Immunization costing and financing situation in the Democratic People's Republic of Korea
Macroeconomic and health system context
The Democratic People Republic of Korea’s economic growth declined in the 1990’s due to disruption of economic and trade links with its old economic and trading partners and a series of natural calamities which seriously disrupted the agricultural and energy sectors. Agricultural production is still around half what it was in the 1980s, and the reduced capacity to obtain commercial imports has led to continuing food insecurity in many parts of the country. External trade continued to decline until 2002. The trade gap continues to be partly met through the provision of official assistance from traditional trading partners in the region. Some evidence of a reversal of this trend is now evident, since the economy has grown by 3% annually since 2002.
The health sector was affected by the food insecurity of the 1990s. During this period, standards of health care in rural areas declined and shortages of medical and hospital supplies occurred. In view of increasing financial constraints, investment in the health sector declined to a minimum in 2002, but has recently begun to increase.
In 2001, per capita expenditures on health were $38.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 74%. The national immunization programme objectives are to:
- increase and sustain coverage of EPI vaccines in all counties and districts, to at least 80% by end of 2004, and at least 90% nationally by 2006;
- achieve interruption of wild polio virus transmission by 2001 and obtain polio certification by the end of 2005;
- achieve elimination of maternal and neonatal tetanus, nationally and in all provinces by the end of 2006;
- sustain measles-free status by raising and sustaining coverage with measles vaccine in all counties/districts by end of 2004;
- ensure injection safety and safe disposal of injection equipment; and
- provide hepatitis B vaccine with routine immunization in a phased manner from 2003 and achieve coverage of 90% nationally, and in all provinces by end of 2006.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, DPR Korea spent $5.0 million on programme-specific expenditures for routine immunization services and an additional $0.3 million on supplemental immunization activities. The programme-specific spending on routine immunization service equated to about $18.6 per DTP3 vaccinated child or $0.22 per capita. Programme-specific spending on routine immunization decreased slightly by 8% in 2003, the first year of GAVI Fund support, due to a reduction in vaccine wastage.
The share of programme expenditures paid by the national and regional governments decreased slightly to 70% in 2003, due to an increase in donor contributions for new vaccines. The government pays mainly for salaries, transport, social mobilization, maintenance and overheads, capital costs and surveillance and monitoring while donors pay for vaccines, transport, training, surveillance and monitoring, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund, WHO and UNICEF.
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 2004-2007 for the NIP are projected to be $7.5 million per year. Over 80% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, 95% of needs are covered.
An annual gap of $0.4 million will exist during 2004-2007 if both secure and probable funding are included ($4.5 million if probable funding not included) during the remaining GAVI Fund years. During the post-GAVI Fund years (2008-2012), the gap is estimated to average $4.1 million if secure and probable funding are taken into account ($5.1 million for secure funding only). In other words, 47% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- to increase the government’s contribution for immunization services;
- to reduce vaccine wastage rates;
- to optimize the use of personnel;
- to optimize the number of immunization sessions;
- to increase external resources and number of donors; and
- to increase domestically produced vaccine.