Uganda's immunization costing and financing situation
Macroeconomic and health system context
Uganda’s economic growth has been favourable during the last decade and is projected to average 6% per annum for the next few years. However, this rate is lower than what is considered necessary for Uganda to meet its poverty eradication goals. Uganda has introduced several health reforms including the restructuring of the Ministry of Health, the decentralisation of health service delivery, health financing reforms, reforms of the regulatory structure and greater involvement of the private sector. In 2001, per capita expenditures on health were $14.
Immunization programme objectives
Uganda’s immunization coverage has been rising in the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2001 was 60%. The objectives of the national immunization programme are to increase and maintain high immunization coverage for routine immunization services, continue to offer hepatitis B and Haemophilus influenzae type b vaccines within the routine programme, and improve quality of services, including injection safety and waste management.
Immunization costs and financing
In 2001, the year before Vaccine Fund support began, Uganda spent $3.0 million to deliver routine immunization services and an additional $2.1 million on supplementary immunization services. The programme-specific spending on routine immunization service equated to about $4.6 per DTP3 vaccinated child or $0.12 per capita. Spending on routine immunization increased in 2002 to $4.9 million, an increase of 60%, due to new vaccine introduction, related injection supplies, and spending on other recurrent costs. Total expenditures on the NIP in 2002 were $5.8 million.
The Ugandan government decreased its financing for the programme from $1.7 million in 2001 to $1.5 million in 2002. As a result, the percent of total expenditures paid by the government for the programme decreased from 57% to 31%. Whereas the government pays for some vaccines, injection supplies, personnel, transport, and other recurrent costs, donors pay for vaccines, injection supplies, training, monitoring and surveillance, and all the capital equipment (vehicles and cold chain). The main funding partners are WHO, GAVI/Vaccine Fund, IFCR, JICA, and USAID.
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 and supplemental immunization activities. The average annual resource requirements during 2002-2006 for the NIP are estimated to be $23.2 million. Over 90% of the funding is considered as secure during these years.
During 2002-2006, the gap in funding for the NIP is on average $2.1 million each year if probable funding is not included, and drops to $0.3 million if probable funding is included. The average annual gap in the post-Vaccine Fund period during 2007-2009 with secure funding rises to $17.6 million, an increase of 750%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) mobilizing additional resources from the government budget for the health sector, from the Ministry of Health budget for immunization, from decentralized local governments, from local, non-governmental sources, from external resources of current and new partners; (2) increasing the reliability of resources by ensuring that financial requirements for immunization are in the MTEF and LTEF, government contributions for vaccines and immunization are secured, GAVI/Vaccine Fund support is phased-out after 5 years, and any unspent resources from donors, or the government are maintained within the programme; and (3) improve the efficient use of allocated resources.