Benin's immunization costing and financing situation
Macroeconomic and health system context
After positive economic growth of 5.3% from 1996 to 2001, growth rates have been declining to 3% since 2004 while inflation has increased. Despite the economic downturn, spending on high-priority sectors, including the Ministry of Public Health, has averaged 11.6% of GDP.
Previous health sector reforms have led to a drop in funding delays and more targeted spending. Benin’s Poverty Reduction Strategy Paper (PRSP) advocates for better control of public spending from 2005 onwards, and the improvement of resource mobilization mechanisms by 2006.
In order to cope with its high debt level, Benin joined the HIPC (Heavily Indebted Poor Country) Initiative in 2000. HIPC debt relief funds are being used to finance social spending and in particular immunization (funding of traditional vaccines and injection supplies). In 2001, per capita expenditures on health were $15.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 85%. The national immunization programme objectives are to:
- increase nationwide immunization coverage for infants aged 0-11 months to 93% for DTP3 and for pregnant women to 73% by the year 2004;
- introduce the pentavalent vaccine in 2005 (Diphtheria, Tetanus, Pertussis, hepatitis B and haemophilus influenzae type b (Hib) into the national immunization schedule;
- reduce vaccine wastage rates by 2013; and
- reduce drop-out rates by 2013.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Benin spent $1.2 million on programme-specific expenditures for routine immunization services, and an additional $3.7 million on supplementary immunization activities. The programme-specific spending on routine immunization service equated to about $5.0 per DTP3 vaccinated child, or $0.17 per capita. Programme-specific spending on routine immunization increased by 73% in 2003, the second year of GAVI Fund support, due to an increase in expenditures on vaccine and health worker salaries. Total expenditures on the NIP in 2003 were $7.4 million.
Although the absolute amount of total expenditures paid by the government for the programme increased during the two years, the percent of total expenditures decreased to 3%, due to an increase in donor contributions for new vaccines and supplementary immunization. The government pays mainly for 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, WHO, the European Union and the government of Japan.
Routine immunization financing by source - 2003
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase as expenditures on vaccines are projected to rise. The average annual resource requirements during 2004-2010 for the NIP are estimated to be $5.8 million per year. Over 80% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, only 3% of needs are unmet.
Only a small annual gap in funding for the NIP exists ($0.2 million) if both secure and probable funding are included ($1.0 million if probable funding not included) during the remaining GAVI Fund years (2004-2010). During the post-GAVI Fund years (2011-2013), the gap increases to $4.0 million a year if both secure and probable funding are taken into account. In other words, 52% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- advocating for an increase in the national budget's share earmarked for immunization;
- advocating for an increase in HIPC debt-relief funds earmarked for immunization;
- advocating for an increase in funding for immunization by sub-national local authorities;
- advocating for an increase in community funding for immunization;
- advocating for additional donor funding;
- improving the cash flow and disbursement procedures; and
- reducing vaccine wastage.