Plan and budget for immunisation finance – SEND Ghana

As part of the medium-term development plans, Metropolitan, Municipal and District Assemblies (MMDAs) have been asked to include immunisation finance in their plans and budgets for effective immunisation service delivery.

“The first stage is therefore to incorporate immunisation financing into the district assemblies’ Medium-Term Development Plan (MTDP). It is encouraging to see that immunisation is covered by the current MTDP (2022–2025).

This was stated in a press release from SEND Ghana, in collaboration with Hope for Future Generations and Socio-Serv Ghana, copied to the Ghana News Agency, in an analysis of immunisation budget execution in selected Metropolitan, Municipal and District Assemblies (MMDAs), Ghana, following the implementation of a monitoring of immunisation budget execution in some districts for the years 2018 to 2021.

The release suggested enhancing coordination between District Assemblies and the District Health Management Team (DHMT) in order to plan, record, and correctly distribute funds received from donors, the DACF, and domestically produced funds.

There has to be more funds committed to specific immunization-related activities including capacity building training, conferences, logistics, and stationery. This will foster trust and open doors for regularised funding.

Additionally, it demanded that the district-level district response programme for malaria be expanded to include immunisation efforts, and that the Assembly be urged to coordinate immunisation efforts to promote community-based health planning and services (CHPS).

It called for advocacy by Civil Society Organizations and other important stakeholders on the inclusion of immunisation financing to core districts indicators from the National Development Planning Commission, claiming that decentralisation of health would cause the Assembly to pay more attention to health like others including education and agriculture.

It became clear that insufficient and delayed funding flows made it impossible to administer routine immunisation, and given that immunisation services were time-sensitive, it was also challenging to start outreach programmes.

Part of the findings revealed that DHMTs and Assemblies stressed the value of immunisation in the districts, so they put the plans into action and conducted assessments every year to gauge how well the districts performed on various health indicators, including immunisation.

The MMDAs receive reports from the DHMTs on a quarterly basis to track the effectiveness of the districts’ immunisation programmes and other health interventions.

The five Assemblies claimed that lack of funding and other competing priorities prevented them from supporting immunisation, while the MMDAs claimed that a large portion of health spending was allocated to infrastructure development.

According to the press release, weak execution rates had made budget performance throughout the years concerning. Analysis of the annual budget performance for 2020 and 2021 showed a health budget execution gap of 7.6 and 6.9 percent, respectively.

“Four districts did not provide funding for immunization-related activities despite it being budgeted for, according to information supplied by the districts on immunisation budgets,” the announcement continued.

As a result of the delay in the delivery of funds from the national level to the district, it was also stated that funding for immunisation operations were not distributed to the districts in a timely manner. This had an impact on the degree of support that the district assemblies gave the DHMTs.

The municipalities and district assemblies included Ho, Shai Osudoku, Asuogyman, Tatale/Sanguli, and Kasena Nankana in the Northern, Eastern, Volta, and Greater Accra regions.

These districts were specifically chosen to advance SEND Ghana’s and HFFG’s prior immunisation initiatives (the immunisation advocacy initiative, 2019 to 2021). The International Budget Partnership (IBP) and UNICEF provided funding and technical assistance for this exercise.

The goals of the visits were to investigate budgetary allocations, disbursements, and utilisation for immunization-related activities in the selected districts for the years 2018 to 2021 as well as to investigate the impact of budget credibility issues on immunisation services. Monitoring and analysis of results were carried out from April 22 to January 23.