Sustainable financing for Immunization Agenda 2030.

Sustainable financing for immunization refers to the sufficient and predictable allocation and use of resources to support the achievement of immunization goals within the framework of overall health financing. The Immunization Agenda 2030 (IA2030) agenda spells out four important focus areas needed for sustainable financing: (1) ensuring sufficient and predictable resources, (2) making optimal use of resources, (3) aligning partnerships, and (4) supporting sustainable transitions from external assistance. This paper summarizes the evidence and proposes interventions under each area. While immunization is one of the best investments and justifies public financing, the COVID-19 pandemic has led to the worst economic recession since the Great Depression and threatens countries' ability to mobilize funding to ensure continuity and access to essential services, including immunization. Strategies for ensuring adequate resources differ by income group but include raising more revenues, reprioritizing the budget towards health, and ensuring that health resources favor Primary Health Care (PHC) and immunization. In low- and lower-middle income countries, support from Gavi, the Vaccine Alliance, which channels the largest amount of external financing, will remain important, but some lower-middle income countries will need to prepare for transition. Countries benefitting from the Global Polio Eradication Initiative (GPEI) are also experiencing a transition from GPEI financing to domestic and other external financing. This paper outlines ways in which countries can improve the use of domestic and external resources to better incentivize high-quality PHC and immunization services and align immunization programs with health sector reforms. While governments must lead, collective action from development partners, the private sector, and civil society is needed to promote health system financing systems that ensure that the world is better prepared for future outbreaks and pandemics, while reinforcing the IA2030 vision and making progress towards universal health coverage and the Sustainable Development Goals.

Diseño, contenido y financiamiento de un paquete nacional de servicios de salud esenciales / Design content and financing of an essential national package of health services

En los países de bajos ingresos se podría ofrecer un paquete mínimo de intervenciones clínicas y de salud pública, muy efectivas en función del costo, destinadas a aliviar la carga ocasionada por las principales enfermedades, por unos US$ 12 anuales por persona, y en los de medianos ingresos, por cerca de $ 22. Al prestarse debidamente, este paquete permitiría eliminar de 21 a 38 por ciento de la carga de mortalidad prematura y discapacidad en niños menores de 15 años y de 10 a 18 por ciento de la que recae en los adultos. El costo excedería lo que los gobiernos gastan en salud en los países más pobres, pero estaría al alcance de los de medianos ingresos. Los gobiernos deberían asegurarse de que por lo menos la población pobre tenga acceso a esos servicios. El gasto público adicional debería destinarse entonces a ampliar la cobertura de la población solvente o a llevarla más allá de los servicios mínimos, para prestar un paquete nacional de servicios de salud esenciales, que incluya intervenciones algo menos efectivas en función del costo para tratar más enfermedades y trastornos

Investing in health wisely. The role of needs-based technology assessment.

Countries worldwide spend huge sums on health--about $1,700 billion a year, or roughly 8% of global income. But the World Development Report 1993: Investing in Health shows that these monies could be spent much more wisely, in the process doing a great deal to help the world's 1 billion poor. Essential national public health and clinical packages are proposed based on assessment of the burden of disease (measured in disability adjusted life years) and the cost-effectiveness of interventions. Governments can play a central role in improving the health of their citizens: they can foster an environment that enables households to improve health and they can also improve their own spending on health, targeting it to support universal access to essential national public health and clinical packages based on the above methods. This is a good example of the concept of needs-based technology assessment, combining the disciplines of epidemiology, economics, and policy formulation. When applied, it should lead to improved effectiveness, efficiency, and equity.

Incentives and provider payment methods.

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Diseño, contenido y financiamiento de un paquete nacional de servicios de salud esenciales / Design content and financing of an essential national package of health services

En los países de bajos ingresos se podría ofrecer un paquete mínimo de intervenciones clínicas y de salud pública, muy efectivas en función del costo, destinadas a aliviar la carga ocasionada por las principales enfermedades, por unos US$ 12 anuales por persona, y en los de medianos ingresos, por cerca de $ 22. Al prestarse debidamente, este paquete permitiría eliminar de 21 a 38 por ciento de la carga de mortalidad prematura y discapacidad en niños menores de 15 años y de 10 a 18 por ciento de la que recae en los adultos. El costo excedería lo que los gobiernos gastan en salud en los países más pobres, pero estaría al alcance de los de medianos ingresos. Los gobiernos deberían asegurarse de que por lo menos la población pobre tenga acceso a esos servicios. El gasto público adicional debería destinarse entonces a ampliar la cobertura de la población solvente o a llevarla más allá de los servicios mínimos, para prestar un paquete nacional de servicios de salud esenciales, que incluya intervenciones algo menos efectivas en función del costo para tratar más enfermedades y trastornos

Se pública en inglés en el Bull. WHO. Vol. 72(4), 1994

Design, content and financing of an essential national package of health services.

A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.

PIP: A minimum package of highly cost-effective public health and clinical interventions could be provided in low-income countries for about US$ 12 per person per year and in middle-income countries for about $22. This package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years old and 10-18% of the burden in adults. The two estimates of the package were calculated in two ways and then compared. One approach was based on the cost of specific activities, estimated from existing studies in many countries of service delivery costs by type of intervention. In the other approach, costs were estimated for a prototype district health system able to deliver the minimum package, consisting of a district hospital, health clinics, and outreach activities. In communities with moderate or high mortality, a few causes typically account for a large share of deaths. In 1990 an estimated 55% of the burden of disease was concentrated in children under 15 years old, with 660 million disability-adjusted life years (DALYs) lost. Just 10 disease conditions cause 71% of this loss. Except for congenital malformations, all these causes correspond to very cost-effective interventions, at less than $100 per DALY. Protein-energy malnutrition and vitamin-A deficiency can produce death or disability directly or through other diseases with a total loss 5-6 times larger when their indirect effect is included. The cost of the package would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that poor populations have access to these services with additional public expenditures either to extending coverage to the non-poor or to expansion beyond the minimum to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases.