Zambia's immunization costing and financing situation
Macroeconomic and health system context
In 2001, economic growth began to declined to 3% due to inadequate rainfall during the agriculture season. In 2000, per capita GDP was $311. The Zambian government has introduced several health sector reforms. These reforms include the introduction of a sector-wide approach (SWAp), decentralization of the planning, management and decision-making of health services to the health boards, and the restructuring of health delivery systems. In 2000, per capita expenditures on health in Zambia were $17.1.
Immunization programme objectives
Zambia’s immunization coverage has remained at similar levels for the past few years. According to the WHO and UNICEF best estimates, the DTP3 coverage in 2000 was 78%. The national immunization programme’s objectives are to increase and maintain routine immunization coverage for all childhood antigens (BCG, measles, OPV, DPT) to 90% by 2004; to increase and maintain TT2+ coverage in pregnant women to 60%; to attain and sustain all targets for AFP surveillance and initiate an integrated surveillance system; to follow-up on implementation of the Vaccine Independence Initiative (VII); to improve the quality of immunization services, especially with regards injection safety; to conduct a comprehensive review of the immunization programme and develop a multi year plan in 2004; and to introduce new vaccine into the national immunization schedule.
Immunization costs and financing
In 2000, the year before Vaccine Fund support began, Zambia spent $1.7 million to deliver routine immunization services and $1.3 million on supplementary immunization activities. The programme-specific spending on routine immunization service equated to about $5.5 per DTP3 vaccinated child or $0.16 per capita. Spending on routine immunization rose in 2002 to $2.4 million, an increase of 41%, due to the purchase of cold chain equipment for the programme.
The government’s expenditures on the immunization programme increased from $0.1 thousand in 2000 to $0.3 thousand in 2002. Relative to all funding for immunization, the share of expenditures paid by the government increased to about 1%. The government pays for personnel, transport and other recurrent costs while donors pay for vaccines, injection supplies, personnel, some operational costs, vehicles, cold chain equipment and supplemental immunization activities. The main funding partners WHO, UNICEF, GAVI/Vaccine Fund, the donor pool, 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. The average annual resource requirements during 2003-2012 for the NIP are estimated to be $9.5 million. About half of the funding is considered as secure during these years. If probable funding is included as well, 80% of the funding needs to meet programme objectives would be covered.
During 2003-2012, the gap in funding for the NIP is on average $4.9 million each year if probable funding is not included, and drops to $1.8 million if probable funding is included. It should be noted that there is no clearly stated post-Vaccine Fund period in the Zambian FSP and projections assume the government is still a recipient of GAVI/Vaccine Fund support for new vaccines until 2012.
Average annual funding gaps (millions of US$)
Financial sustainability strategies
Several strategies have been developed to increase financial sustainability and lower the gap in funding. These include: (1) mobilizing additional government resources for the programme; (2) mobilizing additional local government resources for immunization; (3) mobilizing resources from the private sector; (4) expanding the ICC; (5) increasing the reliability of public resources; (6) reducing vaccine wastage; (7) increasing vaccination through static units; (8) increasing private provider provision for vaccination; (9) increasing the number of infants per outreach session; and (10) improving health worker management and service delivery skills.