Sustainable Immunization Financing in Asia Pacific: Indonesia Country Brief

Key messages

Context

• Indonesia expects to benefit from moderate economic growth, stable cohorts of new children to immunize, and slow but steady improvements in child health outcomes and immunization coverage.
• The burden of disease is shifting, with NCDs increasing and communicable diseases (including vaccine-preventable diseases) decreasing. There will be new demands on the health system, requiring the immunization program to compete for resources.
• Indonesia is one of the top 10 countries with the most unvaccinated children.

Immunization Financing

• Despite Indonesia’s strong economic performance in the last two decades, its growth has not translated efficiently to government social spending, with low public expenditure on health (6% of GDP in 2014) and large levels of support for the immunization program still coming from donors.
• The government will need to direct significant additional resources to immunization to bring the current vaccine schedule in line with international recommendations and other middle-income countries in the region, and to finance plans for new vaccine introductions.
• The multiple sources of financing for the program produces complexity in understanding roles and responsibilities, threatening its performance.

Key Findings

• Indonesia is highly decentralized, with local priorities continuing to rule health spending. However, most local governments miss their health allocation targets and fail to execute their entire budget.
• The central government has limited ability to influence how resources are allocated at the district level where delivery is done, thus high variability in outputs and outcomes in immunization persists.
• The implementation of a national health insurance mechanism, JKN, is facing worrisome fiscal deficits and will not likely reach its 2019 universal coverage target. There is potential for JKN to take on more financing for the immunization program, but it is unclear if the deficit will prevent expansion of the benefits package or support further coverage of prevention services.
• With the country’s impending transition to fully self-financing its immunization program in 2019, Indonesia needs to find new sources of new resources to replace the 10-15% externally financed share of the immunization program budget.
• While earmarked taxes have not yet been politically viable, there are plenty of efficiency gains to be had to increase fiscal space.
• Prioritization of new and underutilized vaccine introductions is closely linked to the production capacity of domestic manufacturer BioFarma. The country holds an exclusive procurement agreement with the stateowned company.
• The ITAGI is relatively nascent and relies heavily on WHO recommendations and secondary findings from neighboring countries.