Burundi's immunization costing and financing situation
Macroeconomic and health system context
The socio-political crisis has resulted in a worsening of Burundi’s economic indicators, a freeze on external financing and a slowdown in economic activities. National income has fallen sharply and the reduction in financial resources has led to a heavy debt burden, rising inflation, negative growth in GDP and a budget deficit. Growth in GDP declined from 4.5% in 1992 to 2.5% in 2002 and in 2001, the per capita GDP was $107. The socio-political conflict in Burundi has also affected the health status of the population and has made it difficult to organize and provide access to basic health care in general and to conduct routine immunization services. Per capita health expenditure in Burundi is $3.9.
Immunization programme objectives
Burundi’s immunization coverage for 2001 is estimated to be 74% according to the WHO and UNICEF best estimates. The national immunization programme’s objectives are to increase immunization coverage for infants to 90% by 2006; to increase immunization coverage for pregnant women to 85% by 2006; and to increase immunization coverage for women of child-bearing age to 10% by 2005 and to 20% by 2006. Specific objectives of the immunization programme include the following: conducting catch-up campaigns; strengthening staff capacities; strengthening management of the programme at all levels of the health system; introducing new vaccines; strengthening disease surveillance; and strengthening partnerships between government ministers as well as stakeholders.
Immunization costs and financing
In 2001, the year before Vaccine Fund support began, Burundi spent $0.9 million to deliver routine immunization services and an additional $0.9 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $4.8 per DTP3 vaccinated child or $0.14 per capita. Spending on routine immunization increased in 2002 to $1.0 million, an increase of 15%, due to an increase in expenditures on the programme and mainly through the additional GAVI/Vaccine Fund support. Total expenditures on the NIP in 2002 were $3.1 million.
The government’s contribution remained about the same from 2001 to 2002 at 5% of overall expenditures on immunization. Donors, other than GAVI/Vaccine Fund, decreased their contributions to the programme during the same period. The government pays mainly for salaries, transport and recurrent costs while donors pay for vaccines, injection supplies, some operational costs, supplementary immunization and capital equipment. The main funding partners in Burundi are UNICEF, WHO and GAVI/Vaccine Fund.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase due to population growth and with planned introduction of new vaccines in 2004 (Hepatitis B and Hib). The average annual resource requirements during 2004-2008 for the NIP are estimated to be $5.1 million. Over 80% of the funding is considered as secured during these years.
During 2004-2008, the gap in funding for the NIP is on average $0.9 million each year if probable funding not included and less than $0.1 million if probable funding is included. The average annual gap in the post-Vaccine Fund period with secure funding rises to $4.2 million, an increase of nearly 500%. It should be noted, though, that the post-Vaccine Fund projections assume the government is still a recipient of GAVI/Vaccine Fund and is receiving funding for new vaccines.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) the mobilization of internal resources through increased state budget allocation, the participation of NGOs and the private sector, and participation of local authorities and health centers; (2) the mobilization of external resources; and (3) improving the effectiveness and efficiency of resource management for immunization.