by 2010.
Immunization costs and financing
In 2001, the year before Vaccine Fund Support began, Armenia spent $1.0 million to deliver routine immunization services. The programme-specific spending on routine immunization service equated to about $35.4 per DTP3 vaccinated child or $0.32 per capita. Spending on routine immunization rose in 2002 to $1.1 million, an increase of 15%, due to the increased expenditures on new and underused vaccines into the programme.
The government’s expenditures on the immunization programme decreased from $0.8 in 2001 to $0.6 in 2002. The percent of total expenditures paid by the government decreased from 78% to 57%, because of the introduction of GAVI/Vaccine Fund support and increased UNICEF funding for vaccines and injection supplies. The government pays mainly for salaries, transport costs, other recurrent costs and some capital costs while donors pay for other injection supplies, some operational costs, and cold chain equipment. The main funding partners are UNICEF, WHO, GAVI/Vaccine Fund, and the private sector.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase slightly due to population growth. The average annual resource requirements during 2003-2006 for the NIP are estimated to be $1.1 million. During the same period, the gap in funding for the NIP is on average $0.16 million each year if probable funding not included. Approximately 86% of the funding is considered as secured during these years.
The average annual gap in the post-Vaccine Fund period (2007-2012) with secure funding increases to $0.2 million. If funding classified as probable is included as well, approximately 85% of requirements will be met as government funding is expected to grow.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability of the immunization programme. These include: (1) taking measures to ensure sustainable financing for the NIP, and in 2005 start financing the renewal of the cold chain equipment and vehicles; (2) have the government gradually phasing out Vaccine Fund resources with financing provided from national sources (starting with 2008); (3) apply to UNICEF and WHO to ensure the continuation of support to training activities; (4) plan the enhancement of training and upgrading of medical personnel for NIP starting in 2005; (5) include immunization in the National Strategy of Poverty Reduction taking into consideration that the programme is a politically and financially viable base for increased and more predictable financing; (6) apply to donor organizations and the Diaspora Armenian unions for support of the NIP; (7) improve stock management of vaccines in order to decrease vaccine wastage; (8) ensure that vaccines are purchased at lowest possible prices; and (9) advocate for external financing and necessary expertise for competent assessment of epidemiological basis for new vaccines.