Azerbaijan's immunization costing and financing situation
Macroeconomic and health system context
Following a period of hyperinflation and economic recession in the early to mid-1990s, the macroeconomic outlook for Azerbaijan has greatly improved. Its economy grew at a rate of 9% from 1997-2003, with low rates of inflation. The economy could potentially expand further if its oil and gas sectors are developed, as planned during the next few years.
Despite the positive economic growth since 1995, government expenditure on health from 1998 to 2003 declined as a percentage of total government spending. One of the reasons for this decline is the existence of budgeting practices that allocates health care financing based on existing use of resources, rather than changing population characteristics and regional differences. Health care reform is currently taking place in the country to improve budgeting practices and also shift to an emphasis on primary health care rather than curative care.
In 2001, per capita total expenditures on health were $27.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 98%. Renewed attention is being paid to improving the immunization programme after disease outbreaks of diphtheria and measles occurred in early 2000s. The national immunization programme objectives are to:
- maintain a high level of coverage with routine and new vaccines (over 90%);
- develop a measles control strategy with a goal of eradication by 2007;
- ensure injection safety;
- provide an adequate supply of high-quality vaccines;
- introduce hepatitis B vaccine other new vaccines into the national immunization schedule.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Azerbaijan spent $1.2 million on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $10.0 per DTP3 vaccinated child, or $0.15 per capita. Programme-specific spending on routine immunization increased by 19% in 2003, the second year of GAVI Fund support, due to an increase in expenditures on vaccine and health worker salaries.
The percent of total expenditures paid by the government increased slightly during the two years, to 62% in 2003, since the government began paying for vaccines. The government pays mainly for vaccines, injection equipment, salaries, transport costs, maintenance and overheads, and cold chain equipment. Donors pay for other vaccines, injection supplies, supplementary immunization, and capital costs. The main funding partners are the GAVI Fund, UNICEF and Vishnevskaya-Rostropovich Fund (VRF).
Immunization financing by source - 2003
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with increasing expenditures on salaries and other operational costs. The average annual resource requirements during 2004-2005 for the NIP are estimated to be $2.0 million. About 90% of the funding is considered secured. If funding classified as probable is included as well, 100% of needs are covered for the entire period.
The average annual gap in the post-GAVI Fund period during 2007-2013 with secure and probable funding staying at approximately the same levels as during the remaining GAVI Fund years.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- improve accuracy and timeliness of projections of vaccine and cold chain equipment needs;
- investigating the potential for use of international mechanisms for vaccine procurement to ensure that the lowest vaccine prices can be obtained;
- increase donor assistance for the immunization;
- explore options for sharing costs between various health programmes and interventions; and
- conduct burden of disease studies to assess whether there is an epidemiological justification for new vaccine introduction.