POLICY BRIEF ON SUSTAINABLE IMMUNIZATION FINANCING
Submitted to the
AFRICAN POPULATION AND HEALTH RESEARCH CENTER
Ghana Coalition of NGOs in Health
Box AC 42, Arts Center, Accra
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.
|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.
2014 2015 2016 2017 2018
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;
Irrespective of the great achievements of vaccination in Ghana, challenges exist with immunization service provision from national to sub-national levels. The challenges include;
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
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.
To ensure that Ghana is able to meet the financial demands of immunization, we recommend that;
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
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