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Advocacy: Communication efforts that generate and maintain support for immunization programmes.

Aggregate costs: A total cost created from the sum of individual components of costs.

Allocative efficiency: The distribution of health sector resources to maximize health benefits. Funding an immunization programme, for example, shows allocative efficiency because such programmes are usually very cost effective.

Annualization: A method of determining the loss in value of a purchased item over the course of a year. Annualization allows you to determine the value of an item during the years it is being used. See depreciation.

Approximation: An estimate that is close enough to actual circumstances to be used in financial planning.

Assumptions: For purposes of planning and budgeting, factors that are considered to be true or real, even though you do not yet have data to prove them. For example, when developing a budget, you must make assumptions about the future costs of vaccines.

Bilateral agency: An entity, usually an official agency of an individual country, which deals directly with another country to provide financial and/or technical assistance.

Budget: A detailed plan that shows the amount of money and other financial resources a programme requires and how it will be used. Budgeting is the process of writing this plan.

Budget line item: A line in a budget showing how much is planned to be spent on a specific component of the overall programme.

Buffer stock: Vaccines and syringes kept in storage to safeguard against unexpected shortages or high demand. Typically the amount is equivalent to approximately 25% of the quantity needed for one year.

Capital costs: The cost of any item that lasts longer than a year, such as cold chain equipment and vehicles. Also called non-recurrent costs. Compare with operational costs.

Clinical trials: Research studies using consenting human subjects that are designed to determine whether new drugs or treatments are safe and effective.

Community financing: Refers to many different community-based mechanisms for funding services, including micro-insurance, community health funds and revolving funds for drugs.

Core funding: Funding from donors that is unrestricted and can be spent on any aspect of an immunization programme. Also called untied funding. In contrast, restricted funding must be spent only on items approved by the donor.

Cost-benefit analysis: Seeks to value and compare all costs and benefits (measured in dollars or other currencies) that result from alternative interventions. It can be used to compare two or more different health programmes, such as malaria control and immunization, to see which provides the most benefits per unit cost. That is, it is used to determine which programmes offer the most efficient use of resources.

Cost effectiveness: A way of measuring value to ensure that the benefits of goods and services are worth the costs.

Cost effectiveness analysis: Compares different ways of achieving the same objective in an effort to identify the least expensive way of achieving that objective. Cost effectiveness is measured using one outcome, such as number of lives saved or number of children vaccinated.

Costing: The process of determining how much your programme costs during one year.

Costing table: A chart that lists a programme's operational and capital costs, and sources of funding. Costing tables can help managers identify their programme's main costs and areas of potential savings, see their main sources of funding, and spot trends in both.

Cost per capita: A way of showing how much a good or service costs per person when spread out over a population. For example, immunization cost per capita shows the cost of immunization services for each person in a country or district.

Costs: The value of the resources, both monetary and non-monetary, used to produce a good or service. Compare to expenditures, which refers to the total amount of money spent on a good or service. See financial costs, economic costs, capital costs, operational costs, shared costs, programme-specific costs, fixed costs, and variable costs.

Cross-subsidies: Subsidies in which some customers pay more for a good or service so that others can pay less for the same or other goods or services.

Debt relief: Refinancing or cancellation of the principal and/or interest payments on loans to developing countries.

Decentralization: The transfer of authority and responsibility for public functions from the central government to provincial or district governments.

Deficit: A government, programme or organization has a deficit when the amount of money spent is more than money obtained, losses are more than profits or financial obligations are more than assets.

Depreciation: Used when describing capital items. Almost any purchased item is worth slightly less each day. This is depreciation.

Direct costs: Resources used to provide a service, such as vaccines and syringes.

Disability adjusted life years (DALYs): A quantitative indication of the burden of disease that takes into account the years of healthy life lost due to disease.

Economic costs: The total value of resources, both monetary and non-monetary, used to produce a good or service. For example, the economic cost of human resources in an immunization programme is the amount of salaries paid (the financial costs) plus the value of volunteers' work and the value of parents' time spent bringing children to immunization sessions.

Economic evaluation: A comparison of the costs and benefits of two alternative actions, for example, improving coverage using a campaign or with outreach. Economic evaluation helps managers decide how to allocate resources.

Effectiveness: The degree to which an activity or programme achieves its objectives. For example, a highly effective polio programme eliminates polio. An ineffective programme does not decrease the prevalence of polio.

Efficiency: The ability to achieve objectives for the least cost. See allocative efficiency and technical efficiency.

EPI: Expanded Programme on Immunization, an international programme launched by WHO in 1974 to increase immunization of the world's children. EPI originally targeted vaccines for six diseases: measles, diphtheria, pertussis, tetanus, tuberculosis and poliomyelitis.

EPI vaccines: Vaccines commonly included in the Expanded Programme on Immunization (EPI). The basic EPI vaccines include tuberculosis (BCG), oral polio vaccine (OPV), diphtheria, tetanus and pertussis (DTP), hepatitis B (HepB), measles, and in some countries yellow fever.

Enhanced pediatric vaccines: Vaccines that have been added to the infant immunization schedule in many countries in recent years, such as combination vaccines containing hepatitis B (HepB); combined measles, mumps and rubella (MMR); Japanese encephalitis; and Haemophilus influenzae type B (Hib).

Equity: The fair distribution of health care resources and benefits across a population. Equity does not necessarily mean equal distribution since some parts of the population may have greater health needs and require more resources. In immunization programmes, equity means all children have access to, use, and benefit from immunization services.
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Expenditure: