Viet Nam's immunization costing and financing situation
Macroeconomic and health system context
Viet Nam has undergone rapid social and economic transformations during the last decade and economic growth has been strong since the 1997 Asia financial crisis - reaching rates of up to 7.0% in recent years. In 2000, per capita GDP was $399. The Government of Viet Nam has introduced various health sector reforms including user fees for health services, legalisation of private medical practice and the deregulation of the pharmaceutical market. In 2000, the per capita expenditures on health were $20.7.
Immunization programme objectives
Vietnam’s immunization coverage has remained at high levels for the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 96%. The national immunization programme’s objectives are to improve the quality and effectiveness of routine immunization services in order to ensure that over 90% of children under one year of age receive the full vaccination schedule; that over 80% of pregnant women and over 90% of women of child bearing age receive Tetanus Toxoid vaccine, and 80% of children in epidemic areas are vaccinated for Japanese Encephalitis, Typhoid and Cholera; that mass immunization campaigns are implemented; that disease surveillance is improved, especially surveillance on polio, neonatal tetanus and measles; that safe injection practices through implementation of the National Plan of Action and Policy is strengthened; and that the production and improvement of quality locally produced vaccines is strengthened.
Immunization costs and financing
In 2000, the year before Vaccine Fund support began, Vietnam spent $6.2 million to deliver routine immunization services and $1.0 million on supplementary immunization activities. The programme-specific spending on routine immunization service equated to about $4.3 per DTP3 vaccinated child or $0.1 per capita. Spending on routine immunization rose in 2003 to $12.0 million, an increase of 93%, due to the introduction of new vaccines into the programme and the renewal of the cold chain equipment.
The government’s expenditures on the immunization programme increased from $4.7 million in 2000 to $5.6 million in 2003. Relative to all funding for immunization, however, the share of expenditures paid by the government decreased from 76% to 46%, due to the introduction of GAVI/Vaccine Fund supported new vaccine introduction and increased support from the Government of Luxembourg for the renewal of the cold chain. The government contributes towards the cost of all inputs to the national immunization programme while donors pay for newer vaccines, injection supplies, some operational costs, and the cold chain equipment. The main funding partners are WHO, UNICEF, GAVI/Vaccine Fund, CVP, JICA, the Government of Luxembourg, and AusAID.
Routine immunization financing by source - 2003
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 2004-2006 for the NIP are estimated to be $12.7 million. About half of the funding is considered as secure during these years. If probable funding is included as well, 95% of the funding needs to meet programme objectives would be covered.
During 2004-2006, the gap in funding for the NIP is on average $6.7 million each year if probable funding is not included, and drops to $0.6 million if probable funding is included. The average annual gap in the post-Vaccine Fund period during 2007-2011 with secure and probable funding rises to $1.5 million, an increase of 150%.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) enhancing government funding for immunization; (2) increasing external resources for immunization; and (3) improving programme efficiency to lower the costs of the programme.