Ghana's immunization costing and financing situation
Macroeconomic and health system context
Ghana has recently become a HIPC country and has developed a Poverty Reduction Strategy to reduce inequalities in its health service delivery. The government is also introducing major health reforms - a sector-wide approach (SWAp) and decentralization. In 2000, per capita total expenditures on health were $10.9.
Immunization programme objectives
Ghana’s immunization coverage has increased steadily in the past years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 84%. The national immunization programme’s objectives are to achieve at least 80% coverage for all vaccines in 80% of districts by 2005, attain polio-free certification by 2005, reduce measles morbidity by 90% and mortality by 95% by 2005, eliminate maternal and neonatal tetanus by 2005, prevent and limit outbreaks of yellow fever by 2002, introduce hepatitis B and Haemophilus influenza type b (Hib) vaccine into routine EPI by 2002, determine the disease burden of vaccine-preventable disease of public health significance, reduce wastage of polio and tetanus Toxoid vaccines to 10% by 2005, and improve vaccine and data management.
Immunization costs and financing
In 2000, the pre-Vaccine Fund year, Ghana spent $2.1 million to deliver routine immunization services and an additional $3.2 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $4.1 per DTP3 vaccinated child or $0.11 per capita. Spending on routine immunization in the Vaccine Fund year (2001) rose to $12.7 million after introduction of the pentavalent vaccine. Total expenditures on the NIP in 2002 were $20.1 million.
The percent of total expenditures paid by the government and donor pool declined slightly during 2000-2001, from 24% to 22% respectively. The absolute amount contributed increased during this period. The government and donor pool pays mainly for some vaccines, salaries, other operational costs, and some vehicle costs while the local government pays for maintenance and some operating costs. International donors pay for other vaccines, injection materials, social mobilization, training, supplementary immunization and capital costs. The main funding partners are GAVI/Vaccine Fund, UNICEF, WHO, Rotary, DFID, and JICA.
Routine immunization financing by source - 2001
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase as the pentavalent vaccine introduction is completed and supplementary immunization activities are projected to continue. The average annual resource requirements during 2002-2006 for the NIP are estimated to be $17.7 million per year. Over 70% of the funding is classified in Ghana’s FSP as secure during these years. If funding classified as probable is included as well, approximately 80% of needs are covered.
The annual gap in funding for the NIP is on average $3.9 million a year ($4.8 million if probable funding not included) during the years of GAVI/Vaccine Fund funding (2002-2006). The average annual gap with secure funding rises in the post-GAVI and Vaccine Fund years (2007-2011) to $12.1 million, an increase of 150%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) initiating dialogue with the Ministry of Finance on a sustainable real increase in health sector share of GDP; (2) ensuring that immunization forms part of the poverty reduction strategy plan and indicators; (3) ensuring that the cost of vaccines are part of the Ministry of Health’s procurement plan each year; (4) improving the timely disbursement of funds to sub-national levels; (5) providing timely cash flow plans to Government and donors to ensure timely disbursement of funds; (6) discuss with donors the possibility of pre-financing the health budget; (7) reduce vaccine wastage levels; (8) strengthen capacity at sub-national levels to enhance efficiency in management of vaccines; and (9) increase supervision from national and regional levels.