Collection and reporting of
immunization financing data for the
WHO/UNICEF Joint Reporting Form
Results of a country survey
DRAFT
2014
Disclaimer:
The views expressed in this report do not necessarily represent the decisions, policy or
views of the World Health Organization.
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Contents
Executive summary ................................................................................................................................. 4
1. Introduction ..................................................................................................................................... 6
2. Survey rationale, objectives and methods ...................................................................................... 6
3. Main findings ................................................................................................................................... 8
3.1 Individuals and institutions involved in the reporting process ............................................... 8
3.2 Sources of information used ......................................................................................................... 9
3.3 Data included............................................................................................................................... 12
3.4 Main challenges ........................................................................................................................... 14
3.5 Ways to improve the reporting system ....................................................................................... 15
3.6 Feedback on reported data ......................................................................................................... 17
3.7 General comments by countries ................................................................................................. 18
4. Conclusions .................................................................................................................................... 18
Annex 1. JRF template 2012-2013, section 6B.2: financing data .......................................................... 19
Annex 2. Survey questionnaire .............................................................................................................. 21
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Executive summary
The immunization financing indicators reported in the WHO/UNICEF Joint Reporting Form (JRF) are of
strategic importance for evaluating and informing immunization policy at global, regional and
country levels. The Global Vaccine Action Plan (GVAP) 2011–2020, adopted by the World Health
Assembly in 2012, gives high priority to country ownership and financial sustainability of
immunization activities; its accountability and monitoring framework includes “domestic
expenditures for immunization per person targeted” as a key indicator for monitoring progress in
GVAP implementation.
Unfortunately, there is considerable variation between countries in the quality, timeliness and
accuracy of their data on immunization and vaccine expenditure. Errors, inconsistencies and missing
data have frequently been identified during the compilation and analysis of time series.
In 2013 and early 2014, WHO, UNICEF and other Gavi Alliance partners conducted a survey in
selected countries, to document the data reporting process, including the methods and data sources
used to estimate the national immunization and vaccine expenditures reported in the JRF. This report
summarizes the country responses.
The survey aimed to:
• identify the sources of information used and the people and departments involved in the
data collection and reporting process;
• document the main obstacles and challenges faced by countries in reporting JRF financing
indicators;
• collect countries’ suggestions on ways of improving data collection, estimates, validation and
reporting.
In 36 Gavi-eligible countries, a questionnaire was completed by interviewing key people involved in
the JRF reporting process in 2010–12.
Ministry of Health expenditure records, expense records of the Expanded Programme on
Immunization (EPI) and the Ministry of Health gazetted budget records were found to be the main
sources of information used to estimate and report each JRF indicator in 2012. The national
comprehensive multi-year plan (cMYP) and documents from the Ministry of Finance, Gavi, UNICEF
and WHO were secondary sources of information.
Some 58% of countries reported that they included data on subnational expenditure on vaccines in
their JRF for 2010, 2011 and 2012; 61% included data on subnational expenditure on routine
immunization.
Of the countries involved in the survey, 39% reported that they had received feedback from the
UNICEF or WHO regional office about the accuracy of their JRF financing data; 33% had adjusted or
revised their data after feedback was given.
The survey revealed a number of issues and challenges, including: a lack of clarity and understanding
of the JRF indicators and reporting instructions; absence of an organized data reporting process; and
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limited capacity, skills and incentives at country level for the collection, estimation, validation and
reporting of correct data.
Improvements suggested by countries focused predominantly on the data collection and validation
process, in particular the disaggregation of expenditure data that are not immunization-specific.
Countries requested greater clarity in the JRF instructions, technical guidance and assistance in
completing and validating the financial data, and closer involvement of partners, particularly the
UNICEF and WHO country offices. Data collection and reporting should benefit primarily the
countries, in addition to the global community, by helping to improve the coverage, management
and financing of immunization programmes.
Despite its limitations, this survey has helped identify some of the challenges and difficulties faced by
countries in reporting quality data on financing of vaccines and routine immunization. It has also
provided some insights and suggestions on how to respond to the urgent and strategic need of
countries, regions and the global community for reliable and sound data on immunization financing.
The results will inform a comprehensive effort to strengthen local and regional capacities, and
promote peer exchange, active feedback, responsibility and better use of quality data for action and
policy-setting within the GVAP.
