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Idris IO, Ouma L, Tapkigen J, Ayomoh FI, Ayeni GO. Is health expenditure on immunisation associated with immunisation coverage in sub-Saharan Africa? A multicountry analysis, 2013-2017. BMJ Open 2024; 14:e073789. [PMID: 38216207 PMCID: PMC10806701 DOI: 10.1136/bmjopen-2023-073789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES The designing of contextually tailored sustainable plans to finance the procurement of vaccines and the running of appropriate immunisation programmes are necessary to address the high burden of vaccine-preventable diseases and low immunisation coverage in sub-Saharan Africa (SSA). We sought to estimate the minimum fraction of a country's health budget that should be invested in national immunisation programmes to achieve national immunisation coverage of 80% or greater depending on the context, with and without donors' support. DESIGN Multicountry analysis of secondary data using retrieved publicly available data from the WHO, Global Alliance for Vaccines and Immunization (GAVI) and World Bank databases. SETTING Data on 24 SSA countries, between 2013 and 2017. METHODS We model the variations in immunisation coverage across the different SSA countries using a fractional logit model. Three different generalised linear models were fitted to explore how various explanatory variables accounted for the variability in each of the three different vaccines-measles-containing vaccine (MCV)1, diphtheria, pertussis, tetanus (DPT3) and BCG. RESULTS We observed an association between current health expenditure (as a percentage of gross domestic product) and immunisation coverage for BCG (OR=1.01, 95% CI: 1.01 to 1.04, p=0.008) and DPT3 (OR=1.01, 95% CI: 1.0 to 1.02, p=0.020) vaccines. However, there was no evidence to indicate that health expenditure on immunisation (as a proportion of current health expenditure) could be a strong predictor of immunisation coverage (DPT, OR 0.96 (95% CI 0.78 to 1.19; p=0.702); BCG, OR 0.91 (0.69 to 1.19; p=0.492); MCV, OR 0.91 (0.69 to 1.19; p=0.482)). We demonstrate in selected countries that to achieve the GAVI target of 80% in the countries with low DPT3 coverage, health expenditure would need to be increased by more than 45%. CONCLUSIONS There is a need to facilitate the development of strategies that support African countries to increase domestic financing for national immunisation programmes towards achieving 2030 targets for immunisation coverage.
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Affiliation(s)
- Israel Oluwaseyidayo Idris
- Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria
- Health Emergencies Programme (WHE), WHO, Geneva, Switzerland
| | - Luke Ouma
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Janet Tapkigen
- Department of Health Sciences, University of Tampere, Tampere, Finland
| | - Francis Ifeanyi Ayomoh
- Health Policy, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gabriel Omoniyi Ayeni
- Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria
- Health Emergencies Programme (WHE), WHO Regional Office for Africa, Daresalam, Tanzania
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Javadinasab H, Masoudi Asl I, Vosoogh-Moghaddam A, Najafi B. Comparing selected countries using sin tax policy in sustainable health financing: Implications for developing countries. Int J Health Plann Manage 2019; 35:68-78. [PMID: 31273831 DOI: 10.1002/hpm.2817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sustainable health financing is one of the main challenges of policy makers and planners. This study aimed at comparing the experiences of countries in using the sin tax policies for sustainable health financing resources. METHODS This qualitative study was conducted in two phases. First, a comparative study was carried out by searching databases from 1990 to 2017, and six countries (Thailand, England, Australia, the Philippines, South Africa, and Vietnam) were selected. Second, the existing Iranian high policy documents from 2005 to 2017 were reviewed deeply by using the content analysis method. RESULTS The sin tax, such as taxes on tobacco and alcohol, was one of the main policies to provide sustainable health financing in all selected countries. The Iranian health system had no significant-related legal and political gap, but there were limitations in enforcing and implementing them. Finally, it is necessary to evaluate the policy and follow its effects up. CONCLUSIONS The main financial resources in the selected countries included health promotion funds with different names and goals which took taxes on harmful goods, tobacco, and alcohol. Weaknesses in implementing laws and monitoring them were the main reasons for the lack of sustainable financing.
