Collection and reporting of immunization financing data ... · Collection and reporting of immunization financing data for the WHO/UNICEF Joint Reporting Form Results of a country

Collection and reporting of

immunization financing data for the

WHO/UNICEF Joint Reporting Form

Results of a country survey

DRAFT

2014

Disclaimer:

The views expressed in this report do not necessarily represent the decisions, policy or

views of the World Health Organization.

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Contents

Executive summary ................................................................................................................................. 4

1. Introduction ..................................................................................................................................... 6

2. Survey rationale, objectives and methods ...................................................................................... 6

3. Main findings ................................................................................................................................... 8

3.1 Individuals and institutions involved in the reporting process ............................................... 8

3.2 Sources of information used ......................................................................................................... 9

3.3 Data included............................................................................................................................... 12

3.4 Main challenges ........................................................................................................................... 14

3.5 Ways to improve the reporting system ....................................................................................... 15

3.6 Feedback on reported data ......................................................................................................... 17

3.7 General comments by countries ................................................................................................. 18

4. Conclusions .................................................................................................................................... 18

Annex 1. JRF template 2012-2013, section 6B.2: financing data .......................................................... 19

Annex 2. Survey questionnaire .............................................................................................................. 21

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Executive summary

The immunization financing indicators reported in the WHO/UNICEF Joint Reporting Form (JRF) are of

strategic importance for evaluating and informing immunization policy at global, regional and

country levels. The Global Vaccine Action Plan (GVAP) 2011–2020, adopted by the World Health

Assembly in 2012, gives high priority to country ownership and financial sustainability of

immunization activities; its accountability and monitoring framework includes “domestic

expenditures for immunization per person targeted” as a key indicator for monitoring progress in

GVAP implementation.

Unfortunately, there is considerable variation between countries in the quality, timeliness and

accuracy of their data on immunization and vaccine expenditure. Errors, inconsistencies and missing

data have frequently been identified during the compilation and analysis of time series.

In 2013 and early 2014, WHO, UNICEF and other Gavi Alliance partners conducted a survey in

selected countries, to document the data reporting process, including the methods and data sources

used to estimate the national immunization and vaccine expenditures reported in the JRF. This report

summarizes the country responses.

The survey aimed to:

• identify the sources of information used and the people and departments involved in the

data collection and reporting process;

• document the main obstacles and challenges faced by countries in reporting JRF financing

indicators;

• collect countries’ suggestions on ways of improving data collection, estimates, validation and

reporting.

In 36 Gavi-eligible countries, a questionnaire was completed by interviewing key people involved in

the JRF reporting process in 2010–12.

Ministry of Health expenditure records, expense records of the Expanded Programme on

Immunization (EPI) and the Ministry of Health gazetted budget records were found to be the main

sources of information used to estimate and report each JRF indicator in 2012. The national

comprehensive multi-year plan (cMYP) and documents from the Ministry of Finance, Gavi, UNICEF

and WHO were secondary sources of information.

Some 58% of countries reported that they included data on subnational expenditure on vaccines in

their JRF for 2010, 2011 and 2012; 61% included data on subnational expenditure on routine

immunization.

Of the countries involved in the survey, 39% reported that they had received feedback from the

UNICEF or WHO regional office about the accuracy of their JRF financing data; 33% had adjusted or

revised their data after feedback was given.

The survey revealed a number of issues and challenges, including: a lack of clarity and understanding

of the JRF indicators and reporting instructions; absence of an organized data reporting process; and

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limited capacity, skills and incentives at country level for the collection, estimation, validation and

reporting of correct data.

Improvements suggested by countries focused predominantly on the data collection and validation

process, in particular the disaggregation of expenditure data that are not immunization-specific.

Countries requested greater clarity in the JRF instructions, technical guidance and assistance in

completing and validating the financial data, and closer involvement of partners, particularly the

UNICEF and WHO country offices. Data collection and reporting should benefit primarily the

countries, in addition to the global community, by helping to improve the coverage, management

and financing of immunization programmes.

Despite its limitations, this survey has helped identify some of the challenges and difficulties faced by

countries in reporting quality data on financing of vaccines and routine immunization. It has also

provided some insights and suggestions on how to respond to the urgent and strategic need of

countries, regions and the global community for reliable and sound data on immunization financing.

