Guidance Note for Strengthening Country Reporting on Immunization and Vaccine Expenditures in the Joint Reporting Form (JRF)

Guidance Note for Strengthening Country Reporting on Immunization and Vaccine Expenditures in the Joint Reporting Form (JRF) 16 March 2015

Guidance Note for Strengthening Country Reporting on Immunization and Vaccine Expenditures in the Joint Reporting Form (JRF) 16 March 2015 World Health Organization (WHO), Geneva, 2015 United Nations Children s Fund (UNICEF), New York, 2015 This document has been prepared by the Gavi Immunization Financing & Sustainability Task Team, which includes WHO, UNICEF, the Bill & Melinda Gates Foundation and the Sabin Institute. It has been prepared and realized solely to facilitate the exchange of knowledge and to stimulate discussion. The findings, interpretations and conclusions expressed in this paper are those of the authors and do not necessarily reflect the policies or views of WHO, or UNICEF or the United Nations. WHO and UNICEF accept no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers. ii

Table of Contents 1 Rationale for the note... 1 2 JRF instructions and definition of relevant terms... 2 2.1 Instructions for JRF indicators... 3 3 What are the best sources of data and information on expenditures?... 5 4 How to manage data inconsistencies and poor data quality... 8 4.1 Identifying common types of inconsistencies and mistakes... 8 4.2 Identifying and correcting gaps and discrepancies over the reporting years... 10 4.3 Other common issues and possible corrective actions... 11 5 Data reporting process... 11 5.1 Timeline... 11 5.2 Roles and responsibilities data collection, estimates, validation and reporting process... 12 6 Some principles and best practices... 14 7 Resources and links to relevant information... 15 7.1 Immunization-specific resources and links... 15 7.2 Health financing and data resources and links... 15 Annex 1 Glossary... 16 iii

1 Rationale for the note Since 1998, WHO Member States have been using the WHO-United Nations Children s Fund (UNICEF) Joint Reporting Form (JRF) mechanism to report country expenditures. These expenditures are reported as part of a set of indicators designed to measure coverage and system performance. The JRF includes six expenditure indicators: Four indicators are expressed in absolute values (US$ or local currency): - total expenditure on routine, including vaccines - government expenditure on routine, including vaccines - total expenditure on vaccines used for routine - government expenditure on vaccines used for routine. Two indicators are expressed in percentages (%): - percentage of routine expenditure financed by government - percentage of vaccine expenditure used for routine financed by government. The overall objective of these indicators is to indicate to what extent countries are moving towards financial sustainability and greater country ownership, as they introduce new vaccines and increase universal access to s. The Global Vaccine Action Plan (GVAP) 2011 2020, adopted by the World Health Assembly in 2012, gives a high priority to country ownership and financial sustainability. In the GVAP accountability and monitoring framework, domestic expenditures for per person targeted is one of the key indicators used to monitor progress towards government commitment to national programmes. The key indicators have become more strategic, and are increasingly used to evaluate and inform policy at the global, regional and country levels. Interest in improving the quality and completeness of fiscal data has increased since 2000, with the formation of the Gavi Alliance. 1 The alliance has helped to improve access to new vaccines and in low-income countries. Financial sustainability is at the centre of the Gavi model, and has been promoted by increasing domestic financing of non-gavi traditional vaccines, Gavi co-financing, and graduation policies and practices (i.e. to graduate from Gavi support). These new developments have radically changed the status of the JRF financial indicators, because the indicators are now more closely monitored by countries, the global community and the World Health Assembly. The current quality, timeliness and accuracy of and vaccine expenditure data for the full range of countries are weak; also, they vary considerably between countries and reporting years. Errors, inconsistencies and missing data are frequently identified when compiling and analysing the data in time series. A recent survey on data collection, validation and reporting, conducted by WHO in 2013 2014 in regions and countries, revealed a number of issues, including limited clarity and understanding of the indicators, definitions and instructions; difficulty in gaining access to actual expenditure data; and lack of capacity, skills and incentives to collect, estimate, validate and report the correct data. These issues are hindering efforts to assess progress towards sustainable financing objectives, and to make financing and strategic decisions based on strong evidence at global, regional and country levels. The aim of this guidance note is to help countries improve the quality, accuracy and timeliness of expenditure reporting in the JRF. The note is part of a comprehensive effort to strengthen local and regional capacities, peer exchange, active feedback, responsibility and use of quality data. 1 The Gavi Alliance brings together public and private sectors to create equal access to new and underused vaccines for children living in the world s poorest countries (http://www.gavi.org/). 1

