Budgeting for Immunization in nine Eastern and Central European countries

Presenter: Ulla Griffiths

Twitter: '@ullakou

Co-authors: Svetlana Stefanet, Jennifer Asman

Poster file: [download]
Introduction Existence of a line item in the Ministry of Health (MOH) budget is often seen as an essential, first step to ensure financial sustainability. Budget execution and budget evaluation are the remaining two necessary functions in the public financial management system. In this study, immunization was used as a reference point for cross-country comparison of budgeting methods in nine Eastern European and Central Asian countries; Armenia, Azerbaijan, Bosnia and Herzegovina, Georgia, Kyrgyzstan, Moldova, Romania, Tajikistan and Uzbekistan. Study objectives were to (i) verify the number and types of budget line items for immunization services, (ii) compare budget execution with budgeted amounts, and (iii) compare values with annual immunization expenditures reported to WHO and UNICEF. Methods UNICEF country offices were contacted for obtaining a copy of the pages in the 2016 and 2017 MOH budgets and budget execution reports where immunization expenses were included. Budgets were compared across countries in terms of budget structure and amounts budgeted. Results Bosnia and Herzegovina had nine line items for immunization, Kyrgyzstan seven, and Georgia four. The remaining six countries only had a single line item. Immunization budget per child in the birth cohort ranged from US$ 6 in Kyrgyzstan to US$ 224 in Romania. Immunization budget as percent of the Government health budget ranged from 0.03% in Azerbaijan to 2.14% in Armenia. The difference between budgets and immunization expenditures reported to WHO and UNICEF ranged from 11% in Georgia to 56% in Kyrgyzstan, with a mean of 29% across the countries. Budget execution reports from Georgia and Moldova showed executions rates of 113% and 97%, respectively. Conclusion There were great differences between country indicators and some values seemed implausible. Budget credibility must be questioned. It is concerning that budget execution reports could only be obtained from two countries.