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1. Introduction
Since 1998, the WHO/UNICEF Joint Reporting Form (JRF) has been used to collect data on
immunization coverage and system performance in WHO Member States. One section of the form is
devoted to immunization financing (see Annex 1). The JRF includes six indicators of immunization
financing, four of which are expressed in absolute terms (US$) and two as percentages:
• total expenditure on routine immunization;
• government expenditure on routine immunization;
• total expenditure on vaccines used for routine immunization;
• government expenditure on vaccines used for routine immunization;
• percentage of expenditure on routine immunization that is financed by government;
• percentage of expenditure on vaccines used for routine immunization that is financed by
government.
These indicators are intended to measure the extent to which countries are moving towards financial
sustainability and greater country ownership.
Interest in such indicators has increased since 2000, when the Gavi Alliance was established to
improve access to new vaccines and immunization in low-income countries. Financial sustainability is
at the centre of the Gavi model and has been translated in terms of increasing domestic financing for
traditional vaccines (not supported by Gavi), Gavi co-financing and graduation policies.
The Global Vaccine Action Plan (GVAP) 2011–2020, adopted by the World Health Assembly in 2012,
gives high priority to country ownership and financial sustainability. In its accountability and
monitoring framework, “domestic expenditures for immunization per person targeted” is a key
indicator used to monitor the progress of GVAP implementation at country and global level. These
new developments have radically changed the status of the JRF financial indicators, as they are now
more closely monitored by the global community and the World Health Assembly. These indicators
are becoming more strategic and are increasingly used to evaluate and inform immunization policy at
global, regional and country levels.
Unfortunately, there is considerable variation between countries in the quality, timeliness and
accuracy of data on immunization and vaccine expenditure. Errors, inconsistencies and missing data
have frequently been identified during the compilation and analysis of time series. These limitations
are hindering efforts to assess progress and to make decisions based on strong evidence at global,
regional and country level. Therefore, improving data collection, validation and reporting is
becoming a priority at country and global level.
2. Survey rationale, objectives and methods
To better understand how the indicators are collected and reported, WHO, UNICEF and other Gavi
Alliance partners conducted a survey in 2013 and early 2014 in selected countries, to document the
data reporting process, including the methods and data sources used to estimate and report national
immunization and vaccine expenditure and financing.
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The survey aimed to:
• identify the sources of information and the people and departments involved in the data
collection and reporting process;
• document the main obstacles and challenges faced by countries in reporting JRF financing
indicators; and
• collect countries’ suggestions on ways of improving data collection, estimates, validation and
reporting.
The survey also aimed to draw lessons and set out key recommendations to clarify the objectives and
methods of the data reporting process, and to strengthen the quality and usefulness of the JRF
financing data.
WHO and UNICEF country offices, in collaboration with Gavi and the Sabin Institute/Sustainable
Immunization Financing Social Investment Fund (SIF) project, completed the questionnaires by
interviewing key persons involved in the JRF reporting process in 2010–12.
The questionnaire included eight questions (see Annex 2), aimed at obtaining the following
information:
• the positions of the people in charge of completing, checking and approving the JRF financing
data for 2010–12;
• the departments and units of the Ministry of Health, Ministry of Finance and other
institutions involved in the JRF reporting process, and the specific information they provide;
• the main and secondary sources of information used to estimate each reported indicator in
2012 ;
• the main challenges in ensuring that the data reported are accurate and up-to-date;
• whether the data reported in 2010, 2011 and 2012 included subnational expenditure on
vaccines and routine immunization;
• whether countries had recently received any feedback, from WHO, UNICEF or others, about
the accuracy of the reported financing data;
• practical suggestions for improving the reporting process for the JRF financing indicators; and
• other comments.
A total of 36 Gavi-eligible countries completed the questionnaire. All completed questionnaires were
then compiled and analysed at regional and global level.
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Table 1: Countries involved in the survey
WHO Region Countries Number Total
Africa Botswana, Burkina Faso, Burundi, Cameroon, Comoros, Kenya,
Madagascar, Sierra Leone, South Africa, Swaziland, Zambia,
Zimbabwe
12 36
Europe Armenia, Azerbaijan, Georgia, Kazakhstan, Republic of Moldova,
Tajikistan, Turkmenistan, Ukraine, Uzbekistan
9
South-East Asia Indonesia, Nepal, Sri Lanka 3
Americas Costa Rica, El Salvador, Honduras, Mexico, Nicaragua, Panama,
Paraguay
7
Western Pacific Viet Nam
1
Eastern
Mediterranean
Afghanistan, Somalia, Sudan, Yemen 4
3. Main findings
3.1 Individuals and institutions involved in the reporting process
Survey questions
• Who has been in charge of filling in, checking and approving the section on financing data for
2010, 2011 and 2012?
