Rwanda's immunization costing and financing situation
Macroeconomic and health system context
Rwanda’s economic growth has been favorable and is projected to continue during the next 15 years. The Ministry of Health is focusing on 3 health reforms – decentralization, development of primary health care through its eight fundamental components, and enhanced community participation in the management and funding of the services. Per capita health expenditure in 2000 was $13.1.
Immunization programme objectives
Rwanda’s immunization coverage has been consistently high in the past years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 90%. The national immunization programme’s objectives are to achieve a vaccination coverage of 95%; eradicate poliomyelitis; eliminate maternal and neonatal tetanus; to bring about a reduction of morbidity and mortality due to measles; to make vitamin A supplementation part of routine vaccination services; to ensure that medical establishments have injection safety, including safe waste disposal; and to ensure the integration of active surveillance of the diseases targeted by the programme.
Immunization costs and financing
Estimated programme-specific expenditures on the routine immunization in the pre-Vaccine Fund year, 2000, were $1.2 million and $0.4 million on supplementary immunization. The spending on routine immunization service equated to about $4.9 per DTP3 vaccinated child or $0.16 per capita. Spending on routine immunization increased in 2001, the pre-Vaccine Fund year, to $1.4, an increase of 27%, due to an increase in expenditures on injection supplies, transport, surveillance and social mobilization. Total expenditures on the NIP in 2002 were about $2.0 million.
Both the government and donors increased their contributions to the programme from 2001-2002. The percent of total expenditures on routine immunization paid by the government remained steady in the two years, at 60%, but the absolute amount contributed increased during this period. The government pays mainly for injection supplies, salaries, transport costs, maintenance and overheads, and vehicles while donors pay for vaccines, injection supplies, salaries, training, social mobilization, monitoring and surveillance, and capital costs. The main funding partners are GAVI/Vaccine Fund, UNICEF, WHO and the private sector.
Routine immunization financing by source - 2001
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase after Hepatitis B and Hib vaccines are introduced. The average annual resource requirements during 2002-2005 for the NIP are estimated to be $7.3 million per year. Over 90% of the funding is classified in the FSP as secure during 2002-2005.
The gap in funding for the NIP for secure funding during the Vaccine Fund years (2002-2005) is $0.1 million. The average annual gap with secure and probable funding increases in the post-Vaccine Fund years (2006-2008) to $2.4 million.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) to increase the Government’s financial contribution to immunization through advocacy; (2) to increase the contribution from bilateral and multilateral cooperation; (3) to increase the sustainability of funding; and (4) to increase the efficiency of the programme.