Cost and resources requirements
- Recurrent costs: these include the costs associated with inputs that will be consumed or replaced in one year or less. The recurrent cost categories used in the FSP include the following: vaccines (traditional and new and underused vaccines), injection supplies, personnel, transport, maintenance and overhead, training, social mobilization/IEC, surveillance and monitoring. See definitions of these cost categories.
- Capital costs: these are the costs of resources that have a value over $100 and are not consumed or replaced every year. Given that capital equipment will last for more than one year, their value is depreciated (or amortized) over its lifetime - known as useful life years (ULY). The capital cost categories used in the FSP include the following: vehicles, cold chain equipment and other immunization specific equipment (incinerators, lab equipment, etc.). The suggested method for the treatment of capital cost is a simple straight line depreciations - the value of the equipment new is divided by its number of useful life years. See definitions of these cost categories.
- Specific costs: Also termed “programme specific costs”, these include the cost of all inputs used specifically for immunization and not shared with any other health service. Their utilization will be 100% for the national immunization programme. Specific costs are intended to be those that the immunization programme has to mobilize for itself alone. Specific costs are considered to be those that are the most comparable across countries with the least chance of distortion due to differences in estimation methods. See tips for data analysis.
- Shared costs: include the cost of inputs that are shared among multiple health services. Traditionally, shared costs include those for service delivery personnel, since they often perform multiple duties beyond immunization, making it difficult to separate out the share to be attributed to immunization. The process to separate the shared portion of certain costs is known as cost allocation. Specific methodologies for cost allocation are provided in the FSP guidelines. Other shared costs are those associated with transportation and buildings. Comparisons across countries of shared costs can be risky because of the differences in cost allocation methods used. Cross-country comparisons using shared costs are likely to be imperfect and subject to misinterpretations. See tips for data analysis.
- Cost projections: This corresponds to the total future costs of both recurrent and capital inputs to the national immunization the programme over the remaining Vaccine Fund years and the post Vaccine Fund period and based on programme objectives. However the future value of capital equipment is depreciated (or amortized) over its lifetime - known as useful life years (ULY). In other words, the value of the capital equipment is spread out over the number of years it will be used and brought to an annual equivalent. An advantage of working with future cost projections is that important cost indicators can be computed and these are comparable over time (e.g. yearly variations in the NIP cost per capita or cost per fully immunized child). The cost projection approach has certain limitations - it does not allow for an accurate comparison between future financial resource needs of the programme and required funding. This is the rational for the resource requirements approach.
- Projection of future resource requirements: This corresponds to the total future resource requirements (Also termed “future resource needs”) of both recurrent and capital inputs to the national immunization programme over the remaining Vaccine Fund years and the post Vaccine Fund period and based on the programme objectives. For capital equipment this means that the value of the capital inputs are not depreciated as in the case of the cost projections approach. Since existing capital equipment has already been paid for, the resource requirements approach is most relevant when looking at exact amounts of future financing that need to be mobilized each year. The advantage of this approach is that it allows for comparisons between future resources requirements and future financing, and how the two need to be matched in order to reduce the financial gaps.
Years and periods
- Pre-VF year: this corresponds to the most recent year for which data on expenditures and financing are available before any Vaccine Fund support has been received by the country. This will usually be the year before the first GAVI awarded support provided by the Vaccine Fund are received by a country (e.g. for new vaccines, immunization services strengthening and injection safety).
- VF year: this corresponds to the most recent year for which complete data on expenditures and financing are available after implementation of GAVI awarded support. This will either be the first year after Vaccine Fund support was received and used by the programme, or the second year of such support with at least a full year of implementation.
- Remaining VF years: these correspond to the remaining years of Vaccine Fund support that countries report in their FSP beyond their VF year.
- VF period: this corresponds to all the years during which Vaccine Fund support has been, and is expected to be provided. Except in selected cases, the VF period will be 5 to 8 years.
- Post VF period: this corresponds to the immediate years (2 to 3) beyond the VF period.
- NIP: this refers to the National Immunization Programme (NIP) in its entirety. The NIP strategy includes all costs, resource requirements and financing for both routine immunization services and campaigns (also known as supplemental immunization activities). [NIP = Routine + Campaigns]. Note that the total NIP costs, resource requirements and/or financing aggregates can be based on either programme specific costs or both specific and shared costs. See tips for data analysis.
- Routine: this refers to routine immunization. The routine strategy will include all costs, resource requirements and financing for routine immunization services only and excludes campaigns (also known as supplemental immunization activities). [Routine = NIP - Campaigns]. Note that the total routine costs, resource requirements and/or financing aggregate can be based on either programme specific costs or both specific and shared costs. See tips for data analysis.
