Is health expenditure on immunisation associated with immunisation coverage in sub-Saharan Africa? A multicountry analysis, 2013-2017.

Autor:	Idris IO; Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria.; Health Emergencies Programme (WHE), WHO, Geneva, Switzerland., Ouma L; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK ouma.ondijo@gmail.com., Tapkigen J; Department of Health Sciences, University of Tampere, Tampere, Finland., Ayomoh FI; Health Policy, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria.; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Ayeni GO; Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria.; Health Emergencies Programme (WHE), WHO Regional Office for Africa, Daresalam, Tanzania.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Jan 12; Vol. 14 (1), pp. e073789. Date of Electronic Publication: 2024 Jan 12.
DOI:	10.1136/bmjopen-2023-073789
Abstrakt:	Objectives: The designing of contextually tailored sustainable plans to finance the procurement of vaccines and the running of appropriate immunisation programmes are necessary to address the high burden of vaccine-preventable diseases and low immunisation coverage in sub-Saharan Africa (SSA). We sought to estimate the minimum fraction of a country's health budget that should be invested in national immunisation programmes to achieve national immunisation coverage of 80% or greater depending on the context, with and without donors' support. Design: Multicountry analysis of secondary data using retrieved publicly available data from the WHO, Global Alliance for Vaccines and Immunization (GAVI) and World Bank databases. Setting: Data on 24 SSA countries, between 2013 and 2017. Methods: We model the variations in immunisation coverage across the different SSA countries using a fractional logit model. Three different generalised linear models were fitted to explore how various explanatory variables accounted for the variability in each of the three different vaccines-measles-containing vaccine (MCV)1, diphtheria, pertussis, tetanus (DPT3) and BCG. Results: We observed an association between current health expenditure (as a percentage of gross domestic product) and immunisation coverage for BCG (OR=1.01, 95% CI: 1.01 to 1.04, p=0.008) and DPT3 (OR=1.01, 95% CI: 1.0 to 1.02, p=0.020) vaccines. However, there was no evidence to indicate that health expenditure on immunisation (as a proportion of current health expenditure) could be a strong predictor of immunisation coverage (DPT, OR 0.96 (95% CI 0.78 to 1.19; p=0.702); BCG, OR 0.91 (0.69 to 1.19; p=0.492); MCV, OR 0.91 (0.69 to 1.19; p=0.482)). We demonstrate in selected countries that to achieve the GAVI target of 80% in the countries with low DPT3 coverage, health expenditure would need to be increased by more than 45%. Conclusions: There is a need to facilitate the development of strategies that support African countries to increase domestic financing for national immunisation programmes towards achieving 2030 targets for immunisation coverage. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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