Sierra Leone's immunization costing and financing situation
Macroeconomic and health system context
Sierra Leone has recently begun emerging from a civil war and its economic progress was slowed during the last decade. Despite the conflict, the government has, since 1996, undertaken important economic reforms. These reforms include policy and administration reforms that support private sector redevelopment and improve public expenditure management and control, exchange and trade liberalization to strengthen competitiveness, financial sector modernization and regulatory reform improvements in governance, and more effective delivery of social services including health. Economic growth began to improve in 2000 when real GDP increased to 4%. However, economic growth will suffer from recent inflation resulting from higher oil prices, delays in international aid disbursements, and inadequate fiscal adjustment policies.
In 2001, per capita expenditures on health were $7.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 63%. The national immunization programme objectives are to:
- increase vaccination coverage by 2009 to 88% for BCG, 80% for the DTP vaccine, and 79% for measles;
- reduce DTP drop-out from 24% in 2004 to 10% in 2009; and
- reduce vaccine wastage.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Sierra Leone spent $2.7 million on programme-specific expenditures for routine immunization services and an additional $1.3 million on supplementary immunization. The programme-specific spending on routine immunization service equated to about $22.2 per DTP3 vaccinated child or $0.56 per capita. Programme-specific spending on routine immunization increased by 30% in 2003, the first year of GAVI Fund support, due to an increase in expenditures on vaccines, injection equipment, transport, monitoring and overhead, and cold chain equipment.
The share of programme expenditures paid by the national government stayed the same at 48% in 2003. The government pays mainly for personnel salaries, transport, maintenance and overheads, training, surveillance, monitoring, and social mobilization, while donors pay for vaccines, injection equipment, capital costs, and supplementary immunization. The main funding partners are the GAVI Fund, UNICEF, and WHO.
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 $3.4 million per year. About 94% of 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 $0.1 million will exist during 2004-2007 if both secure and probable funding are included ($0.2 million if probable funding is not included) during the remaining GAVI Fund years. During the post-GAVI Fund years (2007-2013), the gap is estimated to average $09 million if secure and probable funding are taken into account. In other words, 23% of needs are unmet.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- secure additional funding for primary health unit network to strengthen immunization;
- actively target donor support for immunization; and
- greater involvement of the ministry of health in national budgeting to secure more funding for immunization.