POLICY BRIEF ON SUSTAINABLE IMMUNIZATION FINANCING

POLICY BRIEF ON SUSTAINABLE IMMUNIZATION FINANCING

Submitted to the

AFRICAN POPULATION AND HEALTH RESEARCH CENTER

APRIL, 2020

Ghana Coalition of NGOs in Health

Box AC 42, Arts Center, Accra

Email: healthcoalition2000@yahoo.co.uk

www.healthngos.net

Tel: +233541180325/+233508385212

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Introduction

The Global Alliance for Vaccines and Immunization (GAVI) has immensely supported the activities of Expanded Program on Immunization (EPI) of the Ghana Health Service (GHS) in strengthening the capacity of Integrated Health Systems (IHS) to deliver immunization by resolving health systems constraints, increase the level of equity in access to services and strengthening Civil Society Engagements in the health sector. The funding support of GAVI has made a difference to the MDGs with a significant drop in child mortality in Ghana and iterated that more children than ever before can access life due to immunization¹²

Ghana contributes just about 20% of the total immunization cost.

	40,000,000
	35,000,000
	30,000,000
$	25,000,000
Amount
20,000,000
15,000,000
	10,000,000
	5,000,000
	0
	2013	2014	2015	2016	2017
			Year
		Total Exp.	Gov. exp

Figure 1: government expenditure on immunization as compared to total immunization expenditure.

The Government of Ghana (GoG) is expected to increase its co-financing share for EPI from 13% in 2015 to 100% by 2027. However, the country is yet to identify any domestic source(s) of funding for immunization activities.

Key achievements of immunization in Ghana

Due to GAVI funding support of EPI activities, Ghana has achieved high immunization coverage and these have significantly impacted positively on child health.

1. Ankrah, K. D. (2017). Expanded Program on Immunization activities 2016, Presentation at GCNH pre-implementation training at Oceanic Resort Hotel, Accra, Ghana.

• Amissah-Nyarko, B. (2016). Keynote Address, 2016 World Immunization Week held at the cape coast teaching Hospital, Cape Coast, Ghana.

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98

coverage%                                           88

99

97

93

2014                              2015                              2016                              2017                               2018

Year

 coverage

Figure 2: Coverage for immunization in Ghana – Penta 3.

The high immunization coverage has made the following contributions to the health system of Ghana and especially child health;

• Ghana rarely see large numbers of morbidity and mortality among children under 5 resulting from vaccine-preventable diseases. Even when we see them, they are in mild forms.

• Since 2003, there has not been any record of measles death in Ghana

• Since 2008, there has not been any recorded case of indigenous/wild polio

• Ghana eliminated neonatal Tetanus in 2011

• Contributed to reduction of Under Five Mortality from 111/1000LB in 2003 to 60/1000 LB in 2014

• Drastic reduction in cases of Pneumonia & Diarrhoea in children¹.

Challenges

Irrespective of the great achievements of vaccination in Ghana, challenges exist with immunization service provision from national to sub-national levels. The challenges include;

• Inadequate cold chain facilities at the sub-district level

• Weak data recording and reporting. This is largely seen in discrepancies between tally counts and monthly reports. This may result from unavailability of child health record booklet (due to frequent shortage) at service delivery points.

• Shortage of laboratory reagents for confirmation of VPDs

• Inadequate operational funds for district, sub-district and community level activities

• Lack of detailed micro plans at the sub-district level

• Weak demand generation activities for routine immunisation

• Delays in vaccine payment which has occasionally led to shortage of vaccines nationwide

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• •      Non availability of structured immunization co–payment plan

• Weak demonstration of domestic sources of funding for immunization in the draft transition plan.

• Weak commitment to the engagement of private sector and corporate Ghana for immunization financing after Gavi transits.

The root cause of these challenges is the inconsistency of government of Ghana funding for EPI activities. Aside the inconsistency in government of Ghana funding for immunization, the funds provided are woefully insufficient to support immunization activities from national level to sub – national levels. EPI review in 2019 revealed that the target of achieving 95% vaccination coverage in all antigens was not achieved. This was mainly due to the non–implementation of recommendation on dedicated government of Ghana funding for immunization.