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Affiliation(s)
- Hamideh Javadinasab
- Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Vosoogh-Moghaddam
- Secretariat for supreme council of health and food security, Ministry of Health and Medical Education, Tehran, Iran
| | - Behzad Najafi
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Javadinasab H, Masoudi Asl I, Vosoogh-Moghaddam A, Najafi B. Sustainable financing of health promotion services in selected countries: Best experience for developing countries. Med J Islam Repub Iran 2019; 33:52. [PMID: 31456976 PMCID: PMC6708097 DOI: 10.34171/mjiri.33.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Sustainable health financing is one of the main challenges of policymakers in the health system. Thus, this study aimed to investigate the sustainable financing of health promotion services in 7 selected countries and to analyze the related documents in Iran in 2018.
Methods: This was a comparative and qualitative study (document analysis). In the comparative phase, the studies related to the selected countries- Australia, England, Germany, Japan, Turkey, Sweden, and Denmark- were investigated. In the second phase of the study, through a qualitative method of content analysis, 60 related documents were examined from 2005 to 2018. The initial evaluation of the documents was done using the Scott method and data were analyzed using Nvivo 8 software.
Results: Based on the main findings of the study, there were a variety of approaches to the sustainable financing of health promotion services: excise taxes on goods; health-related behaviors regarding tobacco and alcohol consumption and gambling; using the capacities of social insurance funds in Germany and Turkey; and relying on the government budget in all the studied countries. According to the results of documents analysis related to the sustainable financing of health promotion in Iran, 3 main issues and 11 sub issues were identified.
Conclusion: Using any of these methods or a combination of them depends on the political, social, and cultural structure of each country. The provisions of the law seem to be almost comprehensive; however, implementation, operationalization and monitoring of these elements are of significant importance.
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Affiliation(s)
- Hamideh Javadinasab
- Department of Health Services Management, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Vosoogh-Moghaddam
- Faculty member of secretariate for supreme council of health and food security, Ministry of Health and Medical Education, Tehran, Iran.,NCD Research Center, Endocrine and Metabolism Research Institute, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Behzad Najafi
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of health economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Báscolo E, Cid C, Pablo Pagano J, Soledad Urrutia M, Del Riego A. El desafío de la sostenibilidad de los programas ampliados de inmunizaciones. Rev Panam Salud Publica 2017; 41:e160. [PMID: 31391842 PMCID: PMC6660871 DOI: 10.26633/rpsp.2017.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/22/2017] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Analizar la sostenibilidad y la integración de los programas prioritarios en el marco de la Estrategia para el acceso universal a la salud y la cobertura universal de salud (Salud Universal) de la Organización Panamericana de la Salud de 2014.
Métodos. Se llevó a cabo una revisión no sistemática de la bibliografía reciente enfocada al análisis de la integración y la sostenibilidad.
Resultados. El principal resultado que se extrae de la bibliografía revisada es la necesidad de abordar la sostenibilidad de tal modo que se superen los límites de cualquier análisis restringido a la sostenibilidad financiera. Aunque la integración y la sostenibilidad no se interpretan de forma homogénea, sobresale un abordaje que contempla la integración como un factor facilitador del proceso de sostenibilidad del PAI.
Conclusiones. La efectividad de las estrategias de integración del PAI depende en buena medida de que se consideren la presencia, el fortalecimiento y la transformación de las estructuras organizativas e institucionales que faciliten la participación de los actores con capacidad técnica y política para garantizar sus procesos de implementación. De esta forma, se podrán ponderar los procesos políticos que legitiman una agenda de inclusión del PAI en la Estrategia de salud universal y, por tanto, como parte integrante del fortalecimiento de los sistemas de salud.
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Affiliation(s)
- Ernesto Báscolo
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América. La correspondencia se debe dirigir a Ernesto Báscolo. Correo electrónico:
| | - Camilo Cid
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Juan Pablo Pagano
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | | | - Amalia Del Riego
- Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Henderson K, Gouglas D, Craw L. Gavi’s policy steers country ownership and self-financing of immunization. Vaccine 2016; 34:4354-9. [DOI: 10.1016/j.vaccine.2016.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 11/29/2022]
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Hadisoemarto PF, Reich MR, Castro MC. Introduction of pentavalent vaccine in Indonesia: a policy analysis. Health Policy Plan 2016; 31:1079-88. [PMID: 27107293 PMCID: PMC5013783 DOI: 10.1093/heapol/czw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
The introduction of pentavalent vaccine containing Haemophilus influenzae type b antigen in Indonesia's National Immunization Program occurred nearly three decades after the vaccine was first available in the United States and 16 years after Indonesia added hepatitis B vaccine into the program. In this study, we analyzed the process that led to the decision to introduce pentavalent vaccine in Indonesia. Using process tracing and case comparison, we used qualitative data gathered through interviews with key informants and data extracted from written sources to identify four distinct but interrelated processes that were involved in the decision making: (a) pentavalent vaccine use policy process, (b) financing process, (c) domestic vaccine development process and (d) political process. We hypothesized that each process is associated with four necessary conditions that are jointly sufficient for the successful introduction of pentavalent vaccine in Indonesia, namely (a) an evidence-based vaccine use recommendation, (b) sufficient domestic financing capacity, (c) sufficient domestic vaccine manufacturing capacity and (d) political support for introduction. This analysis of four processes that led to the decision to introduce a new vaccine in Indonesia may help policy makers and other stakeholders understand and manage activities that can accelerate vaccine introduction in the future.