• Which departments and units of the Ministry of Health, Ministry of Finance and other institutions
are involved in the process of reporting financing data for the JRF? What specific information do
they provide?
Rationale for these questions
These questions aim to find out who is involved in the data collection and reporting process, both
within and outside the Ministry of Health. The JRF is mainly compiled by the Expanded Programme
on Immunization (EPI) team. However, it is important to understand the extent to which people in
charge of purchase and supply of vaccines, budgeting and financing of vaccines, and immunization
operational expenditures are solicited and involved in data sharing, estimations, validation and
reporting. The involvement of these people is critical for obtaining information on the planned or
allocated budget and on actual expenditure on routine vaccines and immunization activities.
Summary of the responses
Who is involved?
• The Ministry of Health is involved in 97% of cases. The specific departments involved vary
according to the country and include the EPI unit, the health management information
system, public health, finance, administration and supply services.
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• The Ministry of Finance is involved in 28% of the countries, providing planned budget and
actual expenditures; supporting departments, such as the budgeting unit, sector office for
EPI, and departments of health, social sector, state funds and investment are also included.
• In 42% of the countries, other institutions are involved; these include the Department of
Social Policy of the Ministry of Economics, the Center for Diseases Control and Public Health,
and epidemiology and public health institutes. In one country in the African Region, the
vaccine supplier is involved.
• In almost 50% of the countries, WHO and UNICEF offices are involved in the process
• In one country in the Region of the Americas, the Social Security Administration takes part.
What specific information is provided and in which format?
• The Ministry of Health mainly provides data on budget allocation, budget implementation,
expenditure on vaccines and staff, and vaccine quantity and values . The majority of the data
is provided in Excel format.
• The Ministry of Finance provides data on allocated budget and past expenditure. Data are
generally provided in the format of printed accounting books.
Observations
• The Ministry of Health and EPI play a pivotal role in the process of reporting financing data
through JRF.
• The Ministry of Finance, WHO and UNICEF are involved to a certain extent in preparing the
data estimates and reporting.
• The central level dominates the process; the subnational level is less involved and its
expenditure is frequently underestimated.
• Data on planned and allocated budgets are more often available than those on executed
budget and actual expenditures.
3.2 Sources of information used
Survey question
Please specify all sources of information used in estimating each JRF indicator in 2012; for each
source, indicate whether it is a main source (M) or a secondary source (S).
Rationale of the question
Information for the immunization financing indicators needs to be obtained from more than one
source, for two main reasons.
• There is no single source of funding for immunizations, and information should be collected
from each source. In most Gavi-eligible countries, EPI vaccines are procured through UNICEF
or the Pan American Health Organization (PAHO) and partly funded by Gavi. All sources of
funding for vaccines and immunizations should be identified and the amounts estimated.
• The immunization financing indicators reflect actual expenditures, and not official budgets,
estimated costs or projected expenditures. Cross-checking of data from different sources is
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essential to obtain accurate information on actual spending on routine vaccines and
immunization services.
Summary of the responses
The main source of data on the amount of government funds spent on vaccines used in routine
immunization (indicator 6700 of the JRF template 2012-2013 - see Annex 1) – for 81% of countries
involved in the survey – is the Ministry of Health expenditure record. Overall, 58% of countries
collected data from the EPI expense records, and 39% from the Ministry of Health gazetted budget.
The national comprehensive multi-year plan (cMYP) is also a source of information for 42% of the
countries. UNICEF is an important source of information for 33% of countries in the African Region
(Table 2).
Information on the total expenditure (from all sources) on vaccines used in routine immunization
(indicator 6710) comes from the Ministry of Health expenditure record in 72% of countries and from
EPI expense records in 50% of countries (Table 3).
The Ministry of Health expenditure record, EPI expense records and Ministry of Health gazetted
budget are the main sources of data on the amount of government funds spent on routine
immunization (indicator 6730) (64%, 50% and 30% of countries, respectively) (Table 4).
Data on total expenditure (from all sources) on routine immunization (indicator 6740) are taken from
the Ministry of Health expenditure record in 64% of countries and from EPI expense records in 50%
of countries (Table 5). UNICEF is a main source of information for countries in the African Region.
