Ethiopia's immunization costing and financing situation
Macroeconomic and health system context
The socio-economic and health development of Ethiopia has been hindered by a combination of rapid population growth, poor economic performance and low educational levels. Ethiopia has a new economic policy that is aimed at establishing a market-based economic transformation and redirecting Government interventions to the development and strengthening of social services such as education, health, investment in roads and water resources.
The current health system only reaches about 61% of the population. The government is planning to increase the access to services through expanding the number of primary health facilities and staff to raise health coverage to 85% by 2009 and through introducing a health extension programme (HEP).
In 2001, per capita expenditures on health were $5.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 82%. The national immunization programme objectives are to:
- strengthen and optimize the delivery of sustainable, quality immunization services by increasing DPT3 and measles coverage to 95% by 2009;
- introduce hepatitis B vaccine in 2005-2006 and haemophilus influenzae type b (Hib) vaccine as pentavalent in 2007;
- minimize vaccine wastage through improved forecasting and stock management, effective cold chain system and improvement in the ratio of children to vials opened; and
- accelerate effort to achieve polio eradication, measles control/elimination, and maternal and neonatal tetanus elimination.
In addition, two programmes have been introduced to increase coverage:
- Reaching Every Districts (RED) and
- Sustainable Outreach Services (SOS)
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Ethiopia spent $8.3 million on programme-specific expenditures for routine immunization services and an additional $17.3 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $3.8 per DTP3 vaccinated child or $0.12 per capita. Programme-specific spending on routine immunization increased by 31% in 2003, the first year of GAVI Fund support, due to increased expenditures on vaccines and injection equipment. Total expenditures on the NIP in 2003 were $23.6 million.
The share of programme expenditures paid by the national and regional governments decreased to 30% in 2003, due to an increase in donor contributions for injection equipment and programme operational costs. The government pays mainly for salaries, transport, social mobilization and maintenance and overheads, while donors pay for vaccines, training, supervision, monitoring, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund, USAID, Netherlands, the government of Japan, and UNICEF.
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 2004-2006 for the NIP are projected to be $18.2 per year. Over 60% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, 70% of needs are covered.
An annual gap of $5.3 million will exist during 2004-2006 if both secure and probable funding are included ($6.7 million if probable funding is excluded) during the remaining GAVI Fund years. During the post-GAVI Fund years (2007-2013), the gap is estimated to average $27.2 million if secure and probable funding are taken into account ($49.5 million for secure funding only). In other words, 48% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- increase central and local government contributions for the immunization programme;
- increase private sector resources for the immunization programme;
- increase partner resources for the immunization programme;
- reduce vaccine wastage;
- improve programme management; and
- maximize use of the Health Extension programme.