There are many potential benefits to ensuring that JRF financial data are valid and complete; for example, with such data, countries will more accurately: quantify their financial needs, which may lead to better planning and budgeting for the programme; identify financing gaps and improve their financial management capacity; assess return and value for money of their investment in s; improve tracking of financial flows for services at all administrative levels (national and subnational); advocate for predictable, sustainable and sufficient financing of services; and use the JRF financial data to monitor progress against national and global benchmarks, and to improve the performance of systems. This guide has been developed for members of the national programme (NIP) and those involved in -related activities. Such activities include planning, financing, budgeting and vaccine procurement within and outside the ministry of health (MoH), and the collection, estimation, validation, reporting and use of expenditure data. The note has been specifically designed for use by the following people and organizations: managers and teams of the Expanded Programme on Immunization (EPI); health system and maternal and child health (MCH) entities; MoH planning and finance units; members of interagency coordination committees (ICC) and health system coordination committees, and other partners; commissions of social affairs, health and finance of parliaments; and WHO and UNICEF country offices, and other in-country development partners. Others entities and authorities at country level (e.g. social health insurance institutions) may also be interested in this guidance note and the expenditure reports. 2 JRF instructions and definition of relevant terms Before data are collected, estimated, validated and reported, it is imperative that the instructions for collecting and handling the data are well understood. The survey conducted by WHO in 2013 2014 explored the opinions and experiences of national counterparts when reporting against the six JRF financial indicators. As outlined in Section 1, the results revealed that many definitions and instructions were unclear to users. To clarify these definitions, the JRF instructions have been revised according to the feedback and suggestions received. All the terms used in these instructions are defined in the glossary (Annex 1). 2

2.1 Instructions for JRF indicators Indicator A: What is the government expenditure on vaccines used in routine? (Please be consistent when you are reporting, keeping all units in either local currency or US$) What it includes: This figure should include expenditures made by the government for routine vaccines and associated injection supplies. Government expenditures include all funds allocated through the national and subnational government budgets, social health insurance and pooled financing. The term vaccines used in routine includes expenditures on traditional, new and underused vaccines. It also includes government financing of the Gavi co-financing payments. Excluded from this indicator are vaccine expenditures for supplemental activities (SIAs), extra-budgetary financing from donors, and out-of-pocket and informal private expenditures. Source(s) of information: This figure should come primarily from documents providing actual vaccine expenditures; for example, budget execution reports from the MoH, expenditure records of procurement agencies or NIP. Government expenditures can be corroborated using documents from other sources, provided they contain reliable, accurate and high-quality data. Such sources include system of health accounts (SHA), ad hoc routine expenditure studies, comprehensive multi-year plan (cmyp) baseline estimates or execution reports, UNICEF country office or Supply Division (SD), and Pan American Health Organization (PAHO) country or regional offices. Indicator B: What is the total expenditure (from all sources) on vaccines used in routine? (Please be consistent when you are reporting, keeping all units in either local currency or US$) What it includes: This figure should include expenditures for routine vaccines and associated injection supplies from all sources of funding (including government expenditures on vaccines, as in Indicator A). All sources refers to government, domestic and international donors and partners, health insurance, out-of-pocket expenses, and formal and informal private expenditures. Also included are the value of donations of routine vaccine and expenditures by foundations, private partners and other agencies. Vaccines for SIAs are excluded. Source(s) of information: Government sources include MoH, procurement entities, national or social health insurance offices, and NIP expenditure or budget execution reports (or both). Information on donor expenditures for routine vaccines can be obtained from vaccine procurement records from the Gavi Secretariat, UNICEF country office or SD, PAHO country or regional office, offices of bilateral donors, offices of multilateral donors (e.g. World Bank and regional development banks), and offices of nongovernmental organizations (NGOs) and civil society organizations. Indicator C: Calculate the percentage of total expenditure on vaccines financed by government funds using Indicators A and B. (A/B) 100 Using Indicators A and B, calculate the percentage of government expenditure on vaccines and associated injection supplies as the ratio of government vaccine expenditure (Indicator A) divided by total vaccine expenditure (Indicator B). 3