Table 2: Sources of information on amount of government funds spent on vaccines used in routine
immunization (indicator 6700)
Source of information
Percentage of countries using the source
Africa Europe South-East
Asia Americas
Western
Pacific
Eastern
Mediterranean Average
Ministry of Health expenditure record 83 100 33 86 100 50 81
Ministry of Health gazetted budget 50 56 33 29 0 0 39
EPI expense records 58 56 66 57 100 50 58
EPI budget documents 33 33 66 43 100 50 42
Subnational EPI expense records 0 22 33 43 0 0 17
Social security administration
expenditure records 0 0 0 29 0 0 5
cMYP 42 56 66 14 100 25 42
WHO Office 25 11 33 14 0 0 17
UNICEF Office 33 11 33 0 0 50 22
GAVI decision letter 33 44 33 14 0 25 31
Other GAVI Secretariat 17 0 0 0 0 0 5
Other donor documents 8 0 0 0 0 25 5
National health accounts 25 11 0 0 0 0 11
Other studies 8 0 0 0 0 0 3
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Table 3: Sources of Information on total expenditure (from all sources) on vaccines used in routine
immunization (indicator 6710)
Table 4: Sources of information on amount of government funds spent on routine immunization
(indicator 6730)
Source of information
Percentage of countries using the source
Africa Europe South-
East Asia Americas
Western
Pacific
Eastern
Mediterranean Average
Ministry of Health expenditure record 75 78 0 43 100 50 64
Ministry of Health gazetted budget 42 44 33 14 0 0 30
EPI expense records 42 44 66 57 100 50 50
EPI budget documents 25 22 33 43 100 50 36
Subnational EPI expense records 0 22 0 43 0 0 17
Social security administration expenditure
records 0 0 0 29 0 0 5
cMYP 25 33 33 0 100 75 34
WHO Office 42 0 0 0 0 0 17
UNICEF Office 50 0 0 0 0 50 25
GAVI decision letter 33 22 0 0 0 50 25
Other GAVI Secretariat 17 0 0 0 0 0 5
Other donor documents 8 0 0 0 0 25 5
National health accounts 25 0 0 0 0 0 9
Other sources 8 0 0 0 0 0 3
Source of information
Percentage of countries using the source
Africa Europe South-
East Asia Americas
Western
Pacific
Eastern
Mediterranean Average
Ministry of Health expenditure record 83 89 0 57 100 50 72
Ministry of Health gazetted budget 42 33 33 14 0 0 28
EPI expense records 50 44 66 43 100 50 50
EPI budget documents 25 22 66 29 100 50 33
Subnational EPI expense records 0 22 0 43 0 0 17
Social security administration expenditure
records 0 0 0 29 0 0 5
cMYP 33 44 33 0 100 50 36
WHO Office 25 11 0 0 100 25 19
UNICEF Office 58 11 0 0 100 75 36
GAVI decision letter 25 56 0 14 100 50 36
Other GAVI Secretariat 25 0 0 0 0 0 9
Other donor documents 8 0 0 14 100 25 11
National health accounts 25 0 0 0 0 0 9
Other studies 8 0 0 0 0 0 3
Other sources 8 0 0 0 0 0 3
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Other studies 8 0 0 0 0 0 3
Other sources 0 0 0 0 0 0 0
Table 5: Sources of information on total expenditure (from all sources) on routine immunization
(indicator 6740)
Observations
• The main sources of data are the expenditure records of the Ministry of Health and EPI.
• The cMYP, as well as WHO, UNICEF and Gavi documents, are important secondary sources of
data, particularly in Africa.
• Allocated funds and budgeted expenditures are more easily available than actual expenditures.
• Subnational EPI sources of information are either non-existent or underused, except in the
American and European Regions.
3.3 Data included
Survey question
Do the data your country reported in JRF in 2010, 2011 and 2012 include subnational expenditures
on vaccines and routine immunization?
