Sustainable Immunization Financing: Colombia Country Brief

Executive Summary

Context

• The focus of the Colombian government is on financial coverage through the national health system with the push to reach universal health coverage. However, less than half of the population contribute to the national health system through social health insurance, requiring higher levels of investment from the government than anticipated when the system was designed.
• Along with other macroeconomic factors, high levels of migration within the country have made resource allocation and the ability to respond to local health needs difficult.
• The recent recession strained national investment in immunization. Budget allocations for immunization decreased each year between 2013-2016.

Immunization Financing and Performance

• Despite the downturn in investment in the immunization program in recent years, it has proven to be a prioritized program. The immunization program has been singled out and given its own budget line within the Ministry of Health and Social Protection, giving it great visibility and financial sustainability. During the more fruitful economic times, six new vaccines were introduced to the national program within a five-year period.
• The main source of funding for the national immunization program is general taxation, with limited inputs from the subnational level to manage the program.
• The immunization program is financed by four major actors within the health system: The MSPS manages all procurement for the national program. Departments and municipalities are responsible for program delivery, and the Entidades Promotoras de Salud reimburse service delivery.
• Colombia’s program is extensive with 22 vaccines that cover 26 different diseases, though it is often thought of as a pediatric program within the health system. Limited investment has been made in providing access to vaccines along the life-course through the national program.

Potential for innovation in program financing

• Colombia shows great interest in results-based financing for public programming. Municipalities already have a performance-based program for immunization, though the incentives are not comprehensively designed to promote performance. Other platforms exist to potentially extend results-based financing for immunization, like RIAS.
• Precedent has been set for the utilization of innovative mechanisms that avail of additional or new sources of financing for programs. The public-private partnership-based social impact bond for jobs has been well received in the country and utilizes a specialized innovation fund outside of national budget allocations under the Department of Social Prosperity.
• Colombia’s health system recently created a new health fund, administered by ADRES, which promotes increased levels of transparency in health financing for improved management of health resources. However, this is currently neither being used in any innovative manner to increase financing nor to ensure improved outputs for health expenditures.
• EPS pay service delivery fees for the NIP and have leeway to procure and deliver additional vaccines outside of the NIP, but they have not yet been fully integrated into the immunization program to ensure its success.