Regional Workshop and Policy Forum on Sustainable Immunization Financing

Istanbul, Turkey: November 13-17, 2006  

A regional workshop and policy forum on sustainable immunization financing was conducted in collaboration with WHO/Geneva/EURO. The purpose of the policy forum was to bring together policy makers to make the case for the unfinished agenda for immunization in the region, and the implications for future financing and sustainability. The purpose of the technical workshop was to build country-level capacity for planning and budgeting of the national immunization program, using the Comprehensive Multi-Year Planning (cMYP) tools and guidelines, with a view toward financial sustainability of the program. A total of 13 countries attended the workshop (Albania, Armenia, Azerbaijan, Bosnia & Herzegovina, Georgia, Kazakhstan, Kyrgyz Republic, Moldova, Tajikistan, Turkey, Turkmenistan, Ukraine, and Uzbekistan), with a total of 42 country-level participants for both the policy forum and workshop. Country teams were composed of the national immunization program manager, and persons responsible for planning and budgeting for health and immunization from ministries of finance and health. The format of the workshop and policy forum included presentations, group exercises, and facilitated discussions. Copies of the materials in English and Russian are available here.

The focus of the week was on placing immunization programs within a context of a changing global financing environment and changing health financing and delivery systems at national level. This is critical for the ECA region where despite achievements in immunization coverage, in 2003 measles killed an estimated 4, 850 children; and every year an estimated 32 000 children die from vaccine preventable illnesses. Children in poorer countries are more likely to die; statistics show that a child in an industrialized country is 10 times less likely to die from a preventable disease. As these statistics show, the region still has to expand coverage; and do this within a changing health sector environment. Immunization remains among the most cost-effective interventions, and has had a major impact in reducing the burden of disease. The Expanded Program on Immunization (EPI) has targeted mainly six communicable diseases of childhood, and has been successful in reducing the share of these six diseases in the total burden of disease among children under five from about 23% in the mid-1970s, to less than 10% in 2000. It costs about $17 to fully immunize a child against measles, polio, tetanus, diphtheria, pertussis and tuberculosis, resulting in a cost of US$50 per DALY gained, making immunization one of the most cost-effective interventions available. Nearly 3 million deaths are prevented each year by immunization, and an even greater amount of illness and disability. However, children living in remote areas or in families with low access to basic health services remain unimmunized today. Reaching the unimmunized will be more costly per child than programs have previously experienced because of the need for new strategies and approaches.

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Global resources available for immunization programs, through the GAVI Alliance and the International Finance Facility for Immunization (IFFIm) are significant and increasing—up to $4 billion in 2015 (weblink here). While there are ample resources to support country priorities for scaling up immunization programs, receiving and integrating donor assistance into national planning and budgeting frameworks will be challenging. Immunization managers will need to take into account new planning and priority setting frameworks such as the MDGs -Millennium Development Goals- and PRSPs - Poverty Reduction Strategy Papers- as well as other frameworks that determine resource allocation priorities, such as Sector Wide Approaches (SWAps). At the same time, Immunization mangers and ministries of health will need to understand that external financing flows are directed less at individual programs and are more in support of the health sector or the general budget, in an effort to align their support to country systems, provide more predictable aid flows, and improve sectoral coordination. Therefore, immunization programs are potentially further away from external sources of funding and will need to take additional steps to gain access to these resources. Increasing tendencies toward basket or pooled funding, donor consolidation (fewer donors per sector per country) and SWAps will have implications for immunization programs that have been organized as a vertical effort within ministries of health. Link to Health Projects in ECA.

Competition for resources: Many countries in the ECA Region are challenged by the dual responsibilities of providing health care to address chronic, non-communicable diseases, and at the same time continue to financially support basic primary and preventive health services, such as immunization. Immunization programs will need to identify what systemic issues in the health sector are impeding provision of services; and how the strengthening of health systems could also mean a strengthening of immunization programs.

 

While traditional vaccinations, such as those preventing polio or measles are relatively inexpensive, new vaccines under development, which have the potential of preventing thousands of deaths, are much more expensive to introduce and sustain in national programs. Establishing priorities for allocating public health resources on the basis of evidence and decision-making around affordability and sustainability, as well as public health impact, will become more important in the future.