{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T20:11:46Z","timestamp":1778184706762,"version":"3.51.4"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,12,22]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The designing of contextually tailored sustainable plans to finance the procurement of vaccines and the running of appropriate immunisation programmes are necessary to address the high burden of vaccine-preventable diseases and low immunisation coverage in sub-Saharan Africa (SSA). We sought to estimate the minimum fraction of a country\u2019s health budget that should be invested in national immunisation programmes to achieve national immunisation coverage of 80% or greater depending on the context, with and without donors\u2019 support.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Multicountry analysis of secondary data using retrieved publicly available data from the WHO, Global Alliance for Vaccines and Immunization (GAVI) and World Bank databases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data on 24 SSA countries, between 2013 and 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We model the variations in immunisation coverage across the different SSA countries using a fractional logit model. Three different generalised linear models were fitted to explore how various explanatory variables accounted for the variability in each of the three different vaccines\u2014measles-containing vaccine (MCV)1, diphtheria, pertussis, tetanus (DPT3) and BCG.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We observed an association between current health expenditure (as a percentage of gross domestic product) and immunisation coverage for BCG (OR=1.01, 95% CI: 1.01 to 1.04, p=0.008) and DPT3 (OR=1.01, 95% CI: 1.0 to 1.02, p=0.020) vaccines. However, there was no evidence to indicate that health expenditure on immunisation (as a proportion of current health expenditure) could be a strong predictor of immunisation coverage (DPT, OR 0.96 (95% CI 0.78 to 1.19; p=0.702); BCG, OR 0.91 (0.69 to 1.19; p=0.492); MCV, OR 0.91 (0.69 to 1.19; p=0.482)). We demonstrate in selected countries that to achieve the GAVI target of 80% in the countries with low DPT3 coverage, health expenditure would need to be increased by more than 45%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>There is a need to facilitate the development of strategies that support African countries to increase domestic financing for national immunisation programmes towards achieving 2030 targets for immunisation coverage.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-073789","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T12:36:55Z","timestamp":1705063015000},"page":"e073789","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Is health expenditure on immunisation associated with immunisation coverage in sub-Saharan Africa? A multicountry analysis, 2013\u20132017"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0920-0490","authenticated-orcid":false,"given":"Israel Oluwaseyidayo","family":"Idris","sequence":"first","affiliation":[{"name":"Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria"},{"name":"Health Emergencies Programme (WHE), WHO, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9145-8719","authenticated-orcid":false,"given":"Luke","family":"Ouma","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Tapkigen","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Tampere, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis Ifeanyi","family":"Ayomoh","sequence":"additional","affiliation":[{"name":"Health Policy, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel Omoniyi","family":"Ayeni","sequence":"additional","affiliation":[{"name":"Immunization Analysis & Insights Unit, NAIJAHEALTH Initiative, Lagos, Nigeria"},{"name":"Health Emergencies Programme (WHE), WHO Regional Office for Africa, Daresalam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"key":"2025101810590148000_14.1.e073789.1","unstructured":"African union . Ministerial Conference on Immunization in Africa. Addis Declaration on Immunization. In: Ministerial Conference on Immunization in Africa; 2021 Available: http:\/\/immunizationinafrica2016.org\/ministerial-declaration-english"},{"key":"2025101810590148000_14.1.e073789.2","unstructured":"World Health Organisation . Immmunisation. 2021. Available: https:\/\/www.afro.who.int\/health-topics\/immunization"},{"key":"2025101810590148000_14.1.e073789.3","unstructured":"WHO . Maternal and neonatal tetanus elimination. 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Review of financing of immunization programs in developing and transitional countries. Special initiatives report no 12; 1998. Available: http:\/\/www.childrensvaccine.org\/files\/Financing_imm_programs_in_DCs_PHRplus.pdf"},{"key":"2025101810590148000_14.1.e073789.7","unstructured":"WHO . Ensuring Sustainability: immunization financing in an era of transition; 2016. Ministerial conference on Immunisation in Africa Available: https:\/\/www.afro.who.int\/sites\/default\/files\/2017-12\/MCIA%20Brief_Immunization%20Financing%20in%20an%20Era%20of%20Transition.pdf"},{"key":"2025101810590148000_14.1.e073789.8","unstructured":"WHO . Immunization, vaccines and biologicals. 2022. 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