Indicator D: What is the government expenditure on routine, including vaccines? (Please be consistent when you are reporting, keeping all units in either local currency or US$) NB: This indicator is used to monitor country progress towards Global Vaccine Action Plan (GVAP) commitments, and is reported on an annual basis to the World Health Assembly. What it includes: This figure should include recurrent -specific expenditures for routine financed by the government. It should also include expenditures for routine vaccines (traditional, new and underused) and vaccine co-financing payments using government funds, associated injection supplies, salaries and per diems of health staff working full-time on, transport specific for, vehicles and cold-chain maintenance, -specific training, social mobilization, monitoring and surveillance, and programme management. Government expenditures include all administrative levels (national and subnational), all funds allocated through the national and subnational government budgets, social health insurance and pooled financing. Excluded from this indicator are shared health system costs, 2 extrabudgetary financing from donors, and out-of-pocket and informal private expenditures. Source(s) of information: This figure should primarily come from documents that provide actual -specific expenditures; for example, MoH and NIP budget execution reports. Government expenditures can be corroborated using documents from other sources such as SHA, ad hoc routine expenditure studies, the baseline year from the cmyp or execution reports, and donor agencies, such as UNICEF country office or SD, and PAHO country or regional offices. Indicator E: What is the total expenditure (from all sources) on routine, including vaccines? (Please be consistent when you are reporting, keeping all units in either local currency or US$) What it includes: This figure should include recurrent -specific expenditures on routine from all funding sources, including results from Indicator D. It should also include expenditures for routine vaccines (traditional, new and underused) and associated injection supplies, salaries and per diems of health staff working full-time on, transport specific for, vehicles and cold-chain maintenance, -specific training, social mobilization, monitoring and surveillance, and programme management. Excluded from this indicator are shared health system costs. Source(s) of information: This figure should primarily come from documents providing actual -specific expenditures such as MoH and NIP budget execution reports. Other sources include health insurance, domestic private partners, and international partner agencies and organizations. Total expenditures can be corroborated using documents from other sources such as SHA, ad hoc routine expenditure studies, the baseline year from the cmyp or execution reports, and donor agencies, such as UNICEF country office or SD, and PAHO country or regional office. Indicator F: Calculate the percentage of total expenditure on routine financed by government funds using Indicators D and E. (D/E) 100 To estimate this percentage, divide total government expenditures on routine (Indicator D) by total expenditures on routine from all sources (Indicator E). 2 See the glossary for explanation of this term. 4

3 What are the best sources of data and information on expenditures? The aim is to collect data on actual expenditures, rather than on estimated costs, planned allocation or budgeted resources. Therefore, it is important to refer to and use expenditure records and other documents that record the actual amount spent on routine doses of vaccines and routine services within the NIP. The tables below list possible sources of data and information. Each country may have its own methods for identifying relevant documents and reports that contain up-to-date, high-quality data. Such information may be publically available or may be limited to ministerial use. It is important to carefully assess whether there is a lag between when expenditure occurs and when it is recorded; if so, this lag must be taken into account when estimating expenditures. A range of information sources should be used, so that it is possible to crosscheck data before it is entered into the JRF, and thus assess data quality and generate a more complete picture of expenditure. Distinction is made here between preferred and alternative sources of data and information. These data sources are not prescriptive; rather, they are suggestions on referencing financial information on routine. The following information should be reported: actual expenditures on routine vaccines and operations within the NIP, as defined in the glossary (Annex 1); actual total and government expenditures for a specific year; and expenditures at the country level (including national and subnational level). 5