- Campaigns: this refers supplemental immunization activities. The campaign strategy will include all costs, resource requirements and financing for supplemental immunization activities such as mass measles campaigns or Polio national immunization days. By definition, the campaign strategy will exclude any costs, resource requirements and financing for routine immunization delivery services. [Campaigns = NIP - Routine]. Note that the total campaign costs, resource requirements and/or financing aggregates can be based on either programme specific costs or both specific and shared costs. See tips for data analysis.
Financing and gaps
- Total secure funding: Secure funding refers to the projected future financing available in the short term that is considered as assured. This implies that the funding has been committed and is guaranteed to be made available (e.g. there is a commitment in writing). For instance, once awarded, Vaccine Fund commitments are considered as secured funding. For the most part, secure funds are pledged over 2 to 3 years or less - except in the case of GAVI and the Vaccine Fund (5 years) , monies from a pooled funds (e.g. in a Sector wide approach - SWAp) or debt relief funding for immunization (e.g. HIPC Initiative).
- Total probable funding: Probable funding refers to all other funding that is not assured, but is likely to be made available in the short and medium term. The term "probable" indicates that the projected future funding is likely based on historical trends and/or other information, including discussions with Ministries and donors.
- Gap with secure funding: this refers to the difference between projected resource requirements and secure financing over the corresponding period. [gap with secure funding = resource requirements - secure funding]
- Gap with probable funding: this refers to the difference between projected resource requirements and both secure and probable financing over the corresponding period. [gap with probable funding = resource requirements - (secure + probable funding)]
- Financing source: A source of financing refers to the agents providing the funds for immunization. Given the difficulties in tracking the exact source of financing, countries are asked to report only the source of financing closest to the end use. Therefore, transfers of bilateral donor agency resources to multilateral agencies (such as WHO or UNICEF), or to a health fund or the national treasuries (through pooled funds or budget support) are not attributed to the donor countries. This is of particular (and growing) significance in countries receiving bilateral aid through sector-wide approach (SWAp) programmes and national budget support. In the immunization financing database, only the last source of funding before they get used by the programme are reported (e.g. if USAID channels their funds for immunization through UNICEF, the funding is considered as UNICEF funds. In other words, UNICEF is the end source).
- Government: This source of financing refers to domestic public funding for immunization derived from taxation or other sources of public revenues at the central and/or sub-national levels, and allocated through a formal budgetary process. It can include the non-concessionary portion of a development loan, national budget support and debt relief proceeds.
- Bilateral: This source of financing refers to external public funds for immunization from official development assistance. Typically these are funds derived from taxation in donor countries and constitute the grant funding from bilateral international aid agencies.
- Foundations: This source of financing refers to external private funds for immunization from foundations.
- Multilateral: This source of financing refers to external public grant funding for immunization channeled through multilateral international aid agencies such as UNICEF, WHO and the grant portion of development loans from international and regional development banks (e.g. World Bank or Asian Development Bank).
- NGO: This source of financing refers to external private funds for immunization from non-government organizations.
- Private sector: This source of financing refers to domestic private funds for immunization.
- Other: This source of financing refers to any other source of funding for immunization not elsewhere specified. It includes the sources of funding that were not specified and for which the source could not be determined.
- % government funding: this indicator refers to the ratio between government financed spending on immunization and total spending on immunization irrespective of the funding source. This indicator gives the relative share of government funding for immunization compared to other sources of financing. The same indicator can be calculated for specific cost categories, e.g. % government funding for vaccines. Note that this indicator is very sensitive to the inclusion or not of shared costs.
- Cost per capita: this indicator links total immunization cost or resource requirements to total population in the country and provides a sense of affordability of the immunization programme. This indicator can be compared to the total per capita spending on health in order to give a sense of the relative importance of the immunization programme within overall health sector spending. If this indicator is going to be used to make cross-country comparisons, it is recommended that you use the total routine cost as a numerator. See tips for data analysis.
- Cost per DTP3 child: this indicator links total immunization cost of immunization to the total number of children under 1 year of age that received their 3rd dose of DTP vaccine. The number of DTP3 immunized children is calculated by multiplying the total number of surviving infants by DTP3 coverage. Children under one year of age who receive DTP3 are considered to be fully immunized children (FIC). The cost per DTP3 child is used as an approximation of the value of resources required to fully immunize a child. If this indicator is going to be used to make cross-country comparisons, it is recommended that you use the total routine cost as a numerator. See tips for data analysis.
- Resource requirements, financing or gaps per DTP3 targeted child: the future resource requirements, financing and gaps per targeted DTP3 child are the ratios of the total projected resource requirements, financing or gaps divided by the total number of future children targeted to receive 3 doses of DTP. The number of DTP3 targeted children is calculated by multiplying the projected number of surviving infants by DTP3 coverage targets. This indicator is used to measure future resource requirements and gaps in a way that permits easier interpretation than looking at absolute values. If this indicator is going to be used to make cross-country comparisons, it is recommended that you use the total routine resource requirements or cost as a numerator. See tips for data analysis.