Côte d'Ivoire's immunization costing and financing situation
Macroeconomic and health system context
After a downturn in economic growth following a military coup in 1999, the country’s economic growth rates improved in 2002. Despite the improvement, the macroeconomic climate is being affected by the civil war taking place within the country and an economic downturn is expected. The government is currently introducing health reforms, including decentralization. In 2001, per capita total expenditures on health were $40.1.
Immunization programme objectives
Côte d’Ivoire’s immunization coverage began to decline in 1999. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 57%. The national immunization programme’s objectives are to increase coverage for all NIP antigens, to reduce wastage rates, to introduce new vaccines – Hepatitis B and Haemophilus influenza type b (Hib), to ensure vaccine safety, to facilitate measles and maternal/neonatal tetanus control, to facilitate integrated disease surveillance, to promote training, and communication for development.
Immunization costs and financing
In 2001, the pre-Vaccine Fund year, Cote d’Ivoire spent $3.4 million on programme-specific expenditures of routine immunization services and an additional $1.7 million on supplementary immunization activities. The programme-specific spending on routine immunization service equated to about $11.6 per DTP3 vaccinated child or $0.21 per capita. Programme-specific spending on routine immunization ($3.2 million) was similar in 2002, the first year of Vaccine Fund support, and total programme-specific expenditures on the NIP were $5.2 million.
The percent of total expenditures paid by the government declined slightly during 2001-2002, from 74% to 61% respectively, and the absolute amount contributed also decreased during this period. The government pays mainly for vaccines, injection materials, salaries, transport costs, and other operational costs while donors pay for other vaccines, supplementary immunization and capital costs. The main funding partners are GAVI/Vaccine Fund, UNICEF, WHO, Rotary International and KFW.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase after the phasing-in of Hepatitis B vaccine is completed in 2003 and supplementary immunization activities are projected to continue. The average annual resource requirements during 2003-2006 for the NIP are estimated to be $10.7 million per year. A little less than half of the funding - government expenditures, and WHO and Vaccine Fund contributions – is classified as secure during these years. If funding classified as probable is included as well, over 90% of needs are covered.
The gap in funding for the NIP is on average $1.0 million a year ($5.7 million if probable funding is not included) during the Vaccine Fund years (2003-2006). The average annual gap with secure and probable funding increases in the post Vaccine Fund years (2007-2010) to $6.2 million, an increase of six hundred percent.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) increasing public funding for the health sector and specifically for the immunization programme; (2) increasing immunization funding from external partners; (3). Mobilize non-governmental resources for immunization funding; (4) simplify and improve budgetary process; (5) increase training of immunization personnel; (6) manage vaccines and services efficiently; (7) reduce costs of pricing tenders, and (8) improve flow of programme resources.