Mozambique's immunization costing and financing situation
Macroeconomic and health system context
Mozambique’s economic growth has been favorable since 1996. The Ministry of Health is introducing a sector wide approach (SWAP). Per capita health expenditure in 2001 was $12.2.
Immunization programme objectives
Mozambique's immunization coverage has been increasing in the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 60%. The national immunization programme’s objectives are eradication of poliomyelitis; a 95% reduction in the number of deaths from neonatal tetanus; control of measles, with a 90% reduction in incidence and a 95% reduction of deaths from measles; and a 90% reduction in the prevalence of hepatitis B among children aged under one year by 2005.
Immunization costs and financing
Estimated programme-specific expenditures on the routine immunization in the pre-Vaccine Fund year, 2000, were $3.7. The spending on routine immunization service equated to $9.6 per DTP3 vaccinated child or $0.21 per capita. Expenditures more than doubled in the Vaccine Fund year, 2001, to $7.5 for routine immunization.
The percent of total expenditures on routine immunization paid by the government is about 34%. The government pays mainly for salaries, transport costs, maintenance and overheads, and surveillance while donors pay for vaccines, injection supplies, salaries, training, maintenance and overheads, monitoring and surveillance, and capital costs. The main funding partners are GAVI/Vaccine Fund, the World Bank, and the Netherlands.
Routine immunization financing by source - 2000
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase after Hepatitis B vaccine is introduced. The average annual resource requirements during 2002-2005 are estimated to be $10.1 million per year. Over 80% of the funding is classified in the FSP as secure during 2002-2005.
The gap in funding for the NIP is on average $1.0 million during the Vaccine Fund years (2002-2005). The average annual gap with secure (and probable funding) rises in the post- Vaccine Fund years (2006-2010) to $4.1 million, an increase of 356%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) enhanced efficiency of various levels of immunization; (2) advocacy to ensure an increase in the State budget allocation for the Ministry of Health; (3) advocacy to increase support from the Ministry of Health’s partners for pooling arrangements to purchase vaccines and injection equipment; (4) advocacy to assure an increase in the budget assigned by the Ministry of Health to immunization; (5) advocacy to increase government support for pooling to purchase vaccines and injection equipment; (6) advocacy targeting the Ministry of Health’s traditional partners to immunization; (7) advocacy to secure financial and other forms of support from the private sector, both for profit and non-profit, national and international, for the various EPI activities; (8) advocacy directed at and negotiations with vaccine and other relevant firms to obtain more competitive prices for vaccines; and (9) advocacy to secure financial support from the international community and funding agencies.