Source of information
Percentage of countries using the source
Africa Europe South-East
Asia Americas
Western
Pacific
Eastern
Mediterranean Average
Ministry of Health expenditure
record
75 78 0 43 100 50 64
Ministry of Health gazetted
budget
33 33 33 14 0 0 25
EPI expense records 50 33 66 57 100 50 50
EPI budget documents 33 22 66 43 100 50 38
Subnational EPI expense records 8 22 0 43 0 0 19
Social security administration
expenditure records
0 0 0 43 0 0 9
cMYP 33 44 33 0 100 75 39
WHO Office 50 11 0 0 100 25 28
UNICEF Office 50 0 0 0 100 75 31
GAVI decision letter 33 22 0 0 100 25 25
Other GAVI Secretariat 17 0 0 0 0 0 5
Other donor documents 8 0 0 14 100 25 11
National health accounts 25 0 0 0 0 0 9
Other studies 8 0 0 0 0 0 3
Other sources 0 0 0 0 0 0 0
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Rationale for the question
The JRF immunization financing indicators aim to capture both total and government expenditure on
routine vaccines and routine immunization, some of which may occur at subnational level. While
most EPI vaccines are procured and funded at central level through UNICEF or PAHO, there are
exceptions. More importantly, some operational costs may be funded and recorded at national or
subnational level (e.g. transportation, maintenance and supervision). In addition, central funds that
are officially transferred to the subnational level may not be effectively allocated or spent. It is,
therefore, important to record actual expenditure at both national and subnational levels.
Summary of the responses
More than half of the countries (58%) reported that they included data on subnational expenditure
on vaccines in their JRF for 2010, 2011 and 2012; 61% included subnational expenditure on routine
immunization (Table 6).
Table 6: Inclusion of subnational expenditure on vaccines and routine immunization
Information included in JRF
Yes No Not answered
No. of
countries %
No. of
countries %
No. of
countries %
Subnational expenditure on
vaccines 21 58 12 33 3 8
Africa 10 83 1 8 1 8
Europe 6 67 2 22 1 11
South-East Asia 2 66 1 33 0 0
Americas 0 0 7 100 0 0
Western Pacific 1 100 0 0 0 0
Eastern Mediterranean 2 50 1 25 1 25
Subnational expenditure on
routine immunization 22 61 9 25 5 14
Africa 6 50 4 33 2 17
Europe 4 44 2 22 3 33
South-East Asia 2 66 1 33 0 0
Americas 6 86 1 14 0 0
Western Pacific 0 0 1 100 0 0
Eastern Mediterranean 4 100 0 0 0 0
Observations
• As most vaccines are centrally procured and funded, it is important to clarify what is actually
included from the subnational level, particularly in Africa.
• Immunization expenditures at subnational level may be underestimated, as almost 40% of
the countries do not explicitly take into account subnational expenditure.
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3.4 Main challenges
Survey question
What are the main challenges in ensuring that this section of the JRF contains accurate and up-to-
date data?
Rationale for the question
Countries face many obstacles when attempting to collect accurate, up-to-date and meaningful data.
A number of possible challenges were suggested to help respondents express their concerns and to
permit quantitative analysis of the responses. The challenges listed spanned the data collection and
reporting cycle, starting with understanding the indicators and instructions, and ending with
reporting and alignment issues.
Summary of the responses
In 39% of the countries, the main challenge in ensuring that the financing data reported are accurate
and up-to-date is the data collection itself. In addition, 39% reported challenges with standardization
of the reporting process. Some 25% - 33% had difficulty understanding the indicators and calculating
the estimates, and specifically in identifying what has been spent by partners other than
government, WHO and UNICEF.
Table 7: Main challenges reported by the countries
Percentage of countries reporting as challenge
Africa Europe
South
-East
Asia
Americas Western
Pacific
Eastern
Mediterranean Average
Understanding the indicators 33 11 33 43 0 0 25
Making the estimates 42 22 33 14 0 75 33
Collecting the data 75 33 0 14 0 25 39
Validating the data 33 11 33 14 0 0 20
Consistency issues with different
sources of information/reporting 42 11 33 43 100 25 33
How is the process of collection,
validation, and reporting JRF data
organized?
8 0 0 14 0 0 5
Is the process of reporting
standardized? 25 56 0 57 100 25 39
Are the processes of reporting JRF and
Annual Progress Report (APR) aligned? 17 56 33 29 100 25 33
Others 17 11 0 14 0 0 11
Observations:
• Countries reported three main issues: the indicators and instructions were thought to be
unclear and not well understood; there was difficulty in accessing information on actual
expenditure; and the reporting process was not well standardized.
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• The perception of the issues and obstacles is quite different in the different regions;
observations should, however, be interpreted with caution as the sample is not
representative.
3.5 Ways to improve the reporting system
Survey question
Please make practical suggestions on how the reporting process for JRF financing indicators could be
improved.
Rationale for the question
It is of critical importance for WHO, UNICEF and other Gavi partners to get practical suggestions and
recommendations for improving the reporting process from those directly involved. Countries were
given a list of topics on which they were invited to make suggestions for improvement.
