Immunization costing and financing situation of the Lao People's Democratic Republic
Macroeconomic and health system context
After a downturn in economic growth following the Asia financial crisis of 1997, Lao’s economic growth rates improved since 1998. Despite the improvement, there has been limited change in per capita GDP. The government is introducing two health reforms – decentralization and strengthening of the Primary Health Care network throughout the country. Per capita health expenditure in 2000 was $9.4.
Immunization programme objectives
Lao’s immunization coverage is beginning to increase after a downward trend in the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 53%. The national immunization programme’s objectives are to raise immunization coverage for all antigens to 80%; to introduce Hepatitis B vaccine; to use auto-disable injection equipment by 2004; maintain a polio-free status; reduce incidence of neonatal tetanus and measles by 2005 through accelerated disease control; and promote the integration of immunization and other health services.
Immunization costs and financing
In 2000, the pre-Vaccine Fund year, Lao spent $1.2 million on programme-specific expenditures of routine immunization services and an additional $0.2 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $12.6 per DTP3 vaccinated child or $0.22 per capita. Programme-specific spending on routine immunization remained constant in 2001, the first year of Vaccine Fund support, and total programme-specific expenditures on the NIP were $1.6 million.
The percent of total routine expenditures paid by the government was constant during the two years at about 6%, with a slight increase in absolute spending. The government pays mainly for salaries, transport costs, and maintenance and overhead, while donors pay for vaccines, injection supplies, per-diems for outreach, training, social mobilization, monitoring and surveillance, and all capital equipment. The main funding partners are GAVI and the Vaccine Fund, UNICEF, AusAid, JICA, and Luxembourg.
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 supplementary immunization activities projected to continue. The average annual resource requirements during 2003-2007 for the NIP are estimated to be $3.6 million per year. Over 60% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, approximately 80% of needs are covered.
The gap in funding for the NIP is on average $0.8 million a year ($1.3 million if probable funding not included) during the remaining Vaccine Fund years (2003-2007). The average annual gap with secure and probable funding increases in the post Vaccine Fund years (2008-2010) to $1.4 million ($3.6.million if probable funding not included).
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include to: (1) ensure that the Japanese government continue to provide funding for vaccines after 2003; (2) advocate for a line item in the national budget for the purchase of routine vaccines; (3) ensure that GAVI immunization support is used to reach coverage targets and obtain reward funding after 2004; (4) use the FSP to advocate for immunization in the poverty reduction and debt relief funding process; (5) consider implementing an immunization plus strategy; (6) simplify procedures that cause delays in implementation and funding; (7) improve the mechanisms for UNICEF reporting requirements that affect the timely disbursement of resources; (8) continue efforts to reduce vaccine wastage; (9) continue efforts to develop the most cost-effective ways of conducting outreach; and (9) improve information systems for more efficient planning and budgeting.