Vaccines and immunization services: tracking expenditures and assessing financing bottlenecks

As part of the support to the Decade of Vaccines' Global Vaccine Action Plan (GVAP), UNICEF is complementing the efforts by WHO and the GAVI Secretariat to work with governments and other stakeholders in two interrelated areas: The first is to support better tracking of expenditure on vaccines and immunization services in low and middle-income countries; the second is to conduct a focused analysis of significant bottlenecks to adequate and sustainable financing of national immunizations services. It will be important that the two protocols and activities complement and reinforce each other. As an initial step, UNICEF is requesting the help of TechNet21 readers to identify: 1) Literature (grey or published) on (i) methods or case studies of tracking immunization expenditures, and (ii) methods or case studies on how barriers and bottlenecks to health/immunization financing can be assessed. The aim is to identify and build upon existing tools, and align with existing frameworks such as are being implemented as part of the Commission on Information and Accountability (COIA) for Women's and Children's Health. 2) Identify persons working on immunization expenditure tracking and/or analysis of immunization financing bottlenecks, who could be approached to discuss specific issues. Ideally, this would evolve into an expert database that could be updated on a regular basis. 3) Assess the level of interest in setting up an informal and virtual mechanism for sharing knowledge, identifying areas for further research (see below), and catalysing discussion around specific topics of interest.[/ol] Research areas might include (but certainly are not limited to): • Tracking government, private and external expenditures on vaccines, immunization systems (e.g. cold chain); • Harnessing National Health Accounts (NHA) efforts to track immunization-specific expenditure; • Defining methods to track expenditure when external support is given through Budget Support, SWAps or pooled funding mechanisms; • Defining methods to track off-budget expenditures and project-based support at the sub-national level; • Assessing upstream and downstream bottlenecks to financing all aspects of immunization services (e.g. assessing bottlenecks to sufficient funding of immunization systems; funding of annual operational plans; effective use of budgets; and (critically) overcoming factors that reduce the efficiency of the use of funds (e.g. delayed funds flows, leakages, excessive overheads from poor information systems, etc.). • Analysing and quantifying financial barriers to routine and supplementary immunization activities (SIAs); • Analysing broader health systems investments to assess the direct impact on strengthening immunization services; • Compiling lessons learnt from increasing the fiscal space for immunizations through: i) increased national GDP growth; ii) increased allocation to health as % of total government spending; iii) increased tax revenues; iv) increased efficiency in use of resources; and v) increased use of external funding (including innovative financing mechanisms; [/list] Please send your responses to [email=Thomas O'Connell ]Tom O’Connell[/email], UNICEF