The results will inform a comprehensive effort to strengthen local and regional capacities, and

promote peer exchange, active feedback, responsibility and better use of quality data for action and

policy-setting within the GVAP.

6

1. Introduction

Since 1998, the WHO/UNICEF Joint Reporting Form (JRF) has been used to collect data on

immunization coverage and system performance in WHO Member States. One section of the form is

devoted to immunization financing (see Annex 1). The JRF includes six indicators of immunization

financing, four of which are expressed in absolute terms (US$) and two as percentages:

• total expenditure on routine immunization;

• government expenditure on routine immunization;

• total expenditure on vaccines used for routine immunization;

• government expenditure on vaccines used for routine immunization;

• percentage of expenditure on routine immunization that is financed by government;

• percentage of expenditure on vaccines used for routine immunization that is financed by

government.

These indicators are intended to measure the extent to which countries are moving towards financial

sustainability and greater country ownership.

Interest in such indicators has increased since 2000, when the Gavi Alliance was established to

improve access to new vaccines and immunization in low-income countries. Financial sustainability is

at the centre of the Gavi model and has been translated in terms of increasing domestic financing for

traditional vaccines (not supported by Gavi), Gavi co-financing and graduation policies.

The Global Vaccine Action Plan (GVAP) 2011–2020, adopted by the World Health Assembly in 2012,

gives high priority to country ownership and financial sustainability. In its accountability and

monitoring framework, “domestic expenditures for immunization per person targeted” is a key

indicator used to monitor the progress of GVAP implementation at country and global level. These

new developments have radically changed the status of the JRF financial indicators, as they are now

more closely monitored by the global community and the World Health Assembly. These indicators

are becoming more strategic and are increasingly used to evaluate and inform immunization policy at

global, regional and country levels.

Unfortunately, there is considerable variation between countries in the quality, timeliness and

accuracy of data on immunization and vaccine expenditure. Errors, inconsistencies and missing data

have frequently been identified during the compilation and analysis of time series. These limitations

are hindering efforts to assess progress and to make decisions based on strong evidence at global,

regional and country level. Therefore, improving data collection, validation and reporting is

becoming a priority at country and global level.

2. Survey rationale, objectives and methods

To better understand how the indicators are collected and reported, WHO, UNICEF and other Gavi

Alliance partners conducted a survey in 2013 and early 2014 in selected countries, to document the

data reporting process, including the methods and data sources used to estimate and report national

immunization and vaccine expenditure and financing.

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The survey aimed to:

• identify the sources of information and the people and departments involved in the data

collection and reporting process;

• document the main obstacles and challenges faced by countries in reporting JRF financing

indicators; and

• collect countries’ suggestions on ways of improving data collection, estimates, validation and

reporting.

The survey also aimed to draw lessons and set out key recommendations to clarify the objectives and

methods of the data reporting process, and to strengthen the quality and usefulness of the JRF

financing data.

WHO and UNICEF country offices, in collaboration with Gavi and the Sabin Institute/Sustainable

Immunization Financing Social Investment Fund (SIF) project, completed the questionnaires by

interviewing key persons involved in the JRF reporting process in 2010–12.

The questionnaire included eight questions (see Annex 2), aimed at obtaining the following

information:

• the positions of the people in charge of completing, checking and approving the JRF financing

data for 2010–12;

• the departments and units of the Ministry of Health, Ministry of Finance and other

institutions involved in the JRF reporting process, and the specific information they provide;

• the main and secondary sources of information used to estimate each reported indicator in

2012 ;

• the main challenges in ensuring that the data reported are accurate and up-to-date;

• whether the data reported in 2010, 2011 and 2012 included subnational expenditure on

vaccines and routine immunization;

• whether countries had recently received any feedback, from WHO, UNICEF or others, about

the accuracy of the reported financing data;

• practical suggestions for improving the reporting process for the JRF financing indicators; and

• other comments.

A total of 36 Gavi-eligible countries completed the questionnaire. All completed questionnaires were

then compiled and analysed at regional and global level.

