GAVI Support to Uganda

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GAVI Support to Uganda

• Dr Issa Makumbi
• Programme Manager, UNEPI
• MLM Training Course, Cape Town, South Africa
• October 11-22, 2004

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Background

• Total population (2004) 26,302,000
• Infants 1,131,000
• GDP US 330 per capita
• Health services are decentralised to districts
  (56) and further to HSDs (214)
  
  
  
  
  
  
  
  
  

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Background

• UNEPI launched in 1983
• Decline in services observed 1995-1998
• Revitalisation plan initiated in 2000
• 3 areas of focus
• Strengthening/ revitalising of routine EPI
• Supplemental immunisation activities
• Disease surveillance
• Routine vaccines BCG, DPT, Measles, OPV,
  hepatitis B, Hib

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Strategies/ Interventions

• Rehabilitation of the cold chain
• Improvement of communication system
• Support Supervision
• Strengthening of disease surveillance
• Partnerships/alliance building

• Resource mobilisation
• Expansion of service delivery points
• Capacity building
• Advocacy and social mobilisation/demand creation

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Immunisation Coverage, Uganda, 1998-2003
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District PerformanceDPT3, 2003
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Inception of GAVI in 1999

• An alliance of governments, multi-laterals,
  bilateral, UN Agencies, FPMA, Foundations
  (Melinda and Bill Gates)
• Major objective
• Ensure/catalyze use of life saving vaccines
  especially in developing countries (under-used
  vaccines)

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Decision making process to take up GAVI support

• Nursed plans to introduce Hep B vaccine
• BOD SSA high endemicity (gt8)
• Studies in 1970s and 1990s in Uganda showed 2-16
  prevalence of Hep B virus
• Studies in 1999 22-38 meningitis due to Hib
• RAT (WHO) 44-59/100,000 prevalence of Hib in lt5
  children

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GAVI Application Process

• Application submitted in October 2000
• Criteria for selection
• GNP/ capita lt US 1,000
• ICC in place
• Immunisation assessment conducted in last 3 yrs
• Multi year plan for immunisation

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GAVI Support for Uganda

• GAVI support granted for
• Pentavalent vaccine for 5 years
• Injection safety support for 3 years
• ISS funds(performance related Grant)
• Estimated 5-year support ISS - US 11,794,500
  NVS US 62,778,500

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Introduction of new vaccines

• Training (reconstitution, phasing in, freezing,
  cold chain adjustment, AEFI, IPC)
• Administrative records (I/vcb, tally sheets,
  child health cards)
• Social mobilisation/ public information
• National launching of new vaccines
• Monitor the introduction and post-introduction

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GAVI Process - Progress

• Pentavalent vaccine introduced country-wide in
  June 2002
• Injection safety materials provided for 3 years
  (2002-2004). GOU taken up procurement of
  injection materials in 2004/05.
• ISS funds received 2001-03 US 1,820,000
• DQA successfully conducted in 2002

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Achievements after introduction of pentavalent

• Increased demand for vaccines beyond targets
• 100 of health units using AD syringes
• Improved immunisation coverage 2 rewards from
  GAVI 4.3M in 2003 and US 1M in 2004
• Activities supported by ISS grassroots social
  mobilisation, capacity building, transport, cold
  chain, monitoring and supervision

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Immunisation Financing

• 1980s UNICEF
• 1990s GOU through V.I.I
• 1999 GOU buying all trad. Vaccines
• 2000 Ring-fenced vaccine funds within GOU budget
• 2001 GAVI support for new vaccines

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Funding of Health Services

• Health expenditure/ capita US 18
• Public spending 20 of 18
• GDP expenditure on health 1.5
• Government expenditure on health 9.6

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Country Financial Flows

• Grants disbursed to districts from MOF quarterly
• Donor funds to national and district levels
• NGOs support to districts

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Financial Sustainability Plan

• Process for developing FSP-
• Training of country teams by GAVI /FTF
• Task force formed under DHS (CC) MOH, MOF, WHO,
  UNICEF, USAID
• Inputs from stakeholders in the FS process ICC,
  HPAC, HDG, HSWG, JRM

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FSP (contn)

• FSP submitted in November 2003
• Funding gap anticipated in 2007/8 US 14.9 M
• Cost drivers- population, cost of pentavalent
  vaccines, increasing coverage

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Financial Sustainability Plan

• 3 Strategies
• Mobilisation of additional resources
• Increasing reliability of resources
• Improving efficiency of the programme

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FS - Progress

• GOU contribution to pentavalent costs (2004/05)
  US 695,331
• Strengthening of vaccine management to reduce
  wastage 16 districts
• Promotion of integrated outreaches Nutrition,
  Malaria, IMCI, Health promotion
• Hib impact study
• Cost analysis studies hepatitis B and Hib

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Challenges/ Constraints

• Sustainability of GAVI funded activities/
  vaccines
• Increasing program costs vs decreasing EPI
  allocation
• Budget expenditure ceilings
• Unstable vaccine supply stock-out, release of
  funds from MOH to UNICEF

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Challenges (contn)

• Delayed accountability from districts - slow
  disbursement of funds
• Human resource limitations (s, skills,
  attrition)
• High drop out rates and vaccine wastage
• Inadequate transport and communication at
  district level

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Future Plans

• Continued advocacy and negotiation for resources
  within the MTEF and LTEF planning frameworks.
• Strengthening collaboration with the private
  sector
• Further strengthening of routine immunisation
  using the RED strategy
• Disease control, elimination and eradication
  activities
• Expansion and strengthening of disease
  surveillance- IDSR (Pnuemococcal, Rubella, YF)

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Thank you