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Affiliation(s)
- Panji F Hadisoemarto
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA Faculty of Medicine, Department of Public Health, Padjadjaran University, Jl. Eyckman 38, West Java, Bandung 40161 Indonesia
| | - Michael R Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115, USA
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McQuestion M, Carlson A, Dari K, Gnawali D, Kamara C, Mambu-Ma-Disu H, Mbwanque J, Kizza D, Silver D, Paatashvili E. Routes Countries Can Take To Achieve Full Ownership Of Immunization Programs. Health Aff (Millwood) 2016; 35:266-71. [DOI: 10.1377/hlthaff.2015.1067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael McQuestion
- Michael McQuestion ( ) is director of the Sustainable Immunization Financing Program at the Sabin Vaccine Institute, in Washington, D.C
| | - Andrew Carlson
- Andrew Carlson is a program coordinator at the Sabin Vaccine Institute
| | - Khongorzul Dari
- Khongorzul Dari is a senior program officer at the Sabin Vaccine Institute
| | - Devendra Gnawali
- Devendra Gnawali is a senior program officer at the Sabin Vaccine Institute
| | - Clifford Kamara
- Clifford Kamara is a senior program officer at the Sabin Vaccine Institute
| | | | - Jonas Mbwanque
- Jonas Mbwanque is a senior program officer at the Sabin Vaccine Institute
| | - Diana Kizza
- Diana Kizza is a senior program officer at the Sabin Vaccine Institute
| | - Dana Silver
- Dana Silver is a program officer at the Sabin Vaccine Institute
| | - Eka Paatashvili
- Eka Paatashvili is a senior program officer at the Sabin Vaccine Institute
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Shen AK, Fields R, McQuestion M. The future of routine immunization in the developing world: challenges and opportunities. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:381-94. [PMID: 25611473 PMCID: PMC4307855 DOI: 10.9745/ghsp-d-14-00137] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Vaccine costs in the developing world have grown from < US$1/child in 2001 to about $21 for boys and $35 for girls in 2014, as more and costlier vaccines are being introduced into national immunization programs. To address these and other challenges, additional efforts are needed to strengthen 8 critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.
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Affiliation(s)
- Angela K Shen
- United States Agency for International Development and United States Department of Health and Human Services, Washington, DC, USA
| | - Rebecca Fields
- Maternal and Child Survival Program, Washington, DC, USA
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Wallace AS, Ryman TK, Dietz V. Overview of global, regional, and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives. J Infect Dis 2014; 210 Suppl 1:S514-22. [PMID: 25316875 PMCID: PMC4663673 DOI: 10.1093/infdis/jiu108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers' development of future goals and strategies to improve routine vaccination services. METHODS Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis-containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980-2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage. RESULTS During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%-30% and lowest (-0.9 percentage points) when national coverage levels were 96%-100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%-85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25-29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends. CONCLUSIONS Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives.
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Affiliation(s)
- Aaron S Wallace
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tove K Ryman
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vance Dietz
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Mantel C, Wang SA. The privilege and responsibility of having choices: decision-making for new vaccines in developing countries. Health Policy Plan 2012; 27 Suppl 2:ii1-4. [PMID: 22513728 DOI: 10.1093/heapol/czs041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burchett HED, Mounier-Jack S, Griffiths UK, Biellik R, Ongolo-Zogo P, Chavez E, Sarma H, Uddin J, Konate M, Kitaw Y, Molla M, Wakasiaka S, Gilson L, Mills A. New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries. Health Policy Plan 2012; 27 Suppl 2:ii5-16. [PMID: 22513732 DOI: 10.1093/heapol/czs035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed.
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Affiliation(s)
- H E D Burchett
- Department of Global Health & Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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