Immunization Program Economy & Sustainability in Afghanistan

Presenter: Mohammad Akbar Paiman

Poster file: [download]
Immunization Program Economy & Sustainability in Afghanistan Mohammad Akbar Paiman MD. MSc Epidemiology National Immunization Program, Kabul Afghanistan Background: Afghanistan is one of the poorest countries located between south and central Asia with approximately 35 million population. The four-decade long war has undermined almost all infrastructure and systems in this country. Therefore, lack of sustainability of most programs in this country is cause of concern for both the government and international community, which has long presence in Afghanistan. National Expanded Program on Immunization (NEPI) is one of the core programs of the Ministry of Public Health (MoPH) which has the mandate of management and coordination of all immunization related activities in close coordination with other international partners. Afghanistan is one of the GAVI eligible countries and it hardly affords to provide co-finance for the vaccine purchased by the GAVI. Despite injection of huge amount of fund by different donors from 2001, until now more than 50 % of its population live under poverty line, Afghanistan remained donor depended and it is not clear when this country will be able to repair its fragile economy. In addition, high expenditures of war further put this country in danger regarding sustainability of vaccine economy. Currently GAVI supports this country both in term of vaccine cost and health system strengthening. Below picture shows different durations of GAVI support to fragile countries. Aim: To review the available data on immunization in Afghanistan and recommend new methods for sustainability of immunization program in this country. Methods: We reviewed available data on immunization, minutes of meetings and the author’s personal communications with national and international colleagues who are closely involved in immunization activities of the country from Jan 2016 to September 2018. The author triangulated all the data sources systematically. Main themes from the analyses included: 1. Provision of co-finance for purchasing of vaccine by the government of Afghanistan. 2. Donor dependency of the country for long time. 3. Fragile security and political situation of the country. Findings: The huge amount of fund provided by donors to Afghanistan did little impact and this country still hardly afford to pay the co-finance for its basic vaccines. System building is still a huge problem for this country and evidence shows frustration of donors in long run. Insecurity contributed to weakness of the immunization services a clear example of which is the huge number of polio cases (22) 2018 and (7) in 2019. All these indicate urgent need action for sustainability of immunization program in country. Ensuring political stability in the country is joint responsibly of the world particularly of the neighbor countries. This will pave the way to mobilization of domestic resources for improving systems particularly immunization programs in the country. Conclusion: Afghanistan needs political and security stability, system building and mobilization of domestic resources for having a stable health infrastructure and functional immunization program. Capacity of EPI program should be build regarding cost and economy of vaccine in Afghanistan. Key words: Immunization, Sustainability, Afghanistan