Recommended data sources for vaccine expenditures for Indicators A C Preferred sources Alternative sources Sources Observations Sources Observations Budget execution reports of MoH: units in charge of planning, supply, procurement and payment of vaccines Only routine doses of vaccines should be counted (see definition in the glossary, Annex 1). Immunization cmyp data on expenditures, costs and financing Valid for baseline year if aligned with JRF timeline. Consider only expenditures, NOT estimated costs or budget. Not all countries complete and annually update a cmyp. UNICEF or PAHO data Results from special or ad hoc studies System of health accounts and national health accounts: specific expenditures Particularly relevant source of info and data for countries using UNICEF SD and PAHO reporting forms to acquire EPI vaccines. Potentially a good source of data and information (see text box in Section 4 on features of high-quality data). Ensure that only routine doses of vaccines are taken into account. Good source when available and up to date. Gavi documents: decision letters, annual progress reports JRF data on sources of vaccines Estimated at one point in time. Actual expenditures may differ from what is indicated in the Gavi decision letter. Non-Gavi vaccines are excluded. This source does not provide data on expenditures; however, as a source of additional information on quantities procured and sources of vaccines, it provides data for cross-checking. cmyp, comprehensive multi-year plan; EPI, Expanded Programme on Immunization; JRF, Joint Reporting Form; MoH, ministry of health; PAHO, Pan American Health Organization; SD, Supply Division; UNICEF, United Nations Children s Fund 6

Recommended data sources for routine expenditures for Indicators D F Preferred sources Alternative sources Sources Observations Sources Observations EPI execution budget report Best source of information and data, provided that all routine expenditures are well identified and reported. Costing and financing tool of cmyp Valid for baseline year if aligned with JRF timeline. Not all countries complete and annually update a cmyp. MoH budget execution reports Annual reports on cmyp implementation, EPI annual operational plan report Special or ad hoc studies on costing and financing If detailed enough, MoH budget execution reports may provide data on routine vaccine and expenditures. Excellent source in countries undertaking annual review of their activities and expenditures. Consider only total expenditures for routine, not estimates or planned costs at central level. Potentially a good source, particularly if baseline year is aligned with JRF reporting year. Take into account only routine doses of vaccines and expenditures. NHA or SHA -specific expenditures OECD database and reports Valuable data as earmarked expenditures are reported. Delays in producing and reporting data on programmerelated expenditures. Excellent source of information on expenditures in higher income countries. Immunization expenditures are included under SHA 2011 code HC.6.2. cmyp, comprehensive multi-year plan; EPI, Expanded Programme on Immunization; JRF, Joint Reporting Form; MoH, ministry of health; NHA, national health accounts; OECD, Organisation for Economic Co-operation and Development; SHA, system of health accounts 7

4 How to manage data inconsistencies and poor data quality Features of high-quality data include: validity the degree to which the measures conform to defined rules or constraints (routine does not include supplemental doses delivered to non-targeted groups of the population); accuracy the degree of conformity of a measure to a standard or a true value (e.g. vaccine expenditures supplied by UNICEF SD reflect UNICEF prices); completeness the degree to which all required measures are known (i.e. all related routine expenditures are reported); consistency the degree to which a set of measures is equivalent across systems; inconsistency occurs when two data items in the dataset contradict each other (e.g. routine vaccine expenditures are higher than routine expenditures); and uniformity the degree to which dataset measures are specified using the same units of measure in all systems; for example, all the amounts are expressed in US dollars (USD) or have been converted to USD in a consistent manner; or all the amounts are expressed for a calendar year. No matter how well defined the financing indicators are, errors can easily occur when undertaking data collection and estimates. Such errors threaten the effectiveness, timeliness and completeness of reporting of the indicators. Generally, there are two types of error: vertical and horizontal. Vertical inconsistencies reveal inconsistent and contradictory values and percentages. Horizontal inconsistencies reveal gaps and discrepancies over the reporting years. The next section presents samples of two methods for identifying common inconsistencies and mistakes. 4.1 Identifying common types of inconsistencies and mistakes The table below illustrates inconsistencies and contradictory values and percentages that are reported for a particular year (i.e. vertical inconsistencies), and provides examples of inconsistent and consistent data reporting. To avoid these errors, identify them, and check and clean the data using the logical set of validation rules, which are also set out in the table below. Countries are encouraged to review their estimates using this validation approach before submitting their estimates to the JRF. 8

