Mali's immunization costing and financing situation
Macroeconomic and health system context
Mali’s economic growth has been generally favorable since 1994. Although there was a decline in 2001, future growth prospects are promising. Mali is benefiting from the HIPC initiative and has made commitments to increasing its contribution to health funding. The government is introducing health reforms - switching from a project to a programme approach and introducing a minimum basic service package throughout the country. Per capita health expenditure in 2000 was $9.6.
Immunization programme objectives
Mali’s immunization coverage has been constant since the mid nineties. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 40%. The national immunization programme’s objectives are to raise immunization coverage for all antigens; introduce micro-plans for all health areas with the participation of the communities; introduce performance contracts; renovate the cold chain; strengthening outreach services; and minimize vaccine wastage.
Immunization costs and financing
Estimated programme-specific expenditures on the routine immunization in the pre-Vaccine Fund year, 2000, were $2.0 million and another $2.7 million for supplementary immunization activities. The spending on routine immunization service equated to about $10.0 per DTP3 vaccinated child or $0.17 per capita. Expenditures on routine immunization more than doubled in the Vaccine Fund year (2001) to $4.8 million.
The central government’s expenditures for routine immunization increased slightly from 2000-2001 in absolute terms, but the percentage of their share of total expenditures declined from 85% to 36%. The government pays mainly for vaccines, injection supplies, salaries, transport costs, supplies, other operational costs, and some capital costs while donors pay for vaccines, injection supplies, per-diems, training, social mobilization, monitoring and surveillance, and some capital costs. In Mali, the communities pay for salaries, NGOs pay for social mobilization, and the private sector contributes to operational costs. The main funding partners are GAVI and the Vaccine Fund, UNICEF, WHO, Japan, the European Union, IDA and USAID.
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 of the NIP during 2003-2007 are estimated to be $7.3 million per year. Over 80% of the funding is classified in the FSP as secure during 2003-2007. No funding has been classified as probable. If funding classified as probable is included as well, over 90% of needs are covered.
The gap in funding for the NIP is on average $1.0 million a year (if probable funding not included) during the Vaccine Fund years with gaps (2003-2007). The average annual gap with secure and probable funding rises in the post-GAVI/Vaccine Fund years (2008-2010) to $1.4 million ($2.6 million if probable funding not included).
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) increase the share of the health budget for immunization from 2.1% in 2002 to 4.2% in 2010; (2) use of HIPC debt relief resources for the immunization programme; (3) use of 20% of health allocation of local resources for immunization activities; (4) increase resources of communities on primary health establishments; (5) development of alternative funding mechanisms; (4) involvement of private medical sector in vaccination activities; (5) increased involvement of external partners in funding of the NIP; (6) improve local management of funding; and (7) improvement in effective use of resources.