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. 2021 Jun 8;39(25):3410-3418.
doi: 10.1016/j.vaccine.2021.04.047. Epub 2021 May 18.

Tracking government spending on immunization: The joint reporting forms, national health accounts, comprehensive multi-year plans and co-financing data

Gloria Ikilezi  1 , Steven D Bachmeier  2 , Ian E Cogswell  3 , Emilie R Maddison  4 , Hayley N Stutzman  5 , Golsum Tsakalos  6 , Logan Brenzel  7 , Joseph L Dieleman  8 , Angela E Micah  9
Affiliations

Tracking government spending on immunization: The joint reporting forms, national health accounts, comprehensive multi-year plans and co-financing data

Gloria Ikilezi et al. Vaccine. .

Abstract

Background: Coverage rates for immunization have dropped in lower income countries during the COVID-19 pandemic, raising concerns regarding potential outbreaks and premature death. In order to re-invigorate immunization service delivery, sufficient financing must be made available from all sources, and particularly from government resources. This study utilizes the most recent data available to provide an updated comparison of available data sources on government spending on immunization.

Methods: We examined data from WHO/UNICEF's Joint Reporting Form (JRF), country Comprehensive Multi-Year Plan (cMYP), country co-financing data for Gavi, and WHO National Health Accounts (NHA) on government spending on immunization for consistency by comparing routine and vaccine spending where both values were reported. We also examined spending trends across time, quantified underreporting and utilized concordance analyses to assess the magnitude of difference between the data sources.

Results: Routine immunization spending reported through the cMYP was nearly double that reported through the JRF (rho = 0.64, 95% 0.53 to 0.77) and almost four times higher than that reported through the NHA on average (rho = 3.71, 95% 1.00 to 13.87). Routine immunization spending from the JRF was comparable to spending reported in the NHA (rho = 1.30, 95% 0.97 to 1.75) and vaccine spending from the JRF was comparable to that from the cMYP data (rho = 0.97, 95% 0.84 to 1.12). Vaccine spending from both the JRF and cMYP was higher than Gavi co-financing by a at least two (rho = 2.66, 95% 2.45 to 2.89) and (rho = 2.66, 95% 2.15 to 3.30), respectively.

Implications: Overall, our comparative analysis provides a degree of confidence in the validity of existing reporting mechanisms for immunization spending while highlighting areas for potential improvements. Users of these data sources should factor these into consideration when utilizing the data. Additionally, partners should work with governments to encourage more reliable, comprehensive, and accurate reporting of vaccine and immunization spending.

Keywords: Government spending; Immunization spending; Joint Reporting Form; National Health Accounts.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
The proportion of routine government spending that is spending on vaccines for the Joint Reporting Form (JRF) and Comprehensive Multi-Year Plans (cMYP). Note: Values of zero (and values less than $0.001 per surviving infant) were removed as missingness. The boxplots presenting Comprehensive Multi-Year Plans for 2008, 2016, and 2017 are representative of only 5 data points (1 outlier), 1 data point, and 1 data point, respectively, resulting in distorted boxplots.
Fig. 2
Fig. 2
Comparison of raw data between each source for spending on vaccines or routine immunization. Note: Data are presented in inflation-adjusted 2019 US$. Colors represent GBD super regions. A line of equality is plotted on each panel.
Fig. 3
Fig. 3
Correlation coefficients of spending on vaccines between the Joint Reporting Form (JRF) and Gavi co-financing values, ranked by country in decreasing order. Note: Colors represent GBD super regions. AFG = Afghanistan. AGO = Angola. ARM = Armenia. AZE = Azerbaijan. BEN = Benin. BDI = Burundi. BFA = Burkina Faso. BGD = Bangladesh. BOL = Bolivia. BTN = Bhutan. CAF = Central African Republic. CIV = Côte d'Ivoire. CMR = Cameroon. COD = DR Congo. COG = Congo (Brazzaville). COM = Comoros. DJI = Djibouti. ERI = Eritrea. ETH = Ethiopia. GEO = Georgia. GHA = Ghana. GIN = Guinea. GMB = The Gambia. GNB = Guinea-Bissau. GUY = Guyana. HND = Honduras. IDN = Indonesia. KEN = Kenya. KGZ = Kyrgyzstan. KHM = Cambodia. KIR = Kiribati. LAO = Laos. LBR = Liberia. LKA = Sri Lanka. LSO = Lesotho. MDA = Moldova. MDG = Madagascar. MLI = Mali. MMR = Myanmar. MNG = Mongolia. MOZ = Mozambique. MRT = Mauritania. MWI = Malawi. NER = Niger. NIC = Nicaragua. NGA = Nigeria. NPL = Nepal. PAK = Pakistan. PNG = Papua New Guinea. PRK = North Korea. RWA = Rwanda. SDN = Sudan. SEN = Senegal. SLB = Solomon Islands. SLE = Sierra Leone. STP = São Tomé and PrÍncipe. TCD = Chad. TGO = Togo. TJK = Tajikistan. TLS = Timor-Leste. TZA = Tanzania. UGA = Uganda. UZB = Uzbekistan. VNM = Vietnam. YEM = Yemen. ZMB = Zambia. ZWE = Zimbabwe.
Fig. 4
Fig. 4
Concordance coefficients between each source of data for spending on vaccines or routine immunization. Note: Error bars represent two standard deviations from the coefficient. Number of data points is labeled above the upper error bar.
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