Consequences of the inadequate government of Ghana funding for immunization

Due to the inadequate government of Ghana funding for EPI activities, it incapacitate the program to carry out core activities within the program; for instance;

The programme is unable to confirm vaccine preventable disease (VPD) due to inadequate funds to procure laboratory reagents. This weakens the surveillance system as the provision of timely and relevant data to inform decisions on outbreak of VPD is inadequate. This inhibit the ability to respond to outbreaks at sub-national level – potential of scaling up to national outbreak.

The program is also not able to maintain its cold chain system especially at the district levels. From the EPI review, there are only two persons responsible for maintenance of the cold system nationwide. This is woefully inadequate and it is as a result of lack of funding to train more personnel. The end result of this is the frequent break down of vaccine refrigerators at the district and health facility level and ultimately resulting in stock out in some districts and health facilities.

The program is also unable to reach children in hard-to reach areas especially communities around the Volta basin. This implies that many children are left out of immunization which becomes a risk to the global agenda of controlling, eliminating and eradicating VPDs.

Due to inadequate and lack of committed funding from the government of Ghana, sub-national health directorate do not have cold vans to transport vaccines from the national level. The transportation of vaccines are improvised using cold boxes in pick-up vehicles. In the current system of transporting vaccines from national level to sub-national levels, the concern is the ability to keep the vaccine at the right temperature without its efficacy being affected.

Due to inadequate funding for social mobilization and demand creation activities, immunization coverage in urban areas peri-urban districts and communities is rapidly declining. There are dropout rates observed between vaccines that have multiple doses especially for those that first doses are provided in the first year and subsequent dose provided in the second year. For instance the EPI report revealed that in 2018 national dropout rate between first dose of measles and second dose of measles was 11%. This rate is greater than WHO recommended dropout rate of less than 10%. Over 60% of districts had dropout rates being more the 10%. Social

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mobilization activities which encompasses community education is inadequate for routine immunization service. This results in caregivers of under-fives not well informed on the required vaccines for the child and time period the child is to take a particular vaccine.

Policy Recommendations

To ensure that Ghana is able to meet the financial demands of immunization, we recommend that;

1. Budgetary allocation: The government of Ghana makes increase budgetary allocationfor immunization year on year to cover the cost of immunization.

• Legislation: To complement government efforts on immunization, a law to establish anImmunization Fund under the supervision of EPI – GHS. The law that established immunization should make available a seed money for the duns while fund managers mobilize other resources through appeals to individuals and private sector, and corporate Ghana to make donation into the fund. The fund mobilization from individuals and private sector should be done within the requirement of the law

• A directive to MMDAs to allocate 2% of DACF to support routine immunization at the district level: This will help reduce the challenge of inadequate operational funds for district, sub-district and community level routine immunization activities.

• At the district level, MMDAs support immunization activities in their jurisdiction with internally Generated Funds (IGF): This can be done by encouraging MMDAs to consider support to immunization activities in the jurisdiction as part of recurrent expenditure that is supported by IGF.

• An appeal by the speaker of parliament to all members of parliament to donate 1%of the MP common fund to the immunization fund.

• Update Gavi transition plan to show clear sources of mobilizing domestic funds for immunization financing and efficient ways of disbursement.

Call to action:

Gavi is scheduled to graduate Ghana to full financing of vaccines and its logistics in 2027. The government must put in necessary steps to have a year on year increase in budgetary allocation for immunization to ensure the agenda of eliminating and eradicating VPDs is achieved. Investment in immunization will in the long term lead to less expenditure on treatment of Vaccine preventable diseases and the health of citizens. The failure of government to commit to immunization financing will imply that the exit of Gavi will cause reduction in childhood vaccination and weaken the overall health system of the country. Thus, Vaccine preventable diseases will resurface eroding all the success achieved in child health and the health system in general and the overarching implication is that the burden of disease emerging from VPDs on the

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country’s population after 2027 will increase by 60% if the government fails to establish an immunization fund to absorb the full cost of immunization after Gavi transits

The government must also take the necessary steps to implement the Abuja declaration where a commitment was made to allocate 15% of national budget to health. This we believe will help resolve many of the challenges that confront immunization services and health system as a whole. Investing in immunization and health in general is a cost effective way of saving life, improving living standards, health, and the global economy of a country. Get people healthy and they will make themselves wealthy