Summary of the responses
Most of the suggestions were focused on data collection, the roles of UNICEF and WHO country
offices, and the checking, validation and approval of the data (Table 8).
Table 8: Percentage of countries making suggestions for improvement
Percentage of countries making suggestions for improvement
Africa Europe
South-
East
Asia
Americas Western
Pacific
Eastern
Mediterranean Average
Collection of data on
immunization expenditure
(sources, quality, reliability,
consistency)
75 22 100 43 100 75 58
Collection of data on vaccine
expenditure (sources, quality,
reliability, consistency)
25 22 66 29 0 0 25
Data checking, validation and
approval 58 22 66 43 0 75 47
Use and feedback on financing
indicators 17 22 33 29 0 50 25
Roles of UNICEF and WHO
country offices in the process 67 33 100 29 0 50 50
Additional technical support,
in terms of guidelines, training
or consultancies
42 22 66 29 0 75 39
Specific suggestions included the following.
Collection of data on vaccine expenditures
o It is important to indicate how to disaggregate expenditure data that involve other services.
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o It should be made clear that expenditures on campaigns should not be included in this
calculation.
o The Ministry of Finance and health economists should verify sources, quality and consistency of
reported vaccine expenditures.
o There should be close cooperation with UNICEF to collect and verify vaccine expenditures.
o National norms should be considered.
o All actors and players should be involved.
Data checking, validation and approval
o Guidelines are needed on how to validate data, especially shared costs.
o The Ministry of Finance should validate and approve expenditure data. A mechanism should be
put in place at country level to validate financing data.
o All partners should be involved in completing and reviewing the forms. The forms should include
a space for the signatures of the permanent secretary of Ministry of Health and key partners in
immunization.
o The completed JRF should be reviewed in depth at country level by government and partners,
especially WHO and UNICEF.
o Meetings with WHO and UNICEF should be organized to improve the consistency and reliability
of data.
o The Ministry of Finance and health economists should verify sources, quality and consistency of
reported immunization expenditures. Completeness should also be checked.
o JFR financing data should be widely shared at country level.
o A technical monitoring working group should be established.
o Adequate resources are needed for collection, checking, validation and approval of data under
the leadership of the Ministry of Health.
o Monitoring visits should be carried out to check the quality and conformity of data.
Use and feedback on financing indicators
o The data collected and reported for the JRF are almost never used at the country level; there
appears to be very little, if any, demand for the JRF financing indicators within countries. This
observation should underpin any attempt to improve the JRF system of reporting, unless
incentives and practical uses of data at country level are identified.
o There appears to be very little, if any, feedback from the regional or global level.
o Quarterly meetings should be organized with all stakeholders.
o More feedback should be provided to countries.
o Data analysis and feedback should be used to advocate for allocation of funds to immunization.
Roles of UNICEF and WHO country offices in the process
o The UNICEF and WHO country teams should actively and fully participate in completing the
JRF. They need to work more closely with government to build capacity and need to be
involved in whole JRF process.
o UNICEF and WHO should provide technical assistance for data collection, estimates and
cleaning.
o UNICEF and WHO country offices should serve as the secretariat for completion of the JRF.
o The forms should include space for endorsement by WHO and UNICEF.
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o A forum for completion and discussion of the JRF data should be convened: data should be
complete and thoroughly verified prior to submission.
Additional technical support in terms of guidelines, training or consultancies
o There is a need for clear guidelines and increased awareness among all stakeholders.
o It would be useful to organize workshops on the various sources of data on immunization
expenditure and how to collect and validate them.
o Country teams should be trained on how to complete the JRF and APR; so far, no country
team member has ever been trained to do this.
o Exchange of experiences between countries and training at international and country levels
are requested.
3.6 Feedback on reported data
Survey question
In the past years, have you received any feedback about the accuracy of the JRF financing data
reported?
Rationale for the question
Feedback is a powerful way of helping countries to improve the quality of their data. To be useful,
feedback should be timely, regular, constructive, helpful and collaborative. Feedback is needed on
both the accuracy and quality of the JRF financing indicators and on the analysis and use of the data
at regional and global level.
Summary of the countries’ responses
Of the countries involved in the survey, 39% reported that they had received feedback about the
accuracy of the JRF financing data reported from the UNICEF or WHO regional office; 30% had
received feedback from the UNICEF or WHO country office and 3% from UNICEF or WHO
headquarters. In total, 33% of the countries adjusted or revised their data after receiving feedback
(Table 9).