8

Table 1: Countries involved in the survey

WHO Region Countries Number Total

Africa Botswana, Burkina Faso, Burundi, Cameroon, Comoros, Kenya,

Madagascar, Sierra Leone, South Africa, Swaziland, Zambia,

Zimbabwe

12 36

Europe Armenia, Azerbaijan, Georgia, Kazakhstan, Republic of Moldova,

Tajikistan, Turkmenistan, Ukraine, Uzbekistan

9

South-East Asia Indonesia, Nepal, Sri Lanka 3

Americas Costa Rica, El Salvador, Honduras, Mexico, Nicaragua, Panama,

Paraguay

7

Western Pacific Viet Nam

1

Eastern

Mediterranean

Afghanistan, Somalia, Sudan, Yemen 4

3. Main findings

3.1 Individuals and institutions involved in the reporting process

Survey questions

• Who has been in charge of filling in, checking and approving the section on financing data for

2010, 2011 and 2012?

• Which departments and units of the Ministry of Health, Ministry of Finance and other institutions

are involved in the process of reporting financing data for the JRF? What specific information do

they provide?

Rationale for these questions

These questions aim to find out who is involved in the data collection and reporting process, both

within and outside the Ministry of Health. The JRF is mainly compiled by the Expanded Programme

on Immunization (EPI) team. However, it is important to understand the extent to which people in

charge of purchase and supply of vaccines, budgeting and financing of vaccines, and immunization

operational expenditures are solicited and involved in data sharing, estimations, validation and

reporting. The involvement of these people is critical for obtaining information on the planned or

allocated budget and on actual expenditure on routine vaccines and immunization activities.

Summary of the responses

Who is involved?

• The Ministry of Health is involved in 97% of cases. The specific departments involved vary

according to the country and include the EPI unit, the health management information

system, public health, finance, administration and supply services.

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• The Ministry of Finance is involved in 28% of the countries, providing planned budget and

actual expenditures; supporting departments, such as the budgeting unit, sector office for

EPI, and departments of health, social sector, state funds and investment are also included.

• In 42% of the countries, other institutions are involved; these include the Department of

Social Policy of the Ministry of Economics, the Center for Diseases Control and Public Health,

and epidemiology and public health institutes. In one country in the African Region, the

vaccine supplier is involved.

• In almost 50% of the countries, WHO and UNICEF offices are involved in the process

• In one country in the Region of the Americas, the Social Security Administration takes part.

What specific information is provided and in which format?

• The Ministry of Health mainly provides data on budget allocation, budget implementation,

expenditure on vaccines and staff, and vaccine quantity and values . The majority of the data

is provided in Excel format.

• The Ministry of Finance provides data on allocated budget and past expenditure. Data are

generally provided in the format of printed accounting books.

Observations

• The Ministry of Health and EPI play a pivotal role in the process of reporting financing data

through JRF.

• The Ministry of Finance, WHO and UNICEF are involved to a certain extent in preparing the

data estimates and reporting.

• The central level dominates the process; the subnational level is less involved and its

expenditure is frequently underestimated.

• Data on planned and allocated budgets are more often available than those on executed

budget and actual expenditures.

3.2 Sources of information used

Survey question

Please specify all sources of information used in estimating each JRF indicator in 2012; for each

source, indicate whether it is a main source (M) or a secondary source (S).

Rationale of the question

Information for the immunization financing indicators needs to be obtained from more than one

source, for two main reasons.

• There is no single source of funding for immunizations, and information should be collected

from each source. In most Gavi-eligible countries, EPI vaccines are procured through UNICEF

or the Pan American Health Organization (PAHO) and partly funded by Gavi. All sources of

funding for vaccines and immunizations should be identified and the amounts estimated.

• The immunization financing indicators reflect actual expenditures, and not official budgets,

estimated costs or projected expenditures. Cross-checking of data from different sources is

10

essential to obtain accurate information on actual spending on routine vaccines and

immunization services.


The main source of data on the amount of government funds spent on vaccines used in routine

immunization (indicator 6700 of the JRF template 2012-2013 - see Annex 1) – for 81% of countries

involved in the survey – is the Ministry of Health expenditure record. Overall, 58% of countries

collected data from the EPI expense records, and 39% from the Ministry of Health gazetted budget.

