Burkina Faso's immunization costing and financing situation
Macroeconomic and health system context
Since 1991, the Government of Burkina Faso has implemented several macro-economic and structural reforms. These actions have focused on creating economic growth capable of generating revenues to improve the population’s living standards, particularly in the more resource-constrained rural areas. However, economic growth has not been as high as expected due to recent political and natural event taking place in the country. In 2001, per capita GDP was $203 and economic growth declined to 4.6% in 2002 from 5.6% in 2001. The health sector implemented reforms between 1990 and 1996 that resulted in the decentralization of health services. In 2001, per capita total expenditures on health were $6.1.
Immunization programme objectives
Burkina Faso’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 2002 was 41%. The national immunization programme’s objectives are to increase immunization coverage of infants aged 0-11 months and pregnant women to national levels by 2009; to introduce hepatitis B and Haemophilus influenza type b (Hib) to routine immunization services in 50% of health districts from 2004 onwards; to reduce vaccine wastage until 2009 by 25% for reconstituted vaccines and 15% for non-reconstituted vaccines; to reduce DTP dropout rate to less than 5% by 2009; to increase polio coverage to 100%; to immunize 90% of infants aged between 9-59 months with measles vaccine during mass campaign; to eliminate neonatal tetanus in the hard to reach high risk areas with supplemental immunization activities between 2004 and 2007; to reach and maintain national performance indicators of AFP monitoring for the certification of the eradication of poliomyelitis by 2004; to reach and maintain national performance indicators outlined with regard to monitoring of cases based on the control of measles by 2004; to reach and maintain national performance indicators outlined with regard to monitoring of cases based on the control of post-maternal tetanus by 2004; to ensure a regular supply of auto-destruct syringes and safety boxes in appropriate quantities to all health facilities between 2004 and 2009; and to ensure that all waste is correctly collected and disposed of at all health facilities by 2009.
Immunization costs and financing
In 2001, the year before Vaccine Fund Support began, Burkina Faso spent $2.7 million to deliver routine immunization services and an additional $6.9 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $12.4 per DTP3 vaccinated child or $0.22 per capita. Spending on routine immunization increased in 2002 to $2.9 million, an increase of 10%, due to an increase in expenditures on the programme. Total expenditures on the NIP in 2002 were $6.5 million.
From 2001 to 2002, the government reduced its funding for the immunization program while donors increased their contributions to the programme. The percent of total expenditures paid by the government decreased from 68% to 60% of overall funding. The government pays mainly for basic vaccines, injection supplies, salaries, transport and capital costs (vehicles and cold chain equipment). The main funding partners are UNICEF, WHO, GAVI/Vaccine Fund, the European Union, the World Bank, the Belgian Cooperation, the Italian Embassy, the Dutch Embassy, and Rotary International, and the World Bank. These donors pay for vaccines, supplementary immunization activities and other operational costs. In Burkina Faso there is also an active participation of the community to support the NIP.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with increasing expenditures on capital costs and other operational costs. It is also projected to increase with planned introduction of new vaccines (Hepatitis B and Hib). The average annual resource requirements during 2003-2006 for the NIP are estimated to be $15.7 million. About two thirds of the funding is considered secured. If funding classified as probable is included as well, approximately three-quarters of requirements are covered during the remaining years with Vaccine Fund support.
During 2003-2006, the gap in funding for the NIP is on average $5.2 million each year if probable funding is not included and $3.9 million if probable funding is included. The average annual gap in the post-Vaccine Fund period during 2007-2009 with secure and probable funding rises to $7.5 million, an increase of 192%. It should be noted, though, that the post-Vaccine Fund projections assume the government is still a recipient of GAVI/Vaccine Fund and is receiving funding for new vaccines.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) advocating for an increase of 6% in the government share allocated to immunization; (2) advocating for local communities to increase their contribution every year for the next 7 years; (3) advocating for the Management Committee's share allocated to immunization to be increased by 5% over the 7 years; (4) to advocate for external partners to increase their contribution by 7% every year for the next 7 years; (5) to advocate for mobilization of resources of the Society and Economic Council fund for immunization; (6) to advocate with the business sector to mobilize additional resources; (7) to simplify and improve budget procedures for the purchase of vaccines; (8) to follow-up on HIPC funds allocated to immunization; (9) to reduce vaccine wastage rates over the 7 year period; and (10) to increase vaccine supplies by 0.5% each year for the next 7 years.