Assessment of the crowding out of childhood immunisation expenditures in Pakistan due to the COVID-19 response

The assignment reported on here aimed to investigate how investments in and expenditures for COVID-19 interventions, particularly COVID-19 vaccine procurement and delivery, have impacted investments in and expenditures for routine childhood immunisation in Pakistan. The following scope of work was conducted:

• The assignment identified and described how programmatic areas of interest are budgeted for within the federal and provincial health budgets. Areas of interest included:
  • ο childhood immunisation; and
  • ο COVID-19.
• The assignment identified the trends (in an estimation exercise) in approved budget allocations for each programmatic area of interest in the period 2018–2021.
• The assignment assessed budget execution and expenditure in the programmatic areas of interest in the period 2018–2021.
• The assignment determined financing sources for the programmatic areas of interest (e.g. general revenue, loans, earmarked or special funds, and external funding), either provided through the national budget or directly to MoNHSR&C. External development partner support for relevant areas was quantified where possible, and financing flows to the health sector at the provincial level were established.
• Based on the findings of the research, the assignment developed country-specific and globally relevant recommendations in protecting and maintaining investment in childhood immunisations.