Gambia's immunization costing and financing situation
Macroeconomic and health system context
Although Gambia’s economic growth has been increasing at a rate of approximately 6% per annum, the productive sector has witnessed severe constraints culminating in 2002 in the declaration of a severe food shortage by the government. High inflation and exchange rate fluctuation have severely reduced household incomes particularly in rural areas. The country is a recipient of debt relief through the HIPC initiative. In 2002, per capita GDP was $290 and per capita expenditures on health were $18.5.
Immunization programme objectives
The Gambia’s immunization coverage has remained at the same levels for the past few years with a slight drop between 2001 and 2002. According to the WHO-UNICEF best estimates, the DTP3 coverage in 2002 was 90%. The national immunization programme’s objectives are to increase immunization coverage to 95% and above for all vaccines; to increase the percent of fully immunized children under one to 90%; to prevent vaccine stock-outs at all levels and improve effectiveness of the purchasing system; to reduce measles morbidity and mortality by 90% and 95% respectively; to eliminate neonatal tetanus to less than 1 case per 1,000 live birth in every division; to eradicate poliomyelitis by the 2005; to reduce vaccine wastage to the target levels; to strengthen the cold-chain by increasing capital investment for replacement of old equipment and by adopting a policy of solariation; to integrate in a sustainable manner the pneumococcal vaccine into routine immunization in 2007; to develop key messages on immunization targeting parents and care-givers; to continue to use auto disable syringes; and to ensure the use and proper disposal of safety boxes by all facilities conducting immunization services.
Immunization costs and financing
In 2002, the year before Vaccine Fund Support began, Gambia spent $1.5 million to deliver routine immunization services and an additional $0.3 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $37.4 per DTP3 vaccinated child or $1.11 per capita. Spending on routine immunization increased in 2003 to $1.7 million, an increase of 8%, due to an increase in expenditures on the programme and mainly through the additional GAVI/Vaccine Fund support. Total expenditures on the NIP in 2003 were $2.5 million.
Both the government’s and donors’ (other than GAVI/Vaccine Fund) contributions to the immunization programme declined from 2002 to 2003. The percent of total expenditures paid by the government declined from 40% to 25%. The government pays mainly for vaccines, salaries, transport and recurrent costs while donors pay for vaccines, injection supplies, some operational costs, and capital costs. The main funding partners are UNICEF, WHO, the donor pool, and GAVI/Vaccine Fund. In 2002, Aventis Pasteur supported the purchase of new vaccines.
Routine immunization financing by source - 2003
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to with increasing expenditures on capital costs, supplemental immunization activities and new vaccine introduction. The average annual resource requirements during 2003-2007 for the NIP are estimated to be $1.8 million. More than half of the funding (65%) is classified as secured during these years. If funding classified as probable is included as well, all programme needs would be covered during this period.
During 2003-2007, the gap in funding for the NIP is on average $0.6 million each year if probable funding not included and no gap if probable funding is included. The average annual gap in the post-Vaccine Fund period (2008-2012) with secure funding rises to $1.6, an increase of 270%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) to secure GAVI/Vaccine Fund and other donor funding; (2) to advocate for increased national funding for the programme; (3) to develop a strategic plan for the national immunization programme; (4) to establish targets and monitor performance at all levels; (5) to achieve continual improvements in the effectiveness of service delivery; (6) to improve programme efficiency as specified in the plan; and (7) to strengthen training of human resources for the effective delivery of immunization services.