Yemen's immunization costing and financing situation
Macroeconomic and health system context
During the late 1990s, Yemen implemented reform policies and measures that contributed to economic stabilization, liberalization of trade and private sector involvement in economic activity. Since then, there has been a 4% increase in the economic growth rate, a drop in inflation and stabilization of the foreign currency exchange rate.
The Ministry of Public Health embarked on a reform programme in 1998, with the key elements being the establishment of the district health system, decentralization, community participation and inter-sectoral cooperation. During this period, immunization coverage for DTP increased as a result of the reform.
In 2001, per capita expenditures on health were $22.
Immunization programme objectives
According to the WHO and UNICEF estimates, the DTP3 coverage in 2001 was 80%. The national immunization programme objectives are to:
- introduce the DTP, hepatitis B and haemophilus influenzae type b as a pentavalent vaccine in 2005;
- to achieve at least 80% coverage by 2007 for children less than one year of age;
- to achieve 60% coverage for pregnant women with tetanus toxoid (TT2+);
- to sustain the interruption of polio virus;
- to interrupt indigenous measles virus by the year 2006;
- to ensure safe vaccination; and
- to achieve the maternal neonatal tetanus elimination by the year 2007.
Immunization costs and financing
In 2001, the pre-GAVI Fund year, Yemen spent $8.7 million on programme-specific expenditures for routine immunization services. The programme-specific spending on routine immunization service equated to about $15.1 per DTP3 vaccinated child or $0.47 per capita. Programme-specific spending on routine immunization increased by 6% in 2003, the second year of GAVI Fund support, due to an increase in expenditures on vaccines, injection equipment, personnel salaries, and surveillance and monitoring.
The share of programme expenditures paid by the national and regional governments increased to 80% in 2003, due to an decrease in donor expenditures on supplementary immunization. The national and regional governments pay mainly for vaccines, injection supplies, salaries, transport, maintenance and overheads, training, surveillance and monitoring, social mobilization, and cold chain equipment, while donors pay for vaccines, injection equipment, per diems, training, social mobilization, cold chain equipment, and supplementary immunization. The main funding partners are the GAVI Fund, WHO, UNICEF, and World Bank.
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 2004-2013 for the NIP are projected to be $26.1 million per year. About 80% of the funding is classified in the FSP as secure during these years. If funding classified as probable is included as well, 90% of needs are covered.
An annual gap of $2.9 million will exist during 2004-2013 if both secure and probable funding are included ($5.4 million if probable funding is not included) during the remaining GAVI Fund years. There is no post-GAVI Fund years reported. The FSP reports secured GAVI Funds for the entire 2004-2013 period.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to improve financial sustainability of the NIP. These strategies include:
- to advocate for additional resources for immunization from the government;
- to advocate for additional resources for immunization from donors;
- to improve programme efficiency through reductions in vaccine wastage and the replacements of cold chain equipment and vehicles; and
- to increase the reliability of resource availability.