Ghana Beyond Aid: Implications for Funding Early Immunizations and Inequalities in Immunization Coverage
Presenter: Ama Fenny
Co-authors: Derek Asuman
Poster file: [download]
Introduction Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant barriers in achieving universal coverage of child vaccination among and within countries. Donor support through GAVI is a central source of funding for Ghana’s immunization program. Ghana Beyond Aid refers to a commitment of the government to finance development without recourse to external assistance. Ghana is expected to fully transition from GAVI support in 2020, with funding for immunization services relying on domestic resources. Increasing financial obligations raises concerns for the sustainability of immunization financing and universal coverage of immunizations in Ghana. Objectives This study examines the trends between sources of healthcare financing and the coverage of childhood immunizations in Ghana. In addition, the paper assess the determinants and sources of rural-urban inequalities in Ghana. Method The study uses data from the WHO Global Health Expenditure database to examine the trends between healthcare financing sources and coverage in childhood immunization programs in Ghana. To assess the sources and determinants of rural-urban inequalities in Ghana, we employ data from the two recent rounds of the Ghana Demographic and Health Surveys conducted in 2008 and 2014. A logit estimation is estimated to examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas; using the Oaxaca-Blinder decomposition technique. Results We find that domestic sources has been the main source of healthcare financing in Ghana, with the external sources playing a crucial complementary role. Coverage of childhood immunizations for measles and DPT-Hep B-Hib has been increasing, reaching 92 and 98 percent in 2014 respectively. In 2015 however, coverage for DPT-Hep B-Hib fell to 88 percent whiles vaccinations for measles dropped to 89 percent. The drop in immunization coverage in 2015 coincided with a decline in domestic financing of healthcare. In 2015, domestic sources accounted for 75 percent of the current healthcare spending. This suggest that a reliance on domestic resource mobilisation to fund immunization may be detrimental to efforts to achieve universal coverage of childhood immunizations in Ghana. The findings of the paper reveal significant rural-urban differentials in the probability of a child receiving the required immunization. Specifically, children in rural households are more likely to have completed the required immunizations compared to children in urban areas in both 2008 and 2014. The decomposition analysis of the rural-urban inequalities in child immunization coverage reveals the existence of significant disparities in the probability of a child receiving the full immunization. The direction of the disparities, however, differs in 2008 and 2014. In 2008, there exist a rural disadvantage in child immunization coverage. The gap in immunization coverage is dominated by endowment or explained effect. In 2014, there exist an urban disadvantage in child immunization. The emerging urban disadvantage may reflect the neglect of primary healthcare delivery in fast growing slums and informal settlements in urban areas. Implications The results of this study fits into the workshop’s aim of advancing the use of information on financing of immunisation to improve coverage. To sustain the gains made in extending the coverage of childhood immunization, countries need to bridge the gap in healthcare financing. Improving methodology that produces the required information to policymakers is critical for the health sector. Beyond this, our findings show a change in rural and urban dynamics, as urban population become more informal and slums develop rapidly. We need to begin looking at methods that engage the use of community resources to finance immunizations? There is a lot to reflect improving community level engagement in the broader impact of immunisation. Increasingly, funding from the National Health Insurance Scheme has supplemented budgetary allocations. However, funding from NHIS may decline as the scheme’s financial commitments to other obligation grows and the scheme becomes a major source of funding for investments in the health sector. To reduce the risks posed by the changing mix of immunization financing, alternative financing options should be explored. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas.