Senegal's immunization costing and financing situation
Macroeconomic and health system context
For a long time Senegal was in the World Bank’s lower-middle income bracket, although this changed with the devaluation of the CFA franc in 1994. In 2001 Senegal was formally classified by the UN as one of the world’s 49 “least developed countries” (LDCs), based on its low GDP per capita, weak human resource base and low level of economic diversification. More recently, economic prospects are fairly good, with real GDP growth estimated to be around 5%. The existing investment environment and infrastructure bottlenecks will continue to act as a brake on higher growth rates and prevent the economy from attaining the official annual real GDP growth target of 8%. In 2002, Senegal was qualified for the Highly Indebted Poor Country (HIPC) Initiative.
Since 1998, Senegal adopted a sector wide approach to planning for the health sector (SWAp). In 2001, per capita expenditures on health were $20.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 89%. The national immunization programme objectives are to:
- reach and maintain immunization coverage at 80% levels for children under 1 year of age;
- eliminate neonatal tetanus;
- eradicate polio;
- reduce by 90% morbidity and 95% mortality due to measles;
- introduce hepatitis B and haemophilus influenzae type b (Hib) vaccine into the national immunization schedule;
- strengthen the surveillance system;
- strengthen the management of the national immunization programme;
- strengthen logistics;
- strengthen social mobilization activities; and
- ensure adequate funding for immunization.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Senegal spent $2.5 million on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $7.3 per DTP3 vaccinated child or $0.23 per capita. Programme-specific spending on routine immunization increased by 14% in 2002, the first year of GAVI Fund support, due to an increase in expenditures on vaccines, injection equipment, transport, maintenance and overhead, and cold chain equipment.
The share of programme expenditures paid by the national government was 43% in 2002. The government pays mainly for vaccines, injection supplies, salaries, transport and maintenance and overheads, while donors pay for cold chain equipment, vehicles and other recurrent costs. The main funding partners are the GAVI Fund, UNICEF, the government of Luxembourg, JICA, WHO, USAID, the World Bank, the African Development Bank and the European Union.
Routine immunization financing by source - 2002
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 2003-2008 for the NIP are projected to be $6.2 million per year. About 85% of the funding is classified in the FSP as secure. If funding classified as probable is included as well, 85% of needs are covered.
An annual gap of $0.1 million will exist during 2003-2008 if both secure and probable funding are included ($2.2 million if probable funding is not included) during the remaining GAVI Fund years. During the post-GAVI Fund years (2009-2012), the gap is estimated to average $5.1 million if secure funding is taken into account. In other words, 67% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- increase government funding towards the national budget line item for vaccines and injections supplies;
- advocate for increased national resources for immunization based on the projected increase in the health budget;
- advocate for HIPC debt relief funding for immunization;
- advocate for community participation in the funding of immunization as well as the private sector;
- reduce wastage and drop out rates.