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Immunization Financing: A resource guide for advocates, policymakers, and program managers

Key Questions for Immunization Advocates

Brief 18

Key Points

  • Immunization advocates can benefit from knowing pertinent questions to ask about a country’s immunization program.
  • The questions in this brief can also be useful in discussions with governments and donors.

The following questions can guide advocates in learning about a country’s immunization program and associated program financing; challenges that the program faces; and options for addressing those challenges. These questions can also be used in discussions with governments and donors and to help hold them accountable.

Overall Priority for Immunization

  • Is immunization clearly identified as a priority in the national health plan?

  • What immunization targets has the government committed to, if any?

  • Are immunization indicators used to monitor the success of health strategies and plans?

  • Is immunization clearly identified as a priority at the subnational level?

Program Performance

  • How high is immunization coverage? Note that World Health Organization / UNICEF diphtheria-tetanus-pertussis (DTP3) coverage estimates are often used as a proxy measure for overall performance.

  • How does coverage compare to that of peer countries?

  • Is coverage stable, improving, or declining? If coverage is declining, why?

  • How equitable is immunization coverage? How widely does it vary across geographic regions, income levels, and ethnic groups within the country? (DTP3 coverage by district and by income quintile are often used as indicators.)

Vaccines in the National Schedule

  • What vaccines are in the national immunization schedule? How does this list compare to WHO’s recommended schedule?

  • Which of the newer vaccines—such as rotavirus, pneumococcal, and HPV—have been introduced?

  • Which vaccines is the government planning to introduce next?

  • Does the government have a financial plan for the vaccines it plans to introduce?

  • Does the country have a national immunization technical advisory group (NITAG) to advise on vaccine introduction?

Vaccine Financing

  • What are the sources of financing for vaccines and service delivery? What are the trends in financing?

  • If any vaccines are currently financed by donors, how predictable is that support?

  • If the country is Gavi-eligible or transitioning from Gavi, is the government meeting its annual co-financing commitments?

  • What are the government’s plans for covering these costs when donor support ends?

  • Are other sources of financing for immunization sustainable?

  • Does the government have a clear plan for financing immunization over the next five years?

  • Does the national budget have a line for vaccines and injection supplies? What is funded from the national budget, and what is funded by donors?

  • Are budgeted funds for vaccine procurement released in a timely manner? Does late disbursement impede procurement? If so, what options might be available to address this problem?

  • Do health facilities have adequate funds for immunization services, including staff, transport, and outreach? If there are problems, are they worse in certain areas? What might be done to address funding gaps?

  • What non-financial factors are affecting program performance, and how might they be addressed?

  • Are any health reform initiatives planned or underway that might affect the immunization program? Have the responsibilities for various immunization functions in the reformed system been thought through? Is sufficient funding assured for both vaccine procurement and service delivery?

Vaccine Procurement

  • How reliable are vaccine supplies? Have there been any stock-outs at the national or subnational level in the past two years?

  • How are vaccines procured? Are all procured vaccines WHO-prequalified?

  • If the government is procuring vaccines, is it getting good prices (for example, compared to prices obtained by UNICEF Supply Division)?

  • Are vaccines delivered to health facilities with the appropriate injection supplies?

Further Reading