Abstract
Many countries are facing fiscal constraints from the economic impact of COVID-19, which is constraining government budgets at the same time as governments face higher spending demands for the immediate COVID-19 health and socio-economic response, as well as the pent-up demand for health services from periods of lock-down, and the need to invest in health systems to better meet and respond to pandemic shocks. COVID-19 vaccination adds additional pressures as it may be competing both for a segment of the health sector’s limited resource envelope and for the infrastructure, skills, and resources from national immunization programmes.
This study describes how childhood immunization and COVID-19 vaccine procurement and delivery are budgeted for within the national health budget and assesses the trends in budget allocations and expenditures across 2018-2022, together with the availability of external funding. It investigates whether COVID-19 vaccine procurement and delivery crowded-out expenditures for routine childhood immunization. To do this, the budget process for immunization is analysed, including the adequacy and availability of funding from different sources, and any bottlenecks or constraints to this expenditure. It will formulate practical recommendations that respond to the challenges identified, including improvements to available data, and monitoring and reporting of allocations and spending on childhood immunization and the COVID-19 response.
Preliminary findings show variation across countries with Nepal showing substantial health expenditure increases in 2020/21 and 2021/22, although budget allocations are expected to drop in 2022/23. Despite significant resources dedicated to COVID-19 response and vaccination, the rise in health expenditure indicates limited crowding out of other health expenditure areas, although there were still initial negative impacts on service delivery. This is shown by a fall in immunization coverage rates in 2020, with survey data indicating multiple contributing factors, including border closures affecting the delivery of routine immunization, the impact of lockdowns on transportation and logistics, a shortage of PPE, and household concerns over visiting health facilities.