Kyrgyzstan's immunization costing and financing situation
Macroeconomic and health system context
The Kyrgyz economy was recovering from a recession in 2000, following the 1998 financial crisis in Russia. The macroeconomic performance is expected to be strong in the next few years and lead to steady economic growth in the medium term. In 2002, per capita GDP was $301. The government is introducing several health reforms - sectoral budget programming, the introduction of family group practices for voluntarily enrolled populations, and a gradual shift from guaranteed financing of providers. In 2002, per capita total expenditures on health were $12.
Immunization programme objectives
Kyrgyzstan’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 2002 was 98%. The national immunization programme’s objectives are to control incidence rates of pertussis and diphtheria; prevent epidemic outbreaks of mumps; decrease the incidence of measles; limit the incidence of Hepatitis B in children under 5 years; prevent incidence of poliomyelitis from wild strains; reduce incidence of purulent meningitis and Hib-associated pneumonia; reduce incidence of rubella; prevent incidence of tetanus in neonates; and prevent the incidence of disseminated forms of tuberculosis in infants.
Immunization costs and financing
In 2002, Kyrgyzstan spent $1.6 million to deliver routine immunization services. The programme-specific spending on routine immunization service equated to about $15.3 per DTP3 vaccinated child or $0.32 per capita.
The central and local governments financed 56% of the expenditures of the NIP (with mandatory health insurance funds). The government pays mainly for vaccines, salaries, transport costs, cold chain equipment, training and surveillance, while local governments pay for injection supplies, cold chain equipment and transportation costs. Donors pay for other vaccines, injection supplies, training, social mobilization, monitoring and surveillance, and some cold chain equipment. The main funding partners are UNICEF, GAVI/Vaccine Fund and JICA. It should be noted that in Kyrgyzstan, households contribute to about 2% of the funds for immunization through user fees for purchasing syringes.
Kyrgyzstan did not provide information on the costs and financing of immunization in the year before GAVI/Vaccine Fund resources were made available.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase after Hepatitis B vaccines are introduced. The average annual resource requirements during 2003-2005 for the NIP are estimated to be $2.5 million per year. More than 80% of the funding is classified as secure during 2003-2005. If funding classified as probable is included as well, all resource requirements are covered during the remaining years with Vaccine Fund support.
During 2003-2005 the gap in funding for the NIP is on average $0.35 million each year if probable funding is not included. The average annual gap in the post-Vaccine Fund period (2007-2009) with secure funding rises to $2.3 million, an increase of over 600%. If probable funding is included, all resource requirement are met in both the remaining years with Vaccine Fund support in the immediate three years following the end of current Vaccine Fund commitments.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) assisting immunization leaders to raise funds from local governments for Hepatitis B immunizations; (2) have the central government fund cold chain equipment and the replacement of vehicles; (3) apply to JICA to sustain the supply of basic vaccines and MMR vaccines from 2006 to 2008; (4) have the government consider increasing its allocation for immunization as GAVI/Vaccine Fund resources are phased out beginning in 2006; (5) apply to UNICEF and request support for training activities needed for the introduction of new vaccines; (6) include immunization in the National Strategy for Poverty Reduction; (7) tighten vaccine and immunization management in order to reduce vaccine wastage; (8) monitor the procurement of vaccines to ensure price-efficient purchasing; (9) follow up with the ADB with regards to its plan to provide selective funding for immunization in order to reduce financing fluctuations on programme performance; and (10) seek international funding for a burden of disease assessment for Hib vaccine.