Mapping financial flows for immunisation in Uganda 2009/10 and 2010/11: New insights for methodologies and policy.
BACKGROUND
The Global Vaccine Action Plan highlights the need for immunisation programmes to have sustainable access to predictable funding. A good understanding of current and future funding needs, commitments, and gaps is required to enhance planning, improve resource allocation and mobilisation, and to avoid funding bottlenecks, as well as to ensure that co-funding arrangements are appropriate. This study aimed to map the resource envelope and flows for immunisation in Uganda in 2009/10 and 2010/11.


METHODS
To assess costs and financing of immunisation, the study applied a common methodology as part of the multi-country Expanded Program on Immunisation Costing (EPIC) study (Brenzel et al., 2015). The financial mapping developed a customised extension of the System of Health Accounts (SHA) codes to explore immunisation financing in detail. Data were collected from government and external sources. The mapping was able to assess financing more comprehensively than many studies, and the simultaneous costing of routine immunisation collected detailed data about human resources costs.


RESULTS
The Ugandan government contributed 56% and 42% of routine immunisation funds in 2009/10 and 2010/11, respectively, higher than previously estimated, and managed up to 90% of funds. Direct delivery of services used 93% of the immunisation financial resources in 2010/11, while the above service delivery costs were small (7%). Vaccines and supplies (41%) and salaries (38%) absorbed most funding. There were differences in the key cost categories between actual resource flows and the estimates from the comprehensive multi-year plan (cMYP).


CONCLUSIONS
Results highlight that governments and partners need to improve systems to routinely track immunisation financing flows for enhanced accountability, performance, and sustainability. The modified SHA coding allowed financing to be mapped to specific immunisation activities, and could be used for standardised, resource tracking compatible with National Health Accounts (NHA). Recommendations are made for refining routine resource mapping approaches.
Centre for Economic Governance and AIDS in Africa (CEGAA), Cape Town, South Africa. Electronic address: guthriehealthfinancingconsult@gmail.com.
Teresa
T
Guthrie
HealthNet Consult, Kampala, Uganda. Electronic address: charlotte@healthnetconsult.com.
Charlotte
C
Zikusooka
HealthNet Consult, Kampala, Uganda.
Brendan
B
Kwesiga
HealthNet Consult, Kampala, Uganda.
Christabel
C
Abewe
HealthNet Consult, Kampala, Uganda.
Stephen
S
Lagony
Strategic Development Consultants (SDC), Pietermaritzburg, South Africa. Electronic address: carl.schutte@sdc.co.za.
Carl
C
Schutte
Health and Development Africa (HDA), Johannesburg, South Africa.
Edmore
E
Marinda
Health and Development Africa (HDA), Johannesburg, South Africa.
Kerrin
K
Humphreys
Health and Development Africa (HDA), Johannesburg, South Africa.
Katlego
K
Motlogelwa
Health and Development Africa (HDA), Johannesburg, South Africa.
Zipozihle Chuma
ZC
Nombewu
Bill and Melinda Gates Foundation, Washington, DC, USA. Electronic address: Logan.Brenzel@gatesfoundation.org.
Logan
L
Brenzel
Health and Development Africa (HDA), Johannesburg, South Africa. Electronic address: Anthony.Kinghorn@mottmac.com.
Anthony
A
Kinghorn
D002202:Capital Financing; D017048:Health Care Costs; D006291:Health Policy; D006298:Health Services Administration / Q000191:economics*; D006801:Humans; D014454:Uganda; D014611:Vaccination / Q000191:economics* / Q000379:methods
Donors; Financial flows; Immunisation; Mapping; Resource tracking; Uganda