Abstract
Background. Despite an increase in immunisation coverage
rates and number vaccines offered in Zambia over the past decade, the
financial sustainability to maintain these gains is uncertain. This
paper analyses availability of fiscal space to sustain the immunisation
programme in Zambia in the short to medium term.
Methods. We assessed fiscal space using a standard
framework consisting of five pillars: economic growth, expenditure
reprioritisation, grants and loans, earmarking of funds, and efficiency
gains on existing outlays. To determine fiscal space from the five
sources, we applied various analytical techniques including regression
analysis on time series data from 1995-2018, Data Envelopment Analysis
on cross section administrative data from a sample of 25 health
districts, and benchmarking. Results. The evidence shows
that fiscal space for immunisation in Zambia is negligible. Health
spending is too weakly related to national income to generate fiscal
space from economic growth. Reprioritisation of expenditure is difficult
because of the huge burden from sovereign debt. Further, introducing new
taxes barely three years after the introduction of a social health
insurance tax is politically not feasible. Additionally, grants from
donors are erratic and likely to diminish in the medium to long-run.
However, fiscal space from efficiency gains is quite substantial.
Conclusions. Prospects for increasing funding for
immunisation from the five sources of fiscal space are minimal. However,
efficiency gains in the immunisation programme can go a long way in
freeing up resources. The challenge lies in identifying and resolving
the sources of technical inefficiency.