In the second blog in our World Immunization Week series, Jack Ndegwa, policy and advocacy manager at the Kenya Aids NGOs Consortium discusses the need for increased domestic financing for immunization in Africa.
This year’s World Immunization Week 2016 theme is “closing the immunization gap.” World Immunization Week comes two months after the monumental first Ministerial Conference on Immunization in Africa, in Addis Ababa, Ethiopia. The Conference, attended by global and African leaders, key among them Ministers of Health and Finance, was a powerful platform for governments to demonstrate their commitment to expanding access to vaccines across the continent. Notable was a session chaired by the Chair-elect of the Gavi Board, Ngozi Okonjo-Iweala, “ensuring sustainable resources for immunization in an evolving landscape for health.” African country immunization programs generally have historically received insufficient funds, a key lack that has underpinned some underperformance. Expanded funding for immunization programs provided by country governments will be critical to ensure all African children are able to access vaccines.
The Challenge of Funding
Globally, Africa has the lowest level of immunization coverage of any region: more than half of the world’s unimmunized infants are located in five African countries.
However, over the years, country immunization programs have grown in complexity in terms of service delivery. There has been an increase in the number of children being born every year and introduction of new vaccines to populations beyond the traditional age groups, as evidenced by programs like the roll-out of the Human Papilloma Virus (HPV) vaccine in Rwanda.
Increases in immunization financing investment portfolios are necessary in order to sustain current coverage and to continue to introduce new vaccines, another contributor to the rise in cost of immunization. New vaccines are more expensive and most national budgets remain inadequate to fully roll out routine immunization services while also included new vaccines as they become available.
As noted in Addis Ababa, although the economic benefits of immunization are clear, less than 20 African countries fund more that 50% of their own immunization expenditures. This comes at a time when over the coming years at least 24 Gavi eligible countries are slated to transition out of Gavi support, meaning governments will need to be able to fully fund their immunization programs.
Much remains to be done to ready African countries for Gavi graduation. Though the Addis Ababa meeting had a strong call for African governments to put in place mechanisms for sustainable immunization financing, little may happen at the country level to actualize this.
Any discussion of immunization financing and sustainability should be structured around whether there is a sufficient amount of money in the country to finance vaccines and associated risk in the sustainability of vaccine financing. Others key elements include addressing the questions around effective procurement and having the supply arrangements necessary to ensure availability of vaccines, sufficient funds for operation and maintenance at all levels, and the predictability of immunization resource requirements. Any attempt to answer these questions shows that innovations in financing, budgeting, and advocacy are key for Kenya, to mobilize and efficiently utilize domestic and supplementary external resources on a reliable and predictable basis to achieve current and future target levels of immunization performance in terms of access, utilization, quality, safety and equity.
Innovations such as budget tracking, analysis and advocacy, supporting legislative activities and championing innovations in immunization financing and budgeting are critical. These are some of the areas where KANCO, with the support of the ACTION global health advocacy partnership, has been working in Kenya. If Africa is going to close the gap in immunizations, innovations such as legislation are an essential part of ensuring sustainable immunization financing. In these, advocates and civil society organizations can play a critical role in advocacy immunization for financing, budgeting, legislation and advocacy. In fostering African countries’ ownership for sustainable financing for immunization, though donor support will remain important, the shared goal by African governments should be for all fully finance their national immunization programs.
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