26 February 2016

Egypt's Health Minister Discusses Financial Challenges of Immunization

Addis Ababa — Egypt's health minister told a global conference on vaccination and its costs on Thursday that his ministry "never gave money back to the treasury," sending the room to laughter.

His statement comes at a time when Egypt's healthcare and the quality of services provided has been placed under scrutiny, especially in local media.

Asked at the first-ever Ministerial Conference on Immunization in Africa (MCIA), which is organised by the World Health Organization, if dialogue between him and the ministry of finance goes well, Minister Ahmed Emad al-Din Rady jokingly said "not all the time" but added that the dialogue is there.

Rady said his ministry is always working on assessing its financial needs, not just for vaccination but for all healthcare services. The minister was one of the speakers on a panel that discussed the cost of immunization and financing it at the two-day MCIA conference, which brought together numerous African health ministers, as well as immunisation experts from across the world.

Egyptian doctors have for years been calling for raising the budget for health to 15 per cent, as per the Abuja Declaration which Egypt has signed. Doctors and medical staff say public hospitals are unable to provide quality healthcare because of the budgets they run on.

Yet, despite the labyrinths that riddle the Egyptian health care system, the state has been able to maintain high immunisation coverage. Rady said coverage in Egypt is around 95 per cent and that three diseases have been eliminated including diphtheria and tetanus.

The annual spending on routine emergency vaccination in Egypt has been raised in 2016 from EGP 600 million ($76.6 million) to EGP 700 million ($89.4 million), Rady said.

But Egypt is not the only country in this part of Africa that seems to be performing well. Speaking at the conference on Wednesday, Ala Alwan, the director of the World Health Organization's Eastern Mediterranean region (EMRO) said both Egypt and Tunisia have made "major achievements" despite economic constraints.

Of the seven African countries in the EMRO region, the coverage of the basic life-saving DTP3 vaccine, for diphtheria, whooping cough and tetanus, was over 90 per cent in five countries. Despite the turmoil, Libya has maintained a DTP3 vaccine coverage of 94 per cent. Yet, the rates in Somalia and Djibouti which are included in the African EMRO states have DTP3 vaccination coverage of 42 and 78 per cent, respectively.

Of the seven African EMRO countries, Egypt, Libya, Morroco and Tunisia are fully funding their immunisation programmes, which Alwan described as being "truly commendable" coming without donor support. These four countries do not receive assistance from the GAVI Alliance which has helped support immunisation services in more than 60 countries.

Additionally, all seven EMRO countries in Africa have introduced Hepatitis B vaccine.

But Alwan says that despite the achievements in African EMRO countries, the region still faces serious challenges, touching upon geopolitical and security issues. The MCIA served as both a reminder of how much immunisation or vaccination has made a difference for African children and an alarm bell on how much work still needs to be done, and how to finance it.

The numbers show progress elsewhere in the continent, outside of EMRO. Seychelles and Rwanda are both at 99 per cent DTP3 coverage. According to a UNICEF fact sheet, the number of measles-related deaths across Africa fell from 342,800 in 2000 to 48,000 in 2014.

Africa has gone 18 months without a single case of polio detected. If this period doubles, the continent will become certified polio-free.

Countries are coming up with innovative solutions to bring their numbers up. Ethiopia, for instance, has created a women's development army where a woman is told how important vaccines are and trained, before she becomes responsible for ensuring that five or six other women in her local community immunise their children.

Still, out of five African children, one does not receive basic life-saving immunisations, DTP3.

Speakers at MCIA said much still needs to be done and that more funding needs to be pumped into immunisation across the continent, although they did not reach a conclusion on where the money will come from. Ngozi Okonjo Iweala, the former minister of finance of Nigeria told the conference that Africa has $17 billion in immunization needs, but added that there is a gap of $5 billion.

At the end of the two-day conference, 41 African ministers and country delegations signed a declaration on universal access to immunisation, calling on governments to increase their efforts to secure investments in national immunisation programmes and to negotiate with vaccine manufacturers. But there are no sanctions for countries that do not follow the declaration, which does not set any timeframes.

The signing of the two page-long declaration came amid festivities, Ethiopian music and dance and speeches on how the signatories are committing themselves before the world, a stark comparison to the conditions on the streets of Addis, where the African Union building is. The trip through the capital to the grand, glass African Union building through hilly roads, studded with rundown buildings and homes covered with tin ceilings may be testament to the many challenges ahead for the continent.

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