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Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective

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  • Pankaj Bahuguna

    (Post Graduate Institute of Medical Education and Research
    University of Glasgow)

  • Emiko Masaki

    (World Bank)

  • Gursimer Jeet

    (Post Graduate Institute of Medical Education and Research)

  • Shankar Prinja

    (Post Graduate Institute of Medical Education and Research)

Abstract

Introduction A comprehensive package of immunization services is an internal component of the Essential Health Service Package (ESP) implemented by Government of Lao People’s Democratic Republic (Lao PDR). Thus, the cost of delivering the immunization program and its feasibility given the fiscal space emerges as an important policy question. The present analysis was undertaken to estimate the total cost of implementing the immunization program under ESP, determinants of total cost and the program’s fiscal implications from the government’s perspective. Methodology We employed a normative costing approach for costing of immunization services under ESP. Standard treatment guidelines (STGs) from both within and outside Lao PDR were considered to identify the resource use for each vaccine delivery. Subsequently, cost per dose administered and fully immunized beneficiary were computed. We assessed the fiscal space for financing immunization services in Lao PDR by adapting the decomposition method given by Tandon et al. Results In 2019, the estimated total cost of financing immunization in Lao PDR was US$12 million, which will increase in 2025 by 1.75 times, to US$21 million. The per capita budget for immunization needs to increase from about US$2 to US$7. Introduction of newer vaccines in the immunization schedule accounts for the major share (60%) of the increased cost for financing immunization. In view of current fiscal space, the government immunization expenditure (GIE) allocations will be adequate only in a scenario where no new vaccine is introduced under ESP in future years. Conclusion The current fiscal space would fall short of meeting the aspirational goals of ESP–Immunization for the introduction of newer vaccines in Lao PDR. The present analysis of the fiscal space provides important evidence to support a greater role for the Global Alliance for Vaccine Initiative (GAVI) to continue to finance immunization in Lao PDR. A publicly financed immunization model in Lao PDR would require significant strategic amendments with low short-term viability.

Suggested Citation

  • Pankaj Bahuguna & Emiko Masaki & Gursimer Jeet & Shankar Prinja, 2023. "Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective," Applied Health Economics and Health Policy, Springer, vol. 21(1), pages 131-140, January.
  • Handle: RePEc:spr:aphecp:v:21:y:2023:i:1:d:10.1007_s40258-022-00763-8
    DOI: 10.1007/s40258-022-00763-8
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    References listed on IDEAS

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    1. Jacky Mathonnat & Martine Audibert & Salam Belem, 2020. "Analyzing the Financial Sustainability of User Fee Removal Policies: A Rapid First Assessment Methodology with a Practical Application for Burkina Faso," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 767-780, December.
    2. Helene Barroy & Susan Sparkes & Elina Dale & Jacky Mathonnat, 2018. "Can Low- and Middle-Income Countries Increase Domestic Fiscal Space for Health: A Mixed-Methods Approach to Assess Possible Sources of Expansion," Post-Print hal-02137487, HAL.
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