Table 9: Percentage of countries that received feedback about the accuracy of the JRF financing data
reported
Source of feedback
Percentage of countries receiving feedback
Africa Europe South-
East Asia Americas
Western
Pacific
Eastern
Mediterranean Average
UNICEF or WHO headquarters 0 11 0 0 0 0 3
UNICEF or WHO regional office 67 11 33 43 0 25 39
UNICEF or WHO country office 67 0 33 14 0 25 30
Other 0 0 0 0 0 0 0
Were data adjusted or revised
after the feedback? 58 11 33 29 0 25 33
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Observations
• An increasing amount of feedback is being provided to countries by WHO and UNICEF.
• The feedback comes mainly from country and regional offices.
• The feedback is mainly about data gaps, consistency and completeness, rather than
relevance, analysis, and policy implications.
3.7 General comments by countries
The scope of the questionnaire was quite limited in relation to the range of issues and obstacles that
countries could face in the process of data collection, validation and reporting. Space was therefore
included to allow countries to highlight any other relevant issues or recommendations.
Summary of the comments made by countries
• One country requested an extension of the deadline for submission of the report “to the end
of March or April 15th, because the time for analysis after data collection is too short”.
• Some countries reported that the existing budgeting and reporting forms in the country did
not allow them to allocate costs specifically associated with immunizations. Immunization
financing is often included under a larger programme, such as disease surveillance or child
health. Expenditures may be presented by item and not by programme or intervention. Data
disaggregation is problematic.
• The format of the JRF was also criticized. “Questions in the table are clear, but sometimes
the cells are not functioning and do not accept the data.” Perhaps the format should be
simplified to be more accessible.
• There is an important need for capacity-building within government institutions responsible
for completing the JRF and continuous feedback from WHO headquarters and regional
offices.
4. Conclusions
This report presents the results of a survey conducted among a sample of Gavi-eligible countries, to
identify major difficulties encountered in reporting JRF financing data. A total of 36 countries
completed the survey questionnaire.
Despite its limitations, the survey has helped identify some of the challenges and difficulties faced by
countries in reporting quality data on financing of vaccines and routine immunization. It has also
provided some insights and suggestions on how to respond to the urgent and strategic need of
countries, regions and the global community for reliable and sound data on immunization financing.
The results will inform a comprehensive effort to strengthen local and regional capacities, and
promote peer exchange, active feedback, responsibility and better use of quality data for action and
policy setting within the GVAP agenda.
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Annex 1. JRF template 2012-2013, section 6B.2: financing data
JRF instructions
6700
This figure should be available from multi-year plan for immunization with a costing and financing component. Government includes all administrative levels such as national and sub-national governments, all funds allocated through the National Government Budget. Extra-budgetary financing from donors, out-of-pocket and informal private payments are excluded.
6710
This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all sources of financing vaccines used in routine immunization (e.g. government, health insurance, donors, out-of-pocket and informal private payments)
6720
Give the percentage of expenditure on vaccines used in routine immunization that was financed solely with government funds. Government includes all administrative levels such as national and sub-national governments. The estimate can come from a previous year or a “best guess"
6730
This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all recurrent, immunization-specific
expenditure of routine immunization. In particular, recurrent inputs include vaccines, injection supplies, salaries and per diems of health staff working full-time on immunization, transport, vehicles and cold chain maintenance, training, social mobilization, and monitoring and surveillance. Government includes all administrative levels such as national and sub-national governments, all fund allocated through the National Government Budget. Extra-budgetary financing from donors, out-of-pocket and informal private payments are excluded.
6670
6680
6690(instructions)
6700
(instructions)
<pick one>
6710
(instructions)
<pick one>
6720
(instructions)
6730(instructions)
<pick one>
6740(instructions)
<pick one>
6750
(instructions)
What amount of government funds was spent on routine immunization?
(Please specify whether you are reporting in local currency or US$.)
If total amounts are not available for the previous questions please provide an
estimated percentage of total expenditure on vaccines financed by government
funds
If total amounts are not available for the previous question please provide an
estimated percentage of total expenditure on routine immunization financed by
government funds?
What is the total expenditure (from all sources) on vaccines used in routine
immunization? (Please specify whether you are reporting in local currency or US$.)
What is the total expenditure (from all sources) on routine immunization? (Please
specify whether you are reporting in local currency or US$.)
What amount of government funds was spent on vaccines used in routine
immunization?
