Health spending and vaccination coverage in low-income countries

Abstract

SummaryBackgroundRoutine childhood immunization is a cost-effective way to save lives and protect people from disease. Some low-income countries (LIC) have achieved remarkable success in childhood immunization, despite lower levels of gross national income or health spending compared to other countries. We investigated the impact of financing and health spending on vaccination coverage across LIC and lower-middle income countries (LMIC).MethodsAmong LIC, we identified countries with high-performing vaccination coverage (LIC+) and compared their economic and health spending trends with other LIC (LIC-) and LMIC. We used cross-country multi-year linear regressions with mixed-effects to test financial indicators over time. We conducted three different statistical tests to verify if financial trends of LIC+ were significantly different from LIC- and LMIC; p-values were calculated with an asymptotic χ2 test, a Kenward-Roger approximation for F tests, and a parametric bootstrap method.FindingsDuring 2014–18, LIC+ had a mean vaccination coverage between 91–96% in routine vaccines, outperforming LIC- (67–80%) and LMIC (83–89%). During 2000–18, gross national income and development assistance for health (DAH) per capita were not significantly different between LIC+ and LIC- (p > 0·13, p > 0·65) while LIC+ had a significant lower total health spending per capita than LIC- (p < 0·0001). Government health spending per capita per year increased by US$0·42 for LIC+ and decreased by US$0·24 for LIC- (p < 0·0001). LIC+ had a significantly lower private health spending per capita than LIC- (p < 0·012).InterpretationLIC+ had a difference in vaccination coverage compared to LIC- and LMIC that could not be explained by economic development, total health spending, nor aggregated DAH. The vaccination coverage success of LIC+ was associated with higher government health spending and lower private health spending, with the support of DAH on vaccines.

Protocol: Identification and evaluation of critical factors in achieving high and sustained childhood immunization coverage in selected low- and lower-middle income countries

“…This can include general health systems strengthening and improvements in funding for public health, as well as improvements in maternal and child health that may have driven support for immunization services. [18] Patient and Public Involvement…”

The effectiveness of public health spending in Sub-Saharan Africa.

“…Among the potential route segments presented in the study framework, the study considered the following that reflected health challenges in SSA and were the most investigated: 1) the PHS-immunisation segment, the results of which suggested that PHS is a predictive factor for vaccination coverage (Castillo-Zunino et al, 2021;De Figueiredo et al, 2016), 2) the immunisation-population health outcomes segment, which revealed that immunisation programmes have prevented one million deaths, and that increased health coverage, as measured by immunisation, is related to a decrease in child and adult mortality (Toor et al, 2021), 3) the PHS -malaria segment, the results of which suggested that PHS is making a substantial contribution to reducing malaria cases in the African region (Omoruyi, 2018;Sede & Nosakhare, 2018), 4) the malaria-female education segment, the results of which disclosed malaria's significantly negative effects on education, including female education; with adverse effects of malaria ranging from school absenteeism (Akazili et al, 2007;Baker et al, 2011;King et al, 2015) to attention deficit and cognitive dysfunction in children (Clarke et al, 2008;Nankabirwa et al, 2013;Opoku et al, 2016), 5) the female education -population health outcomes segment, the results of which suggested that female education has a beneficial impact on the health of the population, as assessed by maternal health, neonatal mortality, as well as under-five and infant mortality (Amwonya et al, 2022;Kaffenberger et al, 2018;Wang, 2021;Wu, 2022).…”