Conversion of COVID levy to health fund gathers momentum

Discussions have begun on transforming the existing COVID-19 levy on goods and services into a dedicated National Health Security/Emergency fund.

The move will strategically allocate ring-fenced amounts, serving as a crucial supplement to National Health Insurance Scheme (NHIS) contributions and thereby mitigating, or potentially eliminating, the financial hurdles associated with vaccine-funding.

Government allocates a portion of its annual budget to support immunisation programmes. This funding covers the procurement of vaccines, operational costs and system-strengthening efforts; and this is done through direct and indirect approaches.

The country’s major direct financing of vaccines and immunisation is predominantly through the NHIA, which is largely funded through the National Health Insurance (NHI) levy of 2.5 percent on goods and services.

The Authority normally cedes 10 percent (capped) of its allocation so the Ministry of Health can cater for non-core activities (preventive healthcare), which include vaccination/ immunisation service delivery.

“The NHIS fund’s current use has resulted in an increased availability of vaccines, and needs to be maintained and improved. Increasing the non-core activity contribution and ring-fencing it for vaccine procurement is viable option that is being explored,” said deputy programme manager of the country’s expanded programme on immunisation, Dr. Naziru Tanko Mohammed.

“The fiscal constraints in terms of revenue collection pose a challenge to financing the NHIA, which occasionally affects the timely purchase of vaccines,” he added.

He was speaking at the Financing Immunisation Advocacy Response (FAIR) project-launch by Hope for Future Generations (HFFG) in Accra.

The country’s Expanded Programme on Immunisation (EPI) has significantly evolved over the past 20 years after its launch in 1978. With its main mandate of contributing to poverty reduction by reducing the magnitude of vaccine-preventable diseases (VPDs) through immunisation as an essential component of Primary Health Care (PHC), the programme has seen an increase in number of vaccines it delivers routinely to children and pregnant women.

From an initial six antigens against the six childhood killer diseases to currently 11 vaccines – including Malaria vaccine that is being piloted in seven regions, the programme vaccinates against 14 vaccine-preventable diseases.

“A significant number of these vaccines – such as Pnemococcal Vaccine (PCV), Rotavirus vaccine, Measles second dose, Meningococcal vaccine, etc. – were all introduced within the past 20 years,” Mohammed said; adding that increasing the programme’s number of vaccines “simply means an increase in resource requirement to ensure all eligible children are reached, to reduce zero-dose and under-immunised children and prevent outbreaks of vaccine-preventable diseases.”

Increasing domestic resource-mobilisation

The new Ghana Health Financing Strategy 2023-2030 advocates increased resources for health, especially preventive services, and calls for investments and more advocacy.

“It is my conviction that by using evidence-informed engagement with relevant stakeholders, formation of public-private partnerships, engagement of traditional authorities and communities, we could increase domestic resource mobilisation at national and subnational levels to complement government’s efforts toward ensuring robust primary health care and immunisation service delivery in Ghana,” Mohammed said.

“Through our concerted efforts, we can achieve sustainable progress toward reaching every eligible child or person with vaccines, so that we would conquer vaccine-preventable diseases in Ghana. It is doable, and I hope we will all lend our support to make it a reality,” he added.

Cornerstone of public health

Dr. Francis Kasolo, World Health Organisation (WHO) Representative to Ghana, said the FAIR project’s launch signifies a shared commitment to ensuring universal access to life-saving vaccines for all, and securing sustainable financing for the national immunisation programme.

“In the face of evolving health challenges, it is imperative that we unite in our efforts to make immunisation not just a priority but an accessible reality for everyone. Immunisation is a cornerstone of public health, preventing the spread of infectious diseases and safeguarding the well-being of communities. However, achieving this goal requires strategic collaboration – and this is where the WHO steps forward,” he said.

He reaffirmed the WHO’s collective commitment to advancing health as a fundamental human right, saying: “This commitment is grounded in the understanding that no single entity can address the challenges we face in isolation. By forging strong partnerships, we amplify our collective impact, bringing together the expertise, resources and innovation needed to overcome the barriers to immunisation”.

Despite being the most efficient and impactful on the continent with a high-routine coverage level over the years – of more than 90 percent for most antigens – the country’s immunisation programme has been experiencing some dips recently due to vaccine shortages.

Gavi, the vaccine alliance, supports approximately 70-80 percent of vaccines’ cost and their delivery, including strengthening the country’s health system. Ghana entered accelerated transition during January 2022, and is expected to transition out of Gavi’s support in 2027.

But under revised policies approved by the Gavi Board in December 2022, the country will now stay in accelerated transition until 2029 and should be fully self-financing from January 2030.

It is against this background that HFFG, with funding from Global Health Advocacy Incubator, is implementing the FAIR project to advocate for greater domestic resource mobilisation and increased accountability for results in reaching zero-dose children and increasing immunisation coverage – including of newly-introduced vaccines.

“It aims to address critical gaps in immunisation funding by advocating increases in domestic resource mobilisation at national and/or subnational level; dedicated to primary healthcare (PHC) and immunisation service delivery, ensuring timely payment of immunisation obligations and also ensuring new Gavi-supported vaccines are introduced and the country is aware and willing to meet any related increased co-financing obligations,” said Cecilia Senoo, Executive Director-HFFG.

A transition roadmap toward self-financing for immunisation in country has already been developed to ensure enhanced and sustained access to vaccines and vaccination programmes, and how these can be managed and fully self-financed from 2030 onward, Mohammed stated.

“The transition roadmap provides a guide to a gradual and progressive shift from donor financing toward domestically-funded immunisation services (vaccine supply and deployment, and strengthening the health system),” he stated.

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