Addressing reporting inconsistencies of JRF Indicators A F Financing indicators Example of inconsistent data reporting Example of consistent data reporting A: Government expenditure on vaccines $120 000 $120 000 B: Total (all source) expenditure on vaccines $90 000 $150 000 C: Percentage of government contribution to vaccine 90% 80% expenditure D: Government expenditure on routine $110 000 $180 000 E: Total (all source) expenditure on routine $80 000 $200 000 F: Percentage of government contribution to routine 75% 90% Logical rules Testing inconsistent data Testing consistent data 1: Government vaccine expenditure does not exceed total vaccine expenditure (Indicator A B) Indicator A ($120 000) is $30 000 greater than Indicator B ($90 000) Indicator A ($120 000) is $30 000 less than Indicator B ($150 000) 2: The percentage of government vaccine expenditure reported is equal to the percentage calculated (Indicator C = A/B) The reported 90% of government contributions on vaccines is not equal to the calculated 133% = ($120 000/$90 000) 100 The reported 80% of government contributions on vaccines is equal to the calculated 80% = ($120 000/$150 000) 100 3: Government routine expenditure does not exceed total routine expenditure (Indicator D E) Indicator D ($110 000) is $30 000 greater than Indicator E ($80 000) Indicator D ($180 000) is $20 000 less than Indicator E ($200 000) 4: The percentage of government routine expenditure reported is equal to the percentage calculated (Indicator F = D/E) 5: Total amount spent on vaccines does not exceed total amount spent on routine (Indicator B E) The reported 75% of government contributions on routine is not equal to the calculated 138% = ($110 000/$80 000) 100 Indicator B ($90 000) is $10 000 greater than Indicator E ($80 000) The reported 90% of government contributions on routine is equal to the calculated 90% = ($180 000/$200 000) 100 Indicator B ($150 000) is $50 000 less than Indicator E ($200 000) 6: Government vaccine expenditure does not exceed total government routine expenditure (Indicator A D) Indicator A ($120 000) is $10 000 greater than Indicator D ($110 000) Indicator A ($120 000) is $60 000 less than Indicator D ($180 000) Source: SIF 2014 9

4.2 Identifying and correcting gaps and discrepancies over the reporting years The table below presents common errors and inconsistencies over different reporting years (i.e. horizontal inconsistencies), possible causes and potential corrective measures. Examples of horizontal inconsistencies Gaps in data reporting: no data reported for certain years Unusually high or low data values Possible causes Difficulty in accessing data. Difficulty in estimating data. Misunderstanding of the indicator. Error in the estimate. Potential corrective measures Inform supervisors. Contact stakeholders. Identify alternative sources of information and cross-check multiple sources. Calculate averages based on available values (e.g. from previous and following years) or calculate trends (e.g. % annual change for available years). If a value is missing for a specific year, review the trend and make the best estimates possible. Cross-check with other sources and ask for assistance to validate estimates. Read glossary (Annex 1). Contact the person who provided the information. Request assistance from colleagues and WHO/UNICEF. Contact and check source of data. Check calculation, verify formula and ask for assistance. Correct the error. Excessive change between previous year and current year New events or changed circumstances explain the significant change (e.g. introduction of new vaccines, salary increases). Overestimation of certain items, errors in the estimates or misunderstanding of the indicator. A special study was done that better measured expenditures. Different sources used for estimates in different years. Take note of the new events or changed circumstances, and the consequences for the EPI performance and future funding. A supervisor or qualified team should examine the suspect data to determine their acceptability and to make the appropriate correction. Compare the methods and results, refer to the guidance note and make the adjustments as needed. Assess accuracy and validity of the sources, use the most credible and reliable source of estimates. Country was not reporting data for government vaccine expenditures but the country is listed for payment of Gavi co-financing Disconnect between those reporting and those in charge of ordering or funding of vaccines for the national programme. Lack of information and communication between EPI team and budget and finance teams on timing and implementation of co-financing policy. Countries where co-financing is totally financed by donors. Establish a better communication between EPI, supply, procurement and financing of vaccines and s. Develop working relationships and regular exchange of information and communication between, supply and finance units within and outside MoH. Take appropriate measures to ensure that Gavi cofinancing is paid for using government budget. Collect data and information from the donors providing funding and UNICEF. EPI, Expanded Programme on Immunization; MoH, ministry of health; UNICEF, United Nations Children s Fund 10