The national comprehensive multi-year plan (cMYP) is also a source of information for 42% of the

countries. UNICEF is an important source of information for 33% of countries in the African Region

(Table 2).

Information on the total expenditure (from all sources) on vaccines used in routine immunization

(indicator 6710) comes from the Ministry of Health expenditure record in 72% of countries and from

EPI expense records in 50% of countries (Table 3).

The Ministry of Health expenditure record, EPI expense records and Ministry of Health gazetted

budget are the main sources of data on the amount of government funds spent on routine

immunization (indicator 6730) (64%, 50% and 30% of countries, respectively) (Table 4).

Data on total expenditure (from all sources) on routine immunization (indicator 6740) are taken from

the Ministry of Health expenditure record in 64% of countries and from EPI expense records in 50%

of countries (Table 5). UNICEF is a main source of information for countries in the African Region.

Table 2: Sources of information on amount of government funds spent on vaccines used in routine

immunization (indicator 6700)

Source of information

Percentage of countries using the source

Africa Europe South-East

Asia Americas

Western

Pacific

Eastern

Mediterranean Average

Ministry of Health expenditure record 83 100 33 86 100 50 81

Ministry of Health gazetted budget 50 56 33 29 0 0 39

EPI expense records 58 56 66 57 100 50 58

EPI budget documents 33 33 66 43 100 50 42

Subnational EPI expense records 0 22 33 43 0 0 17

Social security administration

expenditure records 0 0 0 29 0 0 5

cMYP 42 56 66 14 100 25 42

WHO Office 25 11 33 14 0 0 17

UNICEF Office 33 11 33 0 0 50 22

GAVI decision letter 33 44 33 14 0 25 31

Other GAVI Secretariat 17 0 0 0 0 0 5

Other donor documents 8 0 0 0 0 25 5

National health accounts 25 11 0 0 0 0 11

Other studies 8 0 0 0 0 0 3

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Table 3: Sources of Information on total expenditure (from all sources) on vaccines used in routine

immunization (indicator 6710)

Table 4: Sources of information on amount of government funds spent on routine immunization

(indicator 6730)



Africa Europe South-

East Asia Americas

Western

Pacific

Eastern







Social security administration expenditure

records 0 0 0 29 0 0 5

cMYP 25 33 33 0 100 75 34

WHO Office 42 0 0 0 0 0 17

UNICEF Office 50 0 0 0 0 50 25





Other sources 8 0 0 0 0 0 3




East Asia Americas

Western

Pacific

Eastern








records 0 0 0 29 0 0 5

cMYP 33 44 33 0 100 50 36

WHO Office 25 11 0 0 100 25 19

UNICEF Office 58 11 0 0 100 75 36







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Table 5: Sources of information on total expenditure (from all sources) on routine immunization

(indicator 6740)

Observations

• The main sources of data are the expenditure records of the Ministry of Health and EPI.

• The cMYP, as well as WHO, UNICEF and Gavi documents, are important secondary sources of

data, particularly in Africa.

• Allocated funds and budgeted expenditures are more easily available than actual expenditures.

• Subnational EPI sources of information are either non-existent or underused, except in the

American and European Regions.

3.3 Data included

Survey question

Do the data your country reported in JRF in 2010, 2011 and 2012 include subnational expenditures

on vaccines and routine immunization?



Africa Europe South-East

Asia Americas

Western

Pacific

Eastern


Ministry of Health expenditure

record

75 78 0 43 100 50 64

Ministry of Health gazetted

budget

33 33 33 14 0 0 25




Social security administration

expenditure records

0 0 0 43 0 0 9

cMYP 33 44 33 0 100 75 39

WHO Office 50 11 0 0 100 25 28

UNICEF Office 50 0 0 0 100 75 31







13

Rationale for the question

The JRF immunization financing indicators aim to capture both total and government expenditure on

routine vaccines and routine immunization, some of which may occur at subnational level. While

most EPI vaccines are procured and funded at central level through UNICEF or PAHO, there are

exceptions. More importantly, some operational costs may be funded and recorded at national or

subnational level (e.g. transportation, maintenance and supervision). In addition, central funds that

are officially transferred to the subnational level may not be effectively allocated or spent. It is,

therefore, important to record actual expenditure at both national and subnational levels.


