Immunization costing and financing situation in the Democratic Republic of the Congo
Macroeconomic and health system context
The combination of factors such as war, epidemics and deterioration of terms of trade for its minerals and resulting productivity breakdown have led to the deterioration of roads, rail and river infrastructures, an economy based on the informal sector, low and irregularly paid wages, and unemployment, and excessive poverty. After a decline of some 6% of its economic growth in the period 1995 to 2000, and of 2% in 2001, the Congolese economy experienced positive GDP growth rates in recent years reaching close to 6% in 2003.
In 2002, per capita expenditures on health were $4.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2002 was 64%. The national immunization programme objectives are to:
- improve the immunization coverage for each antigen;
- work towards the eradication of poliomyelitis;
- control measles;
- eliminate maternal and neonatal tetanus;
- introduce new vaccines (hepatitis B, haemophilus influenzae type b (Hib);
- improve the management of vaccines and injection equipment; and
- ensure injection safety.
Immunization costs and financing
In 2002, the pre-GAVI Fund year, DR Congo spent $5.6 million on programme-specific expenditures for routine immunization services and an additional $25.5 million on supplementary immunization. The programme-specific spending on routine immunization service equated to about $3.8 per DTP3 vaccinated child or $0.11 per capita. Programme-specific spending on routine immunization increased by 65% in 2004, the first year of GAVI Fund support, due to an increase in expenditures on vaccines, injection equipment and personnel salaries.
The share of programme expenditures paid by the national government increased to 5% in 2004, due to a rise in contributions on training and cold chain equipment. The government pays mainly for salaries, training, cold chain equipment, and some supplementary immunization activities while donors pay for vaccines, injection materials, personnel salaries, maintenance and overheads, training, monitoring and surveillance, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund, UNICEF, WHO, and USAID.
Routine immunization financing by source - 2004
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 2005-2010 for the NIP are projected to be $49.0 million per year. About 23% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, about 95% of needs are covered.
An annual gap of $2.0 million will exist during 2005-2010 if both secure and probable funding are included ($38.0 million if probable funding is excluded) during the remaining GAVI Fund years. During the post-GAVI Fund years (2011-2012), the gap is estimated to average $12.4 million a year if secure and probable funding are taken into account ($42.0 million for secure funding only). In other words, 22% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- increase government expenditures on health;
- mobilize partner resources for immunization;
- promotion of mutual health insurance societies;
- improve efficient management of resources through improved incentives for health personnel, a decline in vaccine wastage, and increased access to services through outreach activities.