Tajikistan's immunization costing and financing situation
Macroeconomic and health system context
In 2001, the average annual income was $172 per capita, with an estimated 82.5% of population living under the poverty line. The Government has set itself the objective to promote strong and sustainable economic growth (5 to 6%) for the period 2003 to 2008, and reduce the poverty to 56% by 2008.
The government is introducing some health sector reforms. It plans to reduce the number of service delivery points, particularly in rural areas and the delivery of primary health care services will be consolidated and provided at clinics and medical posts by general practitioners (family doctors) - a reform which already began in urban areas. In 2001, per capita total expenditures on health were $5.7.
Immunization programme objectives
Tajikistan immunization coverage has remained at high levels for the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 83%. The national immunization programme’s objectives are to ensure effective and safe routine immunization coverage to 95% of targeted children according to the national schedule of immunization; to introduce Hepatitis B vaccination in the whole country by 2005; to ensure that Tajikistan remains polio-free until the global polio eradication; to reduce measles incidence rate to the level of 1 case per 100,000 people and achieve “zero” registration of local measles mortality by 2005; and to achieve elimination of measles by 2010.
Immunization costs and financing
In 2001, the year before Vaccine Fund support began, Tajikistan spent $0.5 million to deliver routine immunization services and an additional $0.2 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $4.0 per DTP3 vaccinated child or $0.1 per capita. Spending on routine immunization increased in 2002 to $1.1 million, due to Hepatitis B introduction and some upgrading of the cold chain. Total expenditures on the NIP in 2002 were $1.5 million.
In absolute terms, both the government and donors increased their contributions to the programme from 2001 to 2002. However, relative to all other financing, the share of total expenditures paid by the government decreased from 14% to 8% mainly due to the effect of new funds available from GAVI/Vaccine Fund. The government pays for some salaries, transport and other recurrent costs while donors pay for vaccines, injection supplies, capital costs, and supplementary immunization. The main funding partners are UNICEF, WHO, GAVI/Vaccine Fund, Aga Khan Foundation, IFRC, Merlin, and MSF.
Routine immunization financing by source - 2002
Future resource requirements, financing and gaps
Resource requirements of the programme are projected to increase with increasing expenditures on new vaccines, other operational costs, cold chain equipment and supplemental immunization activities. The average annual resource requirements during 2003-2005 for the NIP are estimated to be $1.8 million. About sixty percent of the funding is considered as secure during these years.
During 2003-2005, the gap in funding for the NIP is on average $0.7 million each year if probable funding is not included, and changes very little if probable funding is included. The average annual gap in the post-Vaccine Fund period during 2007-2009 with secure and probable funding rises to $1.7 million, an increase of 230%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) advocating for increased budgetary resources allocated to immunization services; (2) improving resources covered by the population as part of community management for primary health care; (3) increase fees for immunization services in the post-Vaccine Fund period; (4) developing new strategies for alternative funding for immunization; (5) mobilizing the private sector to make contributions to the national immunization programme; (6) advocating for resources from external partners; (7) looking for new partners or join/explore new initiatives: (8) expand the ICC membership; (9) assign to the NIP, a programme officer with an economist/finance profile to assist in analysis of the FSP, identifying gaps and developing new strategies and approaches to overcome them; (10) conducting annual reviews of immunization activities with a focus on the difficulties with resource mobilization; (11) improved vaccine management and distribution strategies; (12) introduce a proper system for monitoring indicators; and (13) improve information system for better planning and budgeting for the national immunization programme.