Georgia's immunization costing and financing situation
Macroeconomic and health system context
Since the collapse of the Soviet Union, Georgia’s economy has declined. Although some improvements have occurred since then, economic production in 2004 was still only at 41% of its 1990 level. The country has the lowest GDP per capita among the former Soviet Union countries. The country also has been politically unstable for several years due to the civil unrest in two of its autonomous republics.
The health care system has been undergoing reform, including decentralization beginning in 1995, and a change of health care system model. At the end of 2000, the country changed their health care system to one based on primary health care with services that are high quality but cost-effective. However, the health system continues to need strengthening due to issues associated with the de-linking of providers with the local health care managers, decentralized management, weak human and institutional capacity, and a lack of financial incentives for the primary health care staff.
In 2002, per capita expenditures on health were $23.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 89%. The national immunization programme objectives are to:
- improve coverage up to 90% at the national levels and up to at least 80% at all district levels;
- sustain polio-free activities and accelerated disease control activities for measles and diphtheria;
- decrease vaccine wastage rates;
- introduce new vaccines based on epidemiological and cost-benefit analyses; and
- improve coverage and programme management in conflict-affected areas.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Georgia spent $0.8 million on programme-specific expenditures for routine immunization services and an additional $0.04 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $17.6 per DTP3 vaccinated child or $0.14 per capita. Programme-specific spending on routine immunization only increased slightly by 2% in 2003, the first year of GAVI Fund support. Total expenditures on the NIP in 2003 were $0.8 million.
The share of programme expenditures paid by the national and regional governments increased to 75% in 2003, due to an increase in routine programme expenditures. The government pays mainly for vaccines, salaries, transport, maintenance and overheads, and cold chain equipment while donors pay for other vaccines, other capital costs, social mobilization and training. The main funding partners are the GAVI Fund, UNICEF and USAID.
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 2004-2005 for the NIP are projected to be $0.9 million per year. Over 95% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, 99% of needs are covered.
During the post-GAVI Fund years (2006-2010), the gap is estimated to average $0.26 million a year if secure and probable funding are taken into account ($0.7 million for secure funding only). In other words, 24% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- to ensure vaccine prices are similar to UNICEF prices;
- to obtain advance commitments from traditional donors;
- to insure that future requirements for immunization are incorporated in the Medium Term Expenditure Framework (MTEF);
- to improve management capacity among immunization, cold chain, and supply managers;
- to improve management information systems;
- to develop incentive system to motivate providers to increase coverage; and
- to incorporate the needs of the NIP into primary health care reform.