Guyana's immunization costing and financing situation
Macroeconomic and health system context
Guyana’s GDP per capita has declined during the last five years due to inflation and other factors. On the other hand, Guyana has recently become a HIPC country and some of the money from debt relief will go towards the health sector. The government is introducing some health reforms, including decentralization and a changing role of the Ministry of Health. The Ministry of Health plans to strengthen its steering role, focusing on policy making, standard setting, monitoring and evaluation - it will no longer be involved in the direct delivery of health services. In 2001, per capita total expenditures on health were $47.9.
Immunization programme objectives
Guyana’s immunization coverage has been consistently high in the past years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 88%. The national immunization programme objectives are to ensure that a consistent and adequate supply of vaccines, syringes and needles are procured each year on a timely basis, expand the programme with the introduction of hepatitis B and Haemophilus influenza type b (Hib), eradicate measles, rubella and congenital rubella syndrome, increase the immunization coverage of all antigens to 95% or greater, increase the uniformity of coverage at the regional, sub-regional, district and village level, strengthen national surveillance activities in order to control and eradicate vaccine-preventable diseases, enhance communication and reporting between all levels of the health system, conduct timely outbreak control investigations, strengthen active surveillance, specifically for vaccine-preventable diseases, and strengthen the surveillance capacity of the national laboratory system.
Immunization costs and financing
In 2000, the pre-vaccine Fund year, Guyana spent $1.0 million to deliver routine immunization services. The programme-specific spending on routine immunization service equated to about $68.8 per DTP3 vaccinated child or $1.36 per capita. Spending on routine immunization in the Vaccine Fund year (2001) increased slightly to $1.2 million, an increase of 18% after the Pentavalent vaccine was introduced. Total expenditures on the NIP in 2002 were the same - $1.2 million – since no supplementary immunization activities took place.
The government decreased the percentage of total programme expenditures that it financed from 2001-2002, from 96% to 79%, due to the introduction of GAVI/VF funding. The government pays for most costs of the programme except for new vaccines. In addition, external partners are funding some injection supplies, training, and social mobilization. The main funding partners are GAVI/VF, UNICEF, PAHO, and IDB.
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. The average annual resource requirements during 2002-2007 for the NIP are estimated to be $1.3 million. One half of the funding is classified as secure during these years. If funding classified as probable is included as well, approximately 56% of needs are covered.
The gap in funding for the NIP is on average $0.6 million a year ($0.7 million if probable funding not included) during the years of GAVI and Vaccine Fund funding (2002-07). The average annual gap with secure funding decreases in the post Vaccine Fund years (2008-2009) to $0.1 million as national government is expected to increase its contributions.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) increase government budget allocation by 1.5% per year; (2) increase the number of ICC members and/or immunization personnel at Ministry of Health budget planning sessions to at least 10 out of 15 persons; (3) increase access to health care in hinterland areas; (4) increase the percentage of budgeted or allocated funds actually expended for NIP by the government and international financers to at least 85% by 2008; (5) increase capital spending for immunization by the government by at least 10% starting in 2004; (6) increase access to adequate and functional transportation, communication and cold chain equipment in hinterland regions; (7) reduce vaccine wastage; (8) reduce missed opportunities and attrition rate to 5% by 2007; and (9) increase the number of regional health officers trained in budget preparation to facilitate efficient use of resources to 10 out of 10.