4.3 Other common issues and possible corrective actions The table below outlines other common issues and problems, and possible corrective actions. Common issues and problems Some indicators are not understood or not well defined Data entry errors Errors in adding up routine item expenditures Underestimation of routine item expenditures No mention of the currency used Possible corrective actions By those needing more assistance: Review the instructions and the guidance note. Discuss with colleagues. Ask for clarification from WHO and UNICEF offices. By financial resource persons: Train and coach people in charge of data collection and estimates. Check the JRF template and data entry twice. Check data entry on routine items and routine doses of vaccines twice. Compare to previous years and other estimates (e.g. cmyp or expenditures of the SHA 2011 tool). Estimate value of each of the routine items and routine doses of vaccines. Compare to previous estimates. Ask for advice. Compare to previous years and check consistency with the amounts reported. Contact the source of data to get the converted amount. Check the conversion rate. Conversion between fiscal year and If a country is on a fiscal year, to better compare it to other countries on a calendar year calendar year, annualize the expenditures. Ask for monthly or quarterly data. Work with the raw detailed data to make the best estimates for the calendar year. Ask for advice from MoH finance units. Report data for the calendar year. cmyp, comprehensive multi-year plan; JRF, Joint Reporting Form; MoH, ministry of health; SHA, special health accounts; UNICEF, United Nations Children s Fund; WHO, World Health Organization 5 Data reporting process 5.1 Timeline Countries are requested to complete and to report JRF data and indicators to UNICEF/WHO country offices and to UNICEF headquarters and WHO regional offices by the end of March each year. The JRF template, instructions and cover letter are provided to countries by the end of January. Therefore, countries should start the data collection process in mid-january, in order to report validated quality data covering the period of the previous year by the end of March. Figure 1 shows a timeline, which should be adapted to a country s specific situation. 11

Figure 1 Indicative timeline for the reporting cycle at country level Official data reported by countries are checked and reviewed between April and June by WHO and UNICEF offices. Attempts are then made to correct any remaining inconsistencies and errors, in close collaboration with countries. Validated data are used to prepare estimates and to provide inputs to the GVAP report in July. In mid-august, final data are published and disseminated on the WHO website. Immunization system performance data reports, including expenditures, are part of reporting to ministers of health during regional conferences and at the World Health Assembly. In this process, the JRF is a key instrument for collecting most of the required data to prepare the GVAP report, to support reporting to WHO s Strategic Advisory Group of Experts (SAGE) and to the Member States through the WHO Governing Body meetings. 5.2 Roles and responsibilities data collection, estimates, validation and reporting process The process at country level for estimating and reporting expenditures should be a team effort. We recommend that countries follow the process laid out in the table below. 12

Data collection Data calculation (actual expenditures) Data cleaning EPI team (national and subnational) Full responsibility Full responsibility Full responsibility MoH Directly associated organizations UNICEF and WHO country offices Initiate Facilitate Facilitate Supply, procurement, budget and finance, MCH units within and outside MoH including local authorities, ICC partners. Supply, procurement and finance, MCH units within and outside MoH. Supply, procurement and finance, MCH units within and outside MoH. Assistance Assistance Assistance Data validation Responsible Full responsibility MoH, MoF, ICC members, health Co-responsibility system coordination committee members. Data reporting Final Full responsibility WHO and UNICEF country offices. Co-responsibility preparation Data analysis Responsible Support ICC or health system coordination bodies (or both). Co-responsibility Data dissemination for information, action, policy and advocacy Full responsibility for action Full responsibility for decision making ICC or health system coordination bodies (or both). Analysis, feedback and actions EPI, Expanded Programme on Immunization; ICC, interagency coordination committee; MCH, maternal and child health; MoF, ministry of finance; MoH, ministry of health; UNICEF, United Nations Children s Fund; WHO, World Health Organization 13