More than half of the countries (58%) reported that they included data on subnational expenditure

on vaccines in their JRF for 2010, 2011 and 2012; 61% included subnational expenditure on routine

immunization (Table 6).

Table 6: Inclusion of subnational expenditure on vaccines and routine immunization

Information included in JRF

Yes No Not answered

No. of

countries %

No. of

countries %

No. of

countries %

Subnational expenditure on

vaccines 21 58 12 33 3 8

Africa 10 83 1 8 1 8

Europe 6 67 2 22 1 11

South-East Asia 2 66 1 33 0 0

Americas 0 0 7 100 0 0

Western Pacific 1 100 0 0 0 0

Eastern Mediterranean 2 50 1 25 1 25

Subnational expenditure on

routine immunization 22 61 9 25 5 14

Africa 6 50 4 33 2 17

Europe 4 44 2 22 3 33

South-East Asia 2 66 1 33 0 0

Americas 6 86 1 14 0 0

Western Pacific 0 0 1 100 0 0

Eastern Mediterranean 4 100 0 0 0 0

Observations

• As most vaccines are centrally procured and funded, it is important to clarify what is actually

included from the subnational level, particularly in Africa.

• Immunization expenditures at subnational level may be underestimated, as almost 40% of

the countries do not explicitly take into account subnational expenditure.

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3.4 Main challenges

Survey question

What are the main challenges in ensuring that this section of the JRF contains accurate and up-to-

date data?


Countries face many obstacles when attempting to collect accurate, up-to-date and meaningful data.

A number of possible challenges were suggested to help respondents express their concerns and to

permit quantitative analysis of the responses. The challenges listed spanned the data collection and

reporting cycle, starting with understanding the indicators and instructions, and ending with

reporting and alignment issues.


In 39% of the countries, the main challenge in ensuring that the financing data reported are accurate

and up-to-date is the data collection itself. In addition, 39% reported challenges with standardization

of the reporting process. Some 25% - 33% had difficulty understanding the indicators and calculating

the estimates, and specifically in identifying what has been spent by partners other than

government, WHO and UNICEF.

Table 7: Main challenges reported by the countries

Percentage of countries reporting as challenge

Africa Europe

South

-East

Asia

Americas Western

Pacific

Eastern


Understanding the indicators 33 11 33 43 0 0 25

Making the estimates 42 22 33 14 0 75 33

Collecting the data 75 33 0 14 0 25 39

Validating the data 33 11 33 14 0 0 20

Consistency issues with different

sources of information/reporting 42 11 33 43 100 25 33

How is the process of collection,

validation, and reporting JRF data

organized?

8 0 0 14 0 0 5

Is the process of reporting

standardized? 25 56 0 57 100 25 39

Are the processes of reporting JRF and

Annual Progress Report (APR) aligned? 17 56 33 29 100 25 33

Others 17 11 0 14 0 0 11

Observations:

• Countries reported three main issues: the indicators and instructions were thought to be

unclear and not well understood; there was difficulty in accessing information on actual

expenditure; and the reporting process was not well standardized.

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• The perception of the issues and obstacles is quite different in the different regions;

observations should, however, be interpreted with caution as the sample is not

representative.

3.5 Ways to improve the reporting system

Survey question

Please make practical suggestions on how the reporting process for JRF financing indicators could be

improved.


It is of critical importance for WHO, UNICEF and other Gavi partners to get practical suggestions and

recommendations for improving the reporting process from those directly involved. Countries were

given a list of topics on which they were invited to make suggestions for improvement.


Most of the suggestions were focused on data collection, the roles of UNICEF and WHO country

offices, and the checking, validation and approval of the data (Table 8).

Table 8: Percentage of countries making suggestions for improvement

Percentage of countries making suggestions for improvement

Africa Europe

South-

East

Asia

Americas Western

Pacific

Eastern


Collection of data on

immunization expenditure

(sources, quality, reliability,

consistency)

75 22 100 43 100 75 58

Collection of data on vaccine

expenditure (sources, quality,

reliability, consistency)

25 22 66 29 0 0 25

Data checking, validation and

approval 58 22 66 43 0 75 47

Use and feedback on financing

indicators 17 22 33 29 0 50 25

Roles of UNICEF and WHO

country offices in the process 67 33 100 29 0 50 50

Additional technical support,

in terms of guidelines, training

or consultancies

42 22 66 29 0 75 39

Specific suggestions included the following.

