Kenya's immunization costing and financing situation
Macroeconomic and health system context
After a downturn in economic growth in 1999-2000, economic growth is projected to increase though the government’s ability to spend on social services is constrained by a high debt burden. The government is currently introducing health reforms - decentralization and a social insurance strategy whereby a minimum basic service package will be introduced. In 2000, per capita total expenditures on health were $29.8.
Immunization programme objectives
Kenya’s immunization coverage began increasing after 2000. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 80%. The national immunization programme’s objectives are to increase demand for immunization by effective advocacy and social mobilization at all levels; improve districts’ capacity to manage vaccines and reduce wastage; improved district coordination of immunization activities through logistical integration with other health activities; improve health worker performance with the use of operational manuals and performance-monitoring tools; and strengthen the collaboration and coordination of stakeholders’ support for immunization activities at national, district, and community levels.
Immunization costs and financing
In 2000, the pre-Vaccine Fund year, Kenya spent $6.4 million on programme-specific expenditures of routine immunization services and an additional $4.9 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $8.4 per DTP3 vaccinated child or $0.21 per capita. Programme-specific spending on routine immunization ($10.9 million) was higher in 2002, the first year of Vaccine Fund support, and total programme-specific expenditures on the NIP were $15.1 million.
The percent of total expenditures paid by the government increased during the two years, from 49% to 53%, since the government’s expenditures on vaccines increased. The government pays mainly for vaccines, salaries, transport costs, other operational costs and cold chain equipment while donors pay for other vaccines, injection supplies, social mobilization, monitoring and surveillance, supplementary immunization and capital costs. The main funding partners are GAVI and Vaccine Fund, UNICEF, WHO, DANIDA, DFID and Japan (JICA).
Routine immunization financing by source - 2001
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with the introduction of Hepatitis B and Hib vaccines and supplementary immunization activities are projected to continue. The average annual resource requirements during 2002-2006 for the NIP are estimated to be $36.7 million per year. Over 80% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, approximately 94% of needs are covered.
The gap in funding for the NIP is on average $4.2 million a year ($6.4 million if probable funding not included) during the remaining Vaccine Fund years (2002-2006). The average annual gap with secure and probable funding rises in the post Vaccine Fund years (2007-2009) to $27.7 million, an increase of 600%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) increasing government funding for the immunization programme; (2) mobilize external resources to fill the funding gap; (3) mobilize local private and community participation; (4) reduce financing fluctuations on programme performance; and (5) improve programme efficiency.