ACHIEVING FINANCIAL SUSTAINABILITY FOR IMMUNIZATION IN UGANDA Presentation to stakeholders, Wednesday June 25, 2003
Presentation outline Background information –Workshop objectives and outcomes –UNEPI programme objectives –Financial Sustainability and its process in Uganda Present and future costs of the EPI programme Strategies to ensure financial sustainability
Introduction Immunization –Reduces unnecessary ill health, death and disability –Reduces service costs –Improves empowerment (averts disability) –Contributes to child survival, growth and development –Is the most CE intervention Is imperative to have adequate, reliable financial resources on long term basis for continuity How to do this: Develop a FSP
Workshop Objectives To sensitize key stakeholders in the FSP development process. To share the results of the costing of the National Immunisation Programme, including demonstration of financial projections to 2010. To show present and projected trends in funding for EPI. To discuss proposed strategies to ensure financial sustainability of the EPI.
Desired outcome of workshop Achieve consensus on relevant, realistic and specific strategies for financial sustainability of immunization program in Uganda.
UNEPI Vision, Mission and Goal Vision:To ensure that the Ugandan population is free of vaccine-preventable diseases and disabilities Mission:To contribute to the overall objective of the HSSP in reducing morbidity,mortality and disability due to childhood vaccine preventable diseases, so that they are no longer of public health importance Goal:To ensure that every child is fully immunized by the first birthday, and every new born is protected from neonatal tetanus
UNEPI Program objectives Strengthen service delivery to increase DPT coverage from 54% in 1999 to 88% by 2010. Increase program effectiveness, efficiency and quality. Introduce and sustain additional vaccines such as the DPT-Hepatitis B + Hib vaccine. Improve disease surveillance. Eradicate polio and eliminate MNT by 2005. Reduce measles mortality and morbidity by 90% by 2006. The FSP addresses all these objectives
Financial Sustainability Plan Financing strategy for immunization in Uganda Assesses the key financial challenges facing the immunization programme, and describes the strategies to overcome these in medium to long term
Definition of Sustainability “Although self-sufficiency is the ultimate goal, in the nearer term sustainable financing is the ability to mobilize and efficiently use domestic and supplementary external resources on a reliable basis to achieve current and future target levels of the immunization performance”
Developing the FSP for Uganda On-going participatory process since 2002, involving MOH, MOF, and development partners. Draft discussed with stakeholders (ICC, HPAC, HDP) FSP process aims to fit within the Uganda national planning and budgeting cycle (MTEF, LTEF)
Value of the FSP generates a clear picture of the financing situation and challenges. identifies relevant, feasible and specific strategies for financial sustainability. is an advocacy tool for discussion between the MOH, the MOFPED and other partners.
2000/01 (Baseline year) The baseline year is the financial year before any support was provided by the Global Alliance for Vaccines and Immunisation (GAVI) Total routine costs in 2000/01 for provision of vaccines to target population: $4.49 million USD (USD $17.36 per child fully immunized, equivalent to USD $0.18 per capita).
2001/02 (First Year) The first financial year in which Uganda received support from GAVI. This included financial support and vaccines for one month (June 2002) Total first year costs including shared personnel: $6.38 million USD.
