Immunisation financing critical to saving lives

Ghana’s immunisation programme is one of the most efficient and impactful on the continent. 

The nation has achieved high routine vaccine coverage levels of more than 90 per cent over the years for most of the antigens until the recent dips being observed which are partly attributed to the COVID-19 pandemic and vaccine shortages.

Vaccination has helped to improve the life expectancy of the population in the country.

 It has contributed to the reduction of under-five mortality from 111 per 1,000 live births in 2003, to 40 per 1,000 live births in 2022, infant mortality from 64 per 1,000 live births, to 28 per 1,000 live births, and neonatal mortality from 43 per 1,000 live births, to 17 per 1,000 live births within the same period.

Immunisation in the country is supported largely by partners.

Currently, Gavi, the vaccine alliance, supports approximately 70 to 80 per cent of the cost of vaccines and their delivery, including health system strengthening.

For the past years, the government’s inability to honour its annual obligation towards vaccine and logistics procurement and on time has become worrying and could erode gains made.

Ghana defaulted in paying its co-financing to GAVI in 2014, 2016 and 2018, and in subsequent years challenges persist in honouring annual co-financing obligations in full and on time.

Now that the country is in Gavi’s accelerated transition phase, early release of funds every year is critical to ensure stock do not run out.

 It entered accelerated transition in vaccine financing in January 2022 and is expected to transition out of Gavi’s support in 2027.

Under the revised policies approved by the Gavi Board in December 2022, Ghana will now stay in accelerated transition until 2029 and should be fully self-financing from January 2030.

Thus, a transition roadmap towards self-financing of immunisation has been developed by the Ministry of Health (MoH) to ensure enhanced and sustained access to vaccines and vaccination programmes, and how these can be managed and fully self-financed from 2030 onwards.

The transition roadmap, as indicated by the Deputy Programme Manager of the Expanded Programme on Immunisation, Dr Naziru Tanko Mohammed, at the launch of a Financing Immunisation Advocacy Response (FAIR) Project, provides a guide to the gradual and progressive shift from donor financing towards domestically funded immunisation services, including vaccine supply, deployment and strengthening of the health system.

It must be noted that the government allocates a portion of its annual budget to support immunisation programmes.

This funding covers the procurement of vaccines, operational costs and system strengthening efforts. 

This is done through direct and indirect approaches.

 The government’s major direct financing of vaccines and immunisation is predominantly through the National Health Insurance Authority (NHIA) which is largely funded through the National Health Insurance (NHI) levy of 2.5 per cent tax on goods and services.

NHIA normally cedes 10 per cent (capped) of its allocation to the MoH to cater for the non-core activities that is preventive health care, which includes vaccination and immunisation service delivery.

However, the government is unable to allocate adequate funds to the health sector each fiscal year, resulting in logistical constraints such as old or no vaccine cold chains, transportation challenges, unavailability of child health record booklets at service delivery points, and human resource to reach the remotest areas and the urban poor.

From an initial six antigens against the six childhood killer diseases to currently 11 vaccines, including the malaria vaccine that is in pilot in seven regions, the programme vaccinates against 14 vaccine preventable disease and Ghana’s Expanded Programme on Immunisation (EPI) has significantly evolved in the past 20 years after its launch in 1978.

The increase in the number of vaccines in the programme simply means an increase in resource requirement to ensure that all eligible children are reached to reduce zero dose and under-immunised children to prevent outbreaks of vaccine preventable diseases.

These vaccines are delivered across the country through static, outreach, camp-outs, mop-ups and campaign strategies at no cost to the recipients.

Indeed, the timely release of funds for the procurement of the vaccines is critical.

We implore the government to release its co-financing before the end of the first quarter of the year to protect and save the future of our children who need the vaccines to survive.

We therefore add our voice to the calls for the government to continue to finance vaccination earnestly in order not to create any gap.