As many low- and middle-income countries pursue Universal Health Coverage (UHC) while maintaining robust immunization programs, Ghana's experience offers valuable insights. With support from Gavi, the Vaccine Alliance, ending by 2030, Ghana faces a critical transition demanding innovative approaches to sustainable vaccine financing. The question is no longer whether to integrate immunization into Universal Health Coverage (UHC) frameworks, but how to do so effectively.
Why Integration Matters
Immunization is one of the most cost-effective public health interventions yet often faces funding instability in donor-dependent contexts. This is particularly true of the current times when donor funding to global public health is dwindling. As Ghana prepares to fully self-finance its immunization program, integrating vaccine procurement into the National Health Insurance Scheme (NHIS) has emerged as a strategic pathway to ensure sustainability.
Established in 2003, the NHIS provides equitable health care access to all Ghanaians. It's funded through a 2.5% National Health Insurance Levy on goods and services, 2.5% of Social Security contributions and income generated from investment of the Fund’s (NHIS) reserves. Ghana's UHC Roadmap (2020-2030) commits the NHIS to allocate at least 50% of resources to primary health care by 2030.
The NHIS-Immunization Financing Connection
At the outset, the NHIS was supposed to cover 95% of disease conditions without preventative interventions such as immunization services. However, a critical mechanism exists: the 2012 NHIS Act revision mandates that 10% of NHIS expenditure goes to the Ministry of Health for non-core activities. Of this allocation, approximately 21% funds vaccine procurement—Ghana's primary domestic source for vaccines.
In 2025, the government significantly boosted NHIS funding. Parliament approved GH¢10.7 billion—a 66% increase from GH¢5.9 billion in 2024. The increase was the result of government uncapping the National Health Insurance Levy and this has created new opportunities for sustainable immunization financing. The National Health Insurance Authority (NHIA) is a key partner in executing Ghana's payment of its contributions to Gavi’s vaccine support known as its Gavi co-financing obligation.
While Gavi has been covering most of the cost of a large list of vaccines for Ghana under its co-financing mechanism since 2000, Ghana must achieve full self-financing by 2030. This means the country’s vaccine funding gap could grow from $73.9 million in 2024 to $135.2 million in 2030. Having experienced vaccine payment defaults in 2014, 2016 and 2018, Ghana urgently needs a reliable domestic funding mechanisms that can be anchored on the NHIS.
Advocacy that Delivers Results
Since 2023, Hope for Future Generations (HFFG), supported by the Global Health Advocacy Incubator (GHAI) through Gavi funding, has led a comprehensive advocacy campaign for sustainable immunization financing in Ghana. HFFG's locally driven strategy combines evidence generation, political engagement and citizen mobilization.
The results are encouraging:
Financial commitments: Ghana increased immunization spending by 44.4%, achieved 100% payment of its 2024 and 2025 co-financing obligation through NHIA.
Policy victories: For the first time, the country’s 2025 budget statement explicitly mentioned immunization.
Lawmakers, in collaboration with GHAI AND HFFG, formed a Parliamentary Immunization Caucus to support advocacy for domestic resource mobilization towards immunization self-financing.
Recognition: HFFG and GHAI are formally implementation partners of the Ministry of Health on Ghana’s Roadmap for Immunization Self-Financing.
These results were made possible by HFFG's three-pronged strategy:
Evidence-based advocacy: Analyses revealed Ghana allocated only 0.8% of its healthcare budget to vaccines—far below the 2.8% average among Gavi countries.
Political engagement: Strategic meetings with the Ministry of Finance, Parliamentary Select Committees and NHIA contributed to securing commitments for timely vaccine co-financing payments.
Citizen mobilization: Media advocacy, meetings with government and other decision makers, and community engagement is creating public awareness on Ghana’s immunization financing obligations and gaps, thereby ensuring that immunization financing is prominently featured in national policy discussions and plans.
Lessons for Other Countries
Ghana’s demarche demonstrates that integrating immunization into UHC frameworks is both feasible and effective. The NHIS mechanism provides a sustainable domestic funding stream that outlasts donor transitions. However, success requires persistent advocacy from civil society with deep local knowledge, combined with technical support from partners like GHAI.
Creating dedicated political structures—like Ghana's Parliamentary Immunization Caucus—ensures immunization remains a priority amid competing demands. As HFFG continues advocating for advance payment mechanisms and dedicated budget lines, the message to other low- and middle-income countries is clear: integrating immunization into UHC requires political will, strategic advocacy and determination to protect every child's right to health.