6 Some principles and best practices a. The country focal point for activities and his or her team should be primarily responsible for collecting, estimating and analysing the expenditures data. b. Data reporting is the responsibility of the MoH. UNICEF and WHO country offices are supporting partners in this process. The data reported should be accurate, complete, consistent, uniform and comparable to other internal and external publications. c. Collaboration should be established with all the concerned units and teams involved in services, to collect, estimate, cross-check, validate and disseminate the expenditure data. Such collaboration should include planning, financing, budget and procurement units within and outside the MoH. d. Standardized templates should be used to collate and compile data, making the best use of existing local data collection and reporting mechanisms. e. A formal data collection process is necessary because it helps to ensure that the data gathered are defined and accurate, and that subsequent decisions based on arguments embodied on the findings are valid. The process provides both a baseline from which to measure and, in certain cases, a target on which to improve. f. Data should be cleaned before processing, analysing or reporting. Data cleaning is an important step in the process of identifying data that are incomplete, incorrect, corrupt, inaccurate or nonrepresentative, or suspect values. Data can be cleaned either manually or automatically (computerbased). Automatic cleaning is preferred, to take advantage of the power of computers, although some manual review will always be required. g. The data collected should be validated to ensure that they are robust, reliable and consistent. Such validation requires countries to adopt and follow appropriate quality assurance and quality control procedures. It is also important to ensure that the concerned authorities (e.g. MoH and MoF, and parliament) and partners (e.g. WHO/UNICEF, and other ICC and health system coordination committee members) are well informed about the set of data to be reported. h. A number of initiatives and efforts are underway to improve JRF data and health sector data in general. It is critical to align with other efforts to improve data quality, and financial management of health and public services. i. A country s programme expenditure is a measure of country ownership and an indicator of the financial sustainability of the programme. Consequences of improperly collected and reported data include an inability to: measure financing indicators repeat and validate the numbers previously reported track resource flows and analyse trends advocate for more resources and support assess progress towards financial sustainability improve programme planning, budgeting and management identify issues, corrective measures and policies compare national data to other countries. 14

7 Resources and links to relevant information 7.1 Immunization-specific resources and links Title WHO/UNICEF Joint Reporting Process Immunization policy and strategies WHO-UNICEF Guidelines for developing a comprehensive multi-year plan (cmyp) WHO-UNICEF Guidelines for comprehensive multi-year planning for : Update September 2013 Principles and considerations for adding a vaccine to a national programme: From decision to implementation and monitoring Sabin Institute: Sustainable Immunization Financing (SIF) Program Overcoming challenges to sustainable financing: Early experiences from Gavi graduating countries Link http://www.who.int//monitoring_surveillance/routin e/reporting/en/ http://www.who.int//programmes_systems/policies_ strategies/en/ http://www.who.int//programmes_systems/financing /tools/cmyp/en/ http://apps.who.int/iris/bitstream/10665/100618/1/who_ivb_14. 01_eng.pdf http://www.who.int//programmes_systems/policies_ strategies/vaccine_intro_resources/nvi_guidelines/en/# http://www.sabin.org/programs/vaccine-advocacyeducation/sustainable--financing-sif-program http://heapol.oxfordjournals.org/content/early/2014/02/08/heapol.czu003.full 7.2 Health financing and data resources and links Title Health financing for universal coverage System of Health Accounts 1.0 OECD Health statistics 2014 Enabling district health teams to identify barriers to equitable access Link http://www.who.int/health_financing/en/ http://www.who.int/health-accounts/documentation/sha1.0/en/ http://www.oecd.org/els/health-systems/health-data.htm http://bit.ly/1b7kz2a 15

Annex 1 Glossary Approved budget Calendar year Disease surveillance and monitoring expenditure Domestic resources Executed budget Expenditure External resources Financing source for Fiscal year Government sources of financing for Immunizationspecific expenditures Injection supplies Maintenance and overheads National level Other recurrent expenditure An itemized summary of expected income and expenditure of a country, programme or activity over a specified period, usually a financial year. The period from 1 January to 31 December. Includes recurrent spending on disease surveillance, supervision and monitoring activities. Refers to fiscal and financial resources accruing within the domestic economy, including public sector revenue, private and household savings, corporate profits and retained earnings, and health insurance funds. The phase of the budget cycle that encompasses all the actions required to effectively, efficiently and economically accomplish the programmes for which funds were requested and approved. It is at this stage that actual expenditures can be captured and monitored. Money that was spent to pay for services or goods. Funds provided by bilateral and multilateral donors and agencies, external foundations and nongovernmental organizations. The agents providing the funds for. Given the difficulties in tracking the exact source of financing, countries are asked to report only the source of financing closest to the end user. Transfers of bilateral donor agency resources to multilateral agencies (e.g. WHO or UNICEF) or to a health fund or the national treasuries (through pooled funds or budget support) are not attributable to the donor countries. This is of particular (and growing) significance in countries receiving bilateral aid through the Sector Wide Approach (SWAp) programmes and national budget support. Also known as a financial year or budget year, this is a period used for calculating an annual ( yearly ) financial statement in businesses and other organizations. Many regulatory laws regarding accounting and financing require such reports once for each 12 month period, but do not necessarily require that the period reported on constitutes a calendar year. Fiscal years vary between businesses and countries. The fiscal year may or may not be the same as a calendar year. Domestic public funding for derived from taxation or other sources of public revenue at the central or subnational level (or both), and allocated through a formal budgetary process. It can include the non-concessionary portion of a development loan, pool funding (SWAp), donors budget support or the proceeds of debt relief. Also termed programme-specific expenditures, these include the expenditures of all inputs used specifically for and not shared with any other health service. Their use will be 100% for the national programme. Specific expenditures are intended to be those that the programme has to mobilize for itself alone. Includes items such as needles, syringes, auto-disable (AD) syringes, safety boxes and other injection supplies. The cost of the injection supplies includes the international market value of injection equipment, as well as transport and handling charges. Includes the maintenance expenditures of cold-chain equipment, and the overheads and expenditures for buildings (e.g. electricity). Involving or relating to a nation or a country as a whole. Includes any other recurrent expenditure category that is not specified elsewhere. 16