Comparison of funding sources 2000/01 – 2002/03
Contributions from the Vaccine Fund (GAVI) in Uganda Injection safety materials: Auto-disable (AD) syringes ($1,157,000 for 3 years) Support funds (US$ 910,000 x 2 years) to strengthen the system and increase coverage Addition of two antigens: –Hepatitis B (Hep B) –Haemophilus influenzae type b (hib) –Using “pentavalent” presentation: DTP+Hep B+hib ($50 million over 5 years)
Cost drivers: 2002 to 2007 Cost of routine EPI –2002: $20,375,520 –2007: $23,363,763 (USD $0.79 per capita) Costs rise due to: –population growth: annual increase in size of birth is 100,000 additional babies (result: 10% of programme cost increases) –coverage increase: 72% to 85% (result: 4% increase of programme cost) –Depreciation of exchange rate: rising costs of all vaccines
Funding gap implications for achievement of UNEPI objectives In 2007, when GAVI no longer provides vaccine, there will be a gap of $17.3 million –$16.5 million is the vaccine cost –$0.8 million funding gap for operational costs Implications –Vaccine shortages –Increased disease burden of immunizeable diseases –Political credibility questioned –Overall Social and Economic development compromised Social protection strategies of govt towards vulnerable groups questioned
What are costs of NOT providing hepatitis B and Hib vaccines? Treatment costs incurred by system –Costs due to illnesses that are a result of a vaccine preventable disease –Refers to treatment costs to the health system, eg. due to Hib meningitis –Treatment and vaccine costs of a vaccine include costs of providing the vaccine, compared to cost of treatment of illnesses due to the immunizable diseases –As vaccine coverage increases, treatment costs decline
EPI expenditures in perspective 2000/012001/022002/03 Cost per capita$.31$.33$.73 Cost per FIC$17.36$16.89$32.50 Vaccine cost to total EPI cost 18%30%73% EPI cost to total health expenditure 11%8%16% EPI allocation to total health expenditure 2.7%2.2%1.8%
STRATEGIES TO ENSURE FINANCIAL SUSTAINABILITY OF THE PROGRAMME
Key strategies Mobilize additional internal resources Mobilize additional external resources Increase reliability of resources Increase program efficiency
Strategy for mobilizing public resources Health Financing Strategy allocates 4% of health budget recurrent costs for vaccines Allocation been reducing annually to under 2% at present Need to halt slide on proportion of health expenditure on vaccines/EPI
Strategy for mobilizing public resources Govt to continue funding the full cost of traditional 6 antigens including the DPT cost and injection supplies. Propose an increase in proportion of health expenditure for vaccines/EPI (1% increase in real terms annually starting 2004/05) Govt budget not expected to fund 100% of vaccine costs in the medium term
Impact of 1% annual increase in EPI allocation 31,44935,6129,91411,2570.305%2006/07 35,03439,66820,80023,6180.648%2009/10 33,78638,25717,00819,3120.527%2008/09 32,59236,81513,38115,1940.416%2007/08 30,35434,3726,6717,5740.204%2005/06 29,30433,1853,5083,9830.113%2004/05 28,29932,0464124670.012%2003/04 Deaths averted Illness episodes averted Deaths averted Illness episodes averted TotalGoU contributionPropn of penta costs covered (bn. shs) Propn of health budget YR
Mobilization of other local resources Immunization activities to be integrated into Local Government activities funded by local resources Local Govts to mobilize resources for selected cost items, such as IEC and social mobilization
Strategies to seek external resources Significant donor support for SIAs imply high confidence among donors in immunization as a disease prevention strategy Advocate for routine vs SIAs support (e.g. rotary, red cross) design a menu for civil society partners and private sector Negotiate with World Bank for buy-down: performance related external support Private sector: corporate partners, lottery, e.g. advertising
Strategies to increase reliability Taper off vaccine fund support beyond 5 years (use performance grants from GAVI) Protection of vaccine commitment in prog. 9 Cost savings from donors to be maintained within programme, as opposed to remitting back Incorporate FSP financial forecasts in govt planning and budgeting processes e.g. MTEF/LTEF Improve district financial mgt. capacity Advocate for sustainability of SWAp partnership
Strategies to improve efficiency Reduce vaccine wastage –Vaccine management monitoring system & MDVP –Create immunisation logistics manager position –Maintain and upgrade cold chain NB. Most strategies to reduce wastage may also reduce immunisation coverage Reduce operational costs –Reduce distribution cost…Switch from gas to electric/gas Rationalise outreach services/ intensify social mobilisation
Summary Immunisation is most Cost Effective use of scarce resources, preventing disease, death and disability, & unnecessary treatment costs UNEPI to continue providing the current 8 antigens EPI programme costs shall continue to raise as newer vaccines are developed Cost implications manageable if phased over time Are many funding partners besides GoU budget, though this is expected to remain main source of funds (in line with SWAp strategy) Inability to cover vaccine costs beyond GAVI support implies higher costs to the system
Discussion points Rising costs of vaccination programme due to popn increase and better coverage. GoU allocation for immunization activities. Long-term vision to enable increased adaptation of newer vaccines over time: yellow fever, pneumococcal vaccine, malaria, HIV, etc.
Next Steps READ the FSP Submit comments on strategy to UNEPI for inclusion in FSP (is a full section on stakeholder comments for inclusion in final FSP) Present strategy to Health Sector Working Group
FSP chapters Section 1: Impact of country and health system context. Section 2: Program characteristics, objectives and strategies. Section 3: Baseline and current program costs and financing Section 4: Future resource requirements, financing gap analysis Section 5: Sustainable financing strategy, actions, indicators Section 6: Stakeholder comments!!!!!
Vision of UNEPI To have a society free of vaccine preventable diseases and disabilities. Immunization expenditures are not mere costs but investments in health and development