Lesotho's immunization costing and financing situation
Macroeconomic and health system context
Lesotho’s economic growth rate has been relatively strong in recent years, estimated at 3.5% in 2002. Several factors however have negatively affected the economy in recent years. While industry is a well developed sector in Lesotho, much of the population relies on subsistence farming for its survival.
In 2001, per capita expenditures on health were $24.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 80%. The national immunization programme objectives are to:
- strengthen immunization systems;
- increase immunization coverage by 5 to 10% point over the next five years so that at least 80% immunization coverage for all antigens is achieved by 2005;
- improve the transport situation in all districts and at the national level;
- introduction of auto-disable syringes (AD) in routine immunization services;
- institute the system of reporting all serious adverse events following immunizations;
- detect one case of AFP per 100,000 population of under 15 years age in each district per year until the country is certified Polio free;
- collect blood specimens from all suspected measles cases for laboratory confirmation; and
- reduce the number of neonatal tetanus cases to less than one case per 1,000 live births in each district.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Lesotho spent $0.6 on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $14.6 per DTP3 vaccinated child or $0.31 per capita. Programme-specific spending on routine immunization increased by 30% in 2003, the first year of GAVI Fund support, due to an increase in expenditures on vaccines, personnel salaries, and monitoring and surveillance.
The share of programme expenditures paid by the national government decreased to 60% in 2003, due to an increase in donor contributions on vaccines, monitoring and surveillance, and supplementary immunization. The government pays mainly for salaries and transport while donors pay for vaccines, injection materials, maintenance and overheads, training, monitoring and surveillance, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund, UNICEF, WHO, JICA and CDC.
Routine immunization financing by source - 2003
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase as expenditures on vaccines are projected to rise. The average annual resource requirements during 2004-2013 for the NIP are projected to be $1.5 million per year. About 60% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, 57% of needs are covered.
An annual gap of $0.67 million will exist during 2004-2013 if secure funding is included. Note that there are no reported GAVI Fund years.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- to mobilize additional resources from the government by ensuring its costing and financing information is included in the new Medium Term Expenditure Framework (MTEF);
- to mobilize additional resources from donor partners;
- to improve the reliability of its resources through ensuring the requirements are included in the health sector MTEF estimates and through improved accounting and reporting mechanisms, and;
- to improve programme efficiency through strengthening capacity of health workers in health care micro planning organization and management, improving/strengthening the monitoring and evaluation systems, and through reduction of vaccine wastage.