Valdés Werner, Janusz Cara Bess, Molina Aguilera Ida Berenice, Mendoza Lourdes, Díaz Iris Yolanda, Resch Stephen
PAHO ProVac Consultant, Bolivia.
Family, Gender and Health Life Course, Immunization Unit, Pan American Health Organization, Washington, DC, USA.
Vaccine. 2015 May 7;33 Suppl 1:A85-92. doi: 10.1016/j.vaccine.2015.01.012.
In Honduras, until 2008, vaccine and injection supplies were financed with domestic resources. With the introduction of rotavirus vaccine in 2009 and pneumococcal conjugate in 2011, the country's Expanded Program on Immunization required an influx of resources to support not only vaccine procurement but also investments in cold chain infrastructure and programmatic strategies. This paper examines the origin, allocation, and use of resources for immunization in 2011 in Honduras, with the aim of identifying gaps in financing.
An adaptation of the System of Health Accounts (2011) codes was used to specifically track resources for immunization services in Honduras for 2011. All financial flows were entered into an Excel database, and each transfer of resources was coded with a financing source and a financing agent. These coded financing sources were then distributed by provider, health care function (activity), health care provision (line item or resource input), and beneficiary (geographic, population, and antigen). All costs were calculated in 2011 United States dollars.
In 2011, financing for routine immunization in Honduras amounted to US$ 49.1 million, which is equal to 3.3% of the total health spending of US$ 1.49 billion and 0.29% of the GDP. Of the total financing, 64% originate from domestic sources. The other 36% is external financing, most importantly Gavi support for introducing new vaccines. This analysis identified potential financing gaps for many immunization-related activities besides procuring vaccines, such as expanding the cold chain, training, social mobilization, information systems, and research.
The funding for Honduras' immunization program is a small share of total public spending on health. However, new vaccines recently added to the schedule with financial support from Gavi have increased the financing requirements by more than 30% in comparison to 2008. The Honduran government and its partners are developing sustainability plans to cover a financing gap that will occur when the country graduates from Gavi support in 2016. Access to lower vaccine prices will make the existing and future program, including the planned introduction of HPV vaccine to adolescent girls, more affordable.
在洪都拉斯，直到2008年，疫苗和注射用品的资金均来自国内资源。随着2009年轮状病毒疫苗和2011年肺炎球菌结合疫苗的引入，该国的扩大免疫规划不仅需要大量资源用于疫苗采购，还需要投资冷链基础设施和规划战略。本文研究了2011年洪都拉斯免疫接种资源的来源、分配和使用情况，旨在找出融资缺口。
采用改编后的《卫生账户体系（2011年）》编码，专门跟踪2011年洪都拉斯免疫服务的资源。所有资金流动都录入到一个Excel数据库中，每次资源转移都用一个融资来源和一个融资机构进行编码。然后，这些编码的融资来源按提供者、医疗保健功能（活动）、医疗保健提供（细目或资源投入）和受益者（地理、人口和抗原）进行分类。所有成本均以2011年美元计算。
2011年，洪都拉斯常规免疫接种的资金达4910万美元，占卫生总支出14.9亿美元的3.3%，占国内生产总值的0.29%。在总融资中，64%来自国内来源。另外36%为外部融资，最重要的是全球疫苗免疫联盟（Gavi）对引入新疫苗的支持。该分析发现，除疫苗采购外，许多与免疫相关的活动，如扩大冷链、培训、社会动员、信息系统和研究等，都存在潜在的融资缺口。
洪都拉斯免疫规划的资金在公共卫生总支出中占比很小。然而，近期在全球疫苗免疫联盟的资金支持下新增纳入计划的疫苗，使得融资需求相比2008年增加了30%以上。洪都拉斯政府及其合作伙伴正在制定可持续性计划，以弥补该国在2016年脱离全球疫苗免疫联盟支持后将出现的融资缺口。获得更低的疫苗价格将使现有及未来的计划，包括计划为青春期女孩引入人乳头瘤病毒（HPV）疫苗，更具可承受性。
