Haiti's immunization costing and financing situation
Macroeconomic and health system context
Haiti’s political instability has negatively affected both the economy and the health system. The high inflation and reduced agricultural production in the country has led to a declining GDP per capita - $461 in 2001. External aid is decreasing as donors leave the country due to current political instability. About 40% of the rural population does not have access to health services, although the government is beginning to hire Cuban doctors to work in these areas. In addition, the public health infrastructure is weak. The health sector is introducing a minimum health services package, of which immunization is one component. In 2001, per capita health expenditures were $23.
Immunization programme objectives
Haiti’s immunization coverage has remained at the same level for the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 43%. The national immunization programme’s objectives are to vaccinate at least 80 % of children with BCG, OPV, MR, and DTP; to eliminate maternal and infantile tetanus by 2006; to continue to block circulation of wild polio virus and vaccine-associated polio paralysis as well as measles; and to introduce new vaccines - Hepatitis B and Hib- in 2005.
Immunization costs and financing
In 2001, the year before Vaccine Fund Support began, Haiti spent $2.0 million to deliver routine immunization services and an additional $3.8 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $20.1 per DTP3 vaccinated child or $0.25 per capita. Despite additional support from GAVI/Vaccine Fund, spending on routine immunization decreased in 2002 to $1.4 million, a decrease of 29%, due to a reduction in expenditures on the programme. Total expenditures on the NIP in 2002 were $3.4 million.
The government’s expenditures on the immunization programme increased 2001 to 2002 by about 5%. As a share of total expenditures, government funding increased from 8% to 11%. Donors, other than GAVI/Vaccine Fund decreased their contributions to the programme during the same period partially because of fewer supplementary immunization activities in 2002. The government pays mainly for salaries and transportation costs while donors pay for vaccines, injection supplies, some operational costs, capital costs, and supplementary immunization activities. The main funding partners are the donor pool, UNICEF, WHO, GAVI/Vaccine Fund, USAID, CDC, CIDA, JICA, and the World Bank.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with increasing expenditures on capital costs, supplemental immunization activities and expected new vaccine introduction in 2005. The average annual resource requirements during 2004-2006 for the NIP are estimated to be $ 7.2 million. Less than a quarter of the funding is considered as secure during these years. If funding classified as probable is included as well, about half of programme needs would be covered during this period.
During 2004-2006, the gap in funding for the NIP is on average $5.9 million each year if probable funding not included and $3.5 if probable funding is included. The average annual gap in the post-Vaccine Fund period (2007-2009) with secure and probable funding rises to $5.6 million, an increase of 159%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) increasing the government’s participation in management and financing of the immunization programme; (2) introduction of a tax on certain luxury products to raise financing for the programme; (3) mobilizing funds from external partners; (4) reinforce the ICC’s role in fund raising; (5) increasing the role of the private sector in providing financing for immunization; (6) developing a more effective management system for vaccines and injection supplies; (7) integrating the immunization programme with other services to reduce costs; (8) improve the financial planning and management of the programme.