Personnel Proposed budget Public sources for Routine doses of Routine expenditures Includes the salaries and benefits of full-time (i.e. programme-specific) personnel involved with the organization and delivery of activities, and should be recorded at the central, provincial and district levels. Amount the national programme (NIP) has proposed as a budget to financially sustain the operational costs for vaccine delivery throughout the fiscal year. Domestic public funding for derived from government budget, public institutions and social health insurance entities. Routine doses are those delivered to the targeted populations according to the national schedule, recorded on cards or registers (or both), and regularly reported in the local and national administrative data collection systems, and in the Administrative Coverage section of the WHO/UNICEF Joint Reporting Form (JRF). See WHO/UNICEF Guidance note: Criteria to determine if a given vaccination is routine or supplemental dose (10 Oct 2011). 3 Include the expenditures associated with inputs that will be consumed or replaced in one year or less. The recurrent expenditures categories include: routine doses of vaccines (traditional, new and underused vaccines) injection supplies full-time Expanded Programme on Immunization (EPI) personnel transport cold-chain maintenance other maintenance and overheads training social mobilization and information, education and communication (IEC) disease surveillance and monitoring. Routine expenditures should include all amounts spent to deliver only routine doses of vaccines (see below). Routine vaccine expenditures Shared health system costs and expenditures Expenditures on all vaccines used in conformity with the national programme, including routine doses of vaccines, and following each country s vaccination schedule. Includes the international market price, as well as transport and handling expenditures. Vaccines used in Child Health Days are included in routine vaccine expenditures, but expenditures related to doses of vaccine given through supplemental activities (SIAs) are excluded. Includes the value of inputs that are not specific to and that are used by different programmes or activities in the health sector (i.e. their use for the NIP is <100%). For instance, a nurse working in a district health centre is likely to be providing services as well as other curative and preventive services. Only a portion of that nurse s salary and time can be attributable to. Likewise, a vehicle in a district health centre (e.g. a four-wheel drive) may be used by staff working for programmes other than, such as malaria or tuberculosis programmes. Therefore, only a portion of the fuel and maintenance costs of these vehicles will be borne by the NIP. The remaining portion will be borne by the budget of the district health administration. This makes it difficult to separate out the portion of these inputs that can be attributed to. These inputs are classified as shared costs. They are not included in the JRF financing indicators. Other typically shared inputs are health centres, cold-chain storage buildings and the use of some cold-chain equipment. 3 http://www.who.int//programmes_systems/policies_strategies/guidance_note_on_vaccination_doses_ oct_10_2011.pdf?ua=1 17

Social mobilization and information, education and communication (IEC) Subnational Supplemental activities (SIAs) Training Transport Includes spending on social mobilization activities and IEC materials relating to the benefits of. Level below the national level: regional, provincial or local. By default, any vaccination not meeting the above defined routine dose is deemed to be a supplemental dose of vaccination and should be reported separately. In the WHO/UNICEF JRF they should be included in the section Supplemental activities. Includes short-term in-service training for activities (for any type of health staff involved) that occur on a regular basis (e.g. training for new vaccine introduction, injection safety, logistics and vaccine management). Includes the expenditures related to the operations and maintenance of vehicles for the delivery of vaccines, supplies and services (e.g. fuel). 18