Ukraine's immunization costing and financing situation
Macroeconomic and health system context
Ukraine’s economy has begun to improve in recent years from the economic downturn in the 1990s. The country had a turnaround in 2000. The economic improvements were broad-based, with strong industrial-output growth, especially in manufacturing, a surge in retail trade and recently in construction, and good agricultural performance.
In 2001, per capita expenditures on health were $33.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 99%. The national immunization programme objectives are to:
- maintain the coverage level at no less than 95% of the target population;
- introduce new vaccines, including hepatitis B;
- achieve measles elimination by 2007;
- reduce the incidence level of diphtheria to less than 0.1 per 100,000 population, and of whooping cough and mumps to less than 1.0 per 100,000 population;
- reduce the prevalence of rubella in newborn children to less than 0.01 per 1000 live births;
- provide safe procedures for preventive vaccinations of the population, including country-wide introduction of auto-destruct syringes;
- create an efficient transport and storage system vaccines;
- reduce vaccine wastage through training of health workers;
- expand research into the main ways of combating infectious diseases, coordinated by specific prevention means;
- improve regional supply system for vaccines; and
- raise public awareness of the prevention of infectious diseases.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, the Ukraine spent $6.5 million on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $16.8 per DTP3 vaccinated child or $0.13 per capita. Programme-specific spending on routine immunization increased by 61% in 2003, the first year of GAVI Fund support, due to an increase in expenditures on vaccines, injection equipment, personnel salaries, and transport.
The share of programme expenditures paid by the national and regional governments decreased slightly to 95% in 2003, due to an increase in donor expenditures on vaccines and injection equipment. The national and regional governments pay mainly for vaccines, injection supplies, salaries, transport, maintenance and overheads, training, surveillance, monitoring, and social mobilization, while donors pay for vaccines and injection equipment. The main funding partners are the GAVI Fund and UNICEF.
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 $14.8 million per year. Over 95% of the funding is classified in the FSP as secure. If funding classified as probable is included as well, 10% of needs are covered.
No gap exists during 2004-2007 if both secure and probable funding are included (a $0.42 million funding gap exists if probable funding is not included) during the remaining GAVI Fund years. During the post-GAVI Fund years (2007-2013), there is no funding gap if secure and probable funding are taken into account (a $2.3 million funding gap exists if only secure funding is included). In other words, there are no unmet needs.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- to optimize centralized vaccine purchasing practices to obtain a more favourable price-quality ratios for vaccines and equipment procured;
- to develop efficient financial incentives system to encourage regional and local authorities to maintain adequate infrastructure for the immunization system at the healthcare establishment level;
- to improve the immunization information system; and
- to improve the criteria for introducing new vaccines into the vaccination calendar.