Collection of data on vaccine expenditures

o It is important to indicate how to disaggregate expenditure data that involve other services.

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o It should be made clear that expenditures on campaigns should not be included in this

calculation.

o The Ministry of Finance and health economists should verify sources, quality and consistency of

reported vaccine expenditures.

o There should be close cooperation with UNICEF to collect and verify vaccine expenditures.

o National norms should be considered.

o All actors and players should be involved.

Data checking, validation and approval

o Guidelines are needed on how to validate data, especially shared costs.

o The Ministry of Finance should validate and approve expenditure data. A mechanism should be

put in place at country level to validate financing data.

o All partners should be involved in completing and reviewing the forms. The forms should include

a space for the signatures of the permanent secretary of Ministry of Health and key partners in

immunization.

o The completed JRF should be reviewed in depth at country level by government and partners,

especially WHO and UNICEF.

o Meetings with WHO and UNICEF should be organized to improve the consistency and reliability

of data.

o The Ministry of Finance and health economists should verify sources, quality and consistency of

reported immunization expenditures. Completeness should also be checked.

o JFR financing data should be widely shared at country level.

o A technical monitoring working group should be established.

o Adequate resources are needed for collection, checking, validation and approval of data under

the leadership of the Ministry of Health.

o Monitoring visits should be carried out to check the quality and conformity of data.

Use and feedback on financing indicators

o The data collected and reported for the JRF are almost never used at the country level; there

appears to be very little, if any, demand for the JRF financing indicators within countries. This

observation should underpin any attempt to improve the JRF system of reporting, unless

incentives and practical uses of data at country level are identified.

o There appears to be very little, if any, feedback from the regional or global level.

o Quarterly meetings should be organized with all stakeholders.

o More feedback should be provided to countries.

o Data analysis and feedback should be used to advocate for allocation of funds to immunization.

Roles of UNICEF and WHO country offices in the process

o The UNICEF and WHO country teams should actively and fully participate in completing the

JRF. They need to work more closely with government to build capacity and need to be

involved in whole JRF process.

o UNICEF and WHO should provide technical assistance for data collection, estimates and

cleaning.

o UNICEF and WHO country offices should serve as the secretariat for completion of the JRF.

o The forms should include space for endorsement by WHO and UNICEF.

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o A forum for completion and discussion of the JRF data should be convened: data should be

complete and thoroughly verified prior to submission.

Additional technical support in terms of guidelines, training or consultancies

o There is a need for clear guidelines and increased awareness among all stakeholders.

o It would be useful to organize workshops on the various sources of data on immunization

expenditure and how to collect and validate them.

o Country teams should be trained on how to complete the JRF and APR; so far, no country

team member has ever been trained to do this.

o Exchange of experiences between countries and training at international and country levels

are requested.

3.6 Feedback on reported data

Survey question

In the past years, have you received any feedback about the accuracy of the JRF financing data

reported?


Feedback is a powerful way of helping countries to improve the quality of their data. To be useful,

feedback should be timely, regular, constructive, helpful and collaborative. Feedback is needed on

both the accuracy and quality of the JRF financing indicators and on the analysis and use of the data

at regional and global level.

Summary of the countries’ responses

Of the countries involved in the survey, 39% reported that they had received feedback about the

accuracy of the JRF financing data reported from the UNICEF or WHO regional office; 30% had

received feedback from the UNICEF or WHO country office and 3% from UNICEF or WHO

headquarters. In total, 33% of the countries adjusted or revised their data after receiving feedback

(Table 9).

Table 9: Percentage of countries that received feedback about the accuracy of the JRF financing data

reported

Source of feedback

Percentage of countries receiving feedback


East Asia Americas

Western

Pacific

Eastern


UNICEF or WHO headquarters 0 11 0 0 0 0 3

UNICEF or WHO regional office 67 11 33 43 0 25 39

UNICEF or WHO country office 67 0 33 14 0 25 30

Other 0 0 0 0 0 0 0

Were data adjusted or revised

after the feedback? 58 11 33 29 0 25 33

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Observations

• An increasing amount of feedback is being provided to countries by WHO and UNICEF.

• The feedback comes mainly from country and regional offices.

• The feedback is mainly about data gaps, consistency and completeness, rather than

relevance, analysis, and policy implications.

3.7 General comments by countries

The scope of the questionnaire was quite limited in relation to the range of issues and obstacles that

countries could face in the process of data collection, validation and reporting. Space was therefore

included to allow countries to highlight any other relevant issues or recommendations.

Summary of the comments made by countries

• One country requested an extension of the deadline for submission of the report “to the end

of March or April 15th, because the time for analysis after data collection is too short”.

• Some countries reported that the existing budgeting and reporting forms in the country did

not allow them to allocate costs specifically associated with immunizations. Immunization

financing is often included under a larger programme, such as disease surveillance or child

health. Expenditures may be presented by item and not by programme or intervention. Data

disaggregation is problematic.

• The format of the JRF was also criticized. “Questions in the table are clear, but sometimes

the cells are not functioning and do not accept the data.” Perhaps the format should be

simplified to be more accessible.

• There is an important need for capacity-building within government institutions responsible

for completing the JRF and continuous feedback from WHO headquarters and regional

offices.

4. Conclusions

This report presents the results of a survey conducted among a sample of Gavi-eligible countries, to

identify major difficulties encountered in reporting JRF financing data. A total of 36 countries

completed the survey questionnaire.

Despite its limitations, the survey has helped identify some of the challenges and difficulties faced by

countries in reporting quality data on financing of vaccines and routine immunization. It has also

provided some insights and suggestions on how to respond to the urgent and strategic need of

countries, regions and the global community for reliable and sound data on immunization financing.

The results will inform a comprehensive effort to strengthen local and regional capacities, and

promote peer exchange, active feedback, responsibility and better use of quality data for action and

policy setting within the GVAP agenda.

19

Annex 1. JRF template 2012-2013, section 6B.2: financing data

JRF instructions

6700

This figure should be available from multi-year plan for immunization with a costing and financing component. Government includes all administrative levels such as national and sub-national governments, all funds allocated through the National Government Budget. Extra-budgetary financing from donors, out-of-pocket and informal private payments are excluded.

6710

This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all sources of financing vaccines used in routine immunization (e.g. government, health insurance, donors, out-of-pocket and informal private payments)

6720

Give the percentage of expenditure on vaccines used in routine immunization that was financed solely with government funds. Government includes all administrative levels such as national and sub-national governments. The estimate can come from a previous year or a “best guess"

6730

This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all recurrent, immunization-specific

expenditure of routine immunization. In particular, recurrent inputs include vaccines, injection supplies, salaries and per diems of health staff working full-time on immunization, transport, vehicles and cold chain maintenance, training, social mobilization, and monitoring and surveillance. Government includes all administrative levels such as national and sub-national governments, all fund allocated through the National Government Budget. Extra-budgetary financing from donors, out-of-pocket and informal private payments are excluded.

6670

6680

6690(instructions)

6700

(instructions)

<pick one>

6710

(instructions)

<pick one>

6720

(instructions)

6730(instructions)

<pick one>

6740(instructions)

<pick one>

6750

(instructions)

What amount of government funds was spent on routine immunization?

(Please specify whether you are reporting in local currency or US$.)

If total amounts are not available for the previous questions please provide an

estimated percentage of total expenditure on vaccines financed by government

funds

If total amounts are not available for the previous question please provide an

estimated percentage of total expenditure on routine immunization financed by

government funds?

What is the total expenditure (from all sources) on vaccines used in routine

immunization? (Please specify whether you are reporting in local currency or US$.)

What is the total expenditure (from all sources) on routine immunization? (Please

specify whether you are reporting in local currency or US$.)

What amount of government funds was spent on vaccines used in routine

immunization?

(Please specify whether you are reporting in local currency or US$.)

the health care waste management

the purchase of vaccines used in routine immunizations

<pick one>

<pick one>

<pick one>

the purchase of injection supplies (such as syringes, needles, and

safety boxes) for routine immunizations

Are there line items in the

national government budget

specifically for:

20

6740

This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all recurrent, immunization-specific expenditure of routine immunization. In particular, recurrent inputs include vaccines, injection supplies, salaries and per diems of health staff working full-time on immunization, transport, vehicles and cold chain maintenance, training, social mobilization, and monitoring and surveillance. It includes all sources of financing

routine immunization (e.g. government, health insurance, donors, out-of-pocket and informal private payments).

6750

Give the percentage of expenditure on routine immunization that was financed solely with government funds. Government includes all administrative levels such as national and sub-national governments. The estimate can come from a previous year or a “best guess”.

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Annex 2. Survey questionnaire

1) Name of the country:

2) Who has been in charge of filling in, checking and approving the section on financing data for

2010, 2011 and 2012?

2010 2011 2012

Role

Function

Contact details

3) Which departments and units of the Ministry of Health, Ministry of Finance and other institutions

are involved in the process of reporting financing data for the JRF? What specific information do they

provide?

Ministry or

institution

Department or unit Specific information

provided

Format: Excel table,

raw data, accounting

books

Ministry of Health

Ministry of Finance

Social Security

administration

Others

4) Please specify all sources of information used in estimating each JRF indicator in 2012; for

each source, indicate whether it is a main source (M) or a secondary source (S).

Sources of information for JRF

indicators

Amount of

government

expenditure

on vaccines

(indicator

6700)

Total

expenditure

(from all

sources) on

vaccines

(indicator

6710)

Amount of

government

expenditure

on routine

immunization

(indicator

6730)

Total

expenditure

(from all

sources) on

routine

immunization

(ndicator

6740)

Ministry of Health expenditure record

(specify joint Ministry of Health, WHO and

UNICEF sources, and GAVI decision letter)

Ministry of Health gazetted budget

(specify _____________________)

EPI expense records

(specify ___________________________)

EPI budget documents

(specify ___________________)

Subnational EPI expense records

(Specify ________________________)


records (specify_________________________)

cMYP (specify year conducted and years of

data used)

WHO Office (specify source documents

22

_____________________)

UNICEF Office (specify source documents

_________________________)

GAVI decision letter Other GAVI Secretariat

(specify ______________________________)

Other donor documents

(specify _____________________)

National health accounts reports

(specify year)

Other studies

(name and date conducted)

Other source

(specify ________________________________)

Other source

(specify __________________________)

5) What are the main challenges in ensuring that this section of the JRF contains accurate and up-to-

date data?

- Understanding the indicators.

- How to make the estimates.

- How to collect the data.

- How to validate the data.

- Consistency issues with different sources of information or reporting.

- How the process of collection, validation, and reporting of JRF data is organized.

- Is the process of reporting standardized?

- Are the processes of reporting for JRF and APR aligned?

- Other.

6) Do the data your country reported in JRF in 2010, 2011 and 2012 include subnational expenditures

on vaccines and routine immunization?

Subnational

expenditure on:

2010 2011 2012

Vaccines

Routine immunization

23

7) In the past years, have you received any feedback about the accuracy of the JRF financing data

reported?

- From UNICEF or WHO Headquarters

- From UNICEF Headquarters or WHO sub Regional IST Office.

- From UNICEF or WHO country office.

- Other. _____________________________________________________

Were your data adjusted or revised after feedback was received?

8) Please make practical suggestions on how the reporting process for the JRF financing indicators

could be improved.

- Data collection (sources, quality, reliability, consistency) on immunization expenditures:

__________________________________________________________________________

- Data collection (sources, quality, reliability, consistency) on vaccine expenditures:

__________________________________________________________________________

__________________________________________________________________________

- Data checking, validation and approval:

__________________________________________________________________________

__________________________________________________________________________

- Use and feedback on financing indicators:

__________________________________________________________________________

__________________________________________________________________________

- Roles of UNICEF and WHO Country Offices in the process:

__________________________________________________________________________

__________________________________________________________________________

- Additional technical support in terms of guidelines, training or consultancies:

__________________________________________________________________________

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__________________________________________________________________________

9) Comments

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Documents

Collection and reporting of immunization financing data ... · Collection and reporting of immunization financing data for the WHO/UNICEF Joint Reporting Form Results of a country