(Please specify whether you are reporting in local currency or US$.)
the health care waste management
the purchase of vaccines used in routine immunizations
<pick one>
<pick one>
<pick one>
the purchase of injection supplies (such as syringes, needles, and
safety boxes) for routine immunizations
Are there line items in the
national government budget
specifically for:
20
6740
This figure should be available from multi-year plan for immunization with a costing and financing component. It includes all recurrent, immunization-specific expenditure of routine immunization. In particular, recurrent inputs include vaccines, injection supplies, salaries and per diems of health staff working full-time on immunization, transport, vehicles and cold chain maintenance, training, social mobilization, and monitoring and surveillance. It includes all sources of financing
routine immunization (e.g. government, health insurance, donors, out-of-pocket and informal private payments).
6750
Give the percentage of expenditure on routine immunization that was financed solely with government funds. Government includes all administrative levels such as national and sub-national governments. The estimate can come from a previous year or a “best guess”.
21
Annex 2. Survey questionnaire
1) Name of the country:
2) Who has been in charge of filling in, checking and approving the section on financing data for
2010, 2011 and 2012?
2010 2011 2012
Role
Function
Contact details
3) Which departments and units of the Ministry of Health, Ministry of Finance and other institutions
are involved in the process of reporting financing data for the JRF? What specific information do they
provide?
Ministry or
institution
Department or unit Specific information
provided
Format: Excel table,
raw data, accounting
books
Ministry of Health
Ministry of Finance
Social Security
administration
Others
4) Please specify all sources of information used in estimating each JRF indicator in 2012; for
each source, indicate whether it is a main source (M) or a secondary source (S).
Sources of information for JRF
indicators
Amount of
government
expenditure
on vaccines
(indicator
6700)
Total
expenditure
(from all
sources) on
vaccines
(indicator
6710)
Amount of
government
expenditure
on routine
immunization
(indicator
6730)
Total
expenditure
(from all
sources) on
routine
immunization
(ndicator
6740)
Ministry of Health expenditure record
(specify joint Ministry of Health, WHO and
UNICEF sources, and GAVI decision letter)
Ministry of Health gazetted budget
(specify _____________________)
EPI expense records
(specify ___________________________)
EPI budget documents
(specify ___________________)
Subnational EPI expense records
(Specify ________________________)
Social security administration expenditure
records (specify_________________________)
cMYP (specify year conducted and years of
data used)
WHO Office (specify source documents
22
_____________________)
UNICEF Office (specify source documents
_________________________)
GAVI decision letter Other GAVI Secretariat
(specify ______________________________)
Other donor documents
(specify _____________________)
National health accounts reports
(specify year)
Other studies
(name and date conducted)
Other source
(specify ________________________________)
Other source
(specify __________________________)
5) What are the main challenges in ensuring that this section of the JRF contains accurate and up-to-
date data?
- Understanding the indicators.
- How to make the estimates.
- How to collect the data.
- How to validate the data.
- Consistency issues with different sources of information or reporting.
- How the process of collection, validation, and reporting of JRF data is organized.
- Is the process of reporting standardized?
- Are the processes of reporting for JRF and APR aligned?
- Other.
6) Do the data your country reported in JRF in 2010, 2011 and 2012 include subnational expenditures
on vaccines and routine immunization?
Subnational
expenditure on:
2010 2011 2012
Vaccines
Routine immunization
23
7) In the past years, have you received any feedback about the accuracy of the JRF financing data
reported?
- From UNICEF or WHO Headquarters
- From UNICEF Headquarters or WHO sub Regional IST Office.
- From UNICEF or WHO country office.
- Other. _____________________________________________________
Were your data adjusted or revised after feedback was received?
8) Please make practical suggestions on how the reporting process for the JRF financing indicators
could be improved.
- Data collection (sources, quality, reliability, consistency) on immunization expenditures:
__________________________________________________________________________
- Data collection (sources, quality, reliability, consistency) on vaccine expenditures:
__________________________________________________________________________
__________________________________________________________________________
- Data checking, validation and approval:
__________________________________________________________________________
__________________________________________________________________________
- Use and feedback on financing indicators:
__________________________________________________________________________
__________________________________________________________________________
- Roles of UNICEF and WHO Country Offices in the process:
__________________________________________________________________________
__________________________________________________________________________
- Additional technical support in terms of guidelines, training or consultancies:
__________________________________________________________________________
24
__________________________________________________________________________
9) Comments
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________