Collection and reporting of immunization financing data for the WHO/UNICEF Joint Reporting Form

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1 Collection and reporting of immunization financing data for the WHO/UNICEF Joint Reporting Form Results of a country survey DRAFT 2014

2 Disclaimer: The views expressed in this report do not necessarily represent the decisions, policy or views of the World Health Organization.

3 Contents Executive summary Introduction Survey rationale, objectives and methods Main findings Individuals and institutions involved in the reporting process Sources of information used Data included Main challenges Ways to improve the reporting system Feedback on reported data General comments by countries Conclusions Annex 1. JRF template , section 6B.2: financing data Annex 2. Survey questionnaire

4 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) , 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 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 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 4

5 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. 5

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) , 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. 6

7 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 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 ; 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. 7

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 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. 8

9 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 9

10 essential to obtain accurate information on actual spending on routine vaccines and immunization services. Summary of the responses The main source of data on the amount of government funds spent on vaccines used in routine immunization (indicator 6700 of the JRF template 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) Percentage of countries using the source Source of information Africa Europe South-East Asia Americas Western Pacific Eastern Mediterranean Average Ministry of Health expenditure record Ministry of Health gazetted budget EPI expense records EPI budget documents Subnational EPI expense records Social security administration expenditure records cmyp WHO Office UNICEF Office GAVI decision letter Other GAVI Secretariat Other donor documents National health accounts Other studies

11 Other sources Table 3: Sources of Information on total expenditure (from all sources) on vaccines used in routine immunization (indicator 6710) Percentage of countries using the source Source of information South- Western Eastern Africa Europe Americas East Asia Pacific Mediterranean Average Ministry of Health expenditure record Percentage of countries using the source Source of information South- Western Eastern Africa Europe Americas East Asia Pacific Mediterranean Average Ministry of Health expenditure record Ministry of Health gazetted budget EPI expense records EPI budget documents Subnational EPI expense records Social security administration expenditure records cmyp WHO Office UNICEF Office GAVI decision letter Other GAVI Secretariat Other donor documents National health accounts Other studies Other sources Table 4: Sources of information on amount of government funds spent on routine immunization (indicator 6730) Ministry of Health gazetted budget EPI expense records EPI budget documents Subnational EPI expense records Social security administration expenditure records cmyp WHO Office UNICEF Office GAVI decision letter Other GAVI Secretariat Other donor documents National health accounts

12 Other studies Other sources Table 5: Sources of information on total expenditure (from all sources) on routine immunization (indicator 6740) Source of information Ministry of Health expenditure record Ministry of Health gazetted budget Africa Europe Percentage of countries using the source South-East Asia Americas Western Pacific Eastern Mediterranean Average EPI expense records EPI budget documents Subnational EPI expense records Social security administration expenditure records cmyp WHO Office UNICEF Office GAVI decision letter Other GAVI Secretariat Other donor documents National health accounts Other studies Other sources 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? 12

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. Summary of the responses 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 No. of countries Information included in JRF Yes No Not answered % No. of countries % No. of countries Subnational expenditure on vaccines Africa Europe South-East Asia Americas Western Pacific Eastern Mediterranean Subnational expenditure on routine immunization Africa Europe South-East Asia Americas Western Pacific Eastern Mediterranean % 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. 13

14 3.4 Main challenges Survey question What are the main challenges in ensuring that this section of the JRF contains accurate and up-todate data? Rationale for the question 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. Summary of the responses 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 Africa Europe Percentage of countries reporting as challenge South -East Asia Americas Western Pacific Eastern Mediterranean Understanding the indicators Making the estimates Collecting the data Validating the data Consistency issues with different sources of information/reporting How is the process of collection, validation, and reporting JRF data organized? Is the process of reporting standardized? Are the processes of reporting JRF and Annual Progress Report (APR) aligned? Others Average 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. 14

15 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. Rationale for the question 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. Summary of the responses 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 Collection of data on immunization expenditure (sources, quality, reliability, consistency) Collection of data on vaccine expenditure (sources, quality, reliability, consistency) Data checking, validation and approval Africa Europe South- East Asia Americas Western Pacific Eastern Mediterranean Average 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 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. 15

16 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. 16

17 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? Rationale for the question 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 Africa Europe Percentage of countries receiving feedback South- East Asia Americas Western Pacific Eastern Mediterranean UNICEF or WHO headquarters UNICEF or WHO regional office UNICEF or WHO country office Other Were data adjusted or revised after the feedback? Average 17

18 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. 18

19 Annex 1. JRF template , section 6B.2: financing data Are there line items in the national government budget specifically for: the purchase of vaccines used in routine immunizations the purchase of injection supplies (such as syringes, needles, and safety boxes) for routine immunizations <pick one> <pick one> 6690 (instructions) the health care waste management <pick one> What amount of government funds was spent on vaccines used in routine immunization? (Please specify whether you are reporting in local currency or US$.) What is the total expenditure (from all sources) on vaccines used in routine immunization? (Please specify whether you are reporting in local currency or US$.) If total amounts are not available for the previous questions please provide an estimated percentage of total expenditure on vaccines financed by government funds What amount of government funds was spent on routine immunization? (Please specify whether you are reporting in local currency or US$.) What is the total expenditure (from all sources) on routine immunization? (Please specify whether you are reporting in local currency or US$.) 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? (instructions) (instructions) (instructions) (instructions) (instructions) (instructions) <pick one> <pick one> <pick one> <pick one> 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 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. 19

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) 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. 20

21 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? Role Function Contact details ) 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 Ministry of Health Ministry of Finance Social Security administration Others Department or unit Specific information provided Format: Excel table, raw data, accounting books 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 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 ) Social security administration expenditure records (specify ) cmyp (specify year conducted and years of data used) WHO Office (specify source documents 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) 21

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-todate 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: Vaccines Routine immunization 22

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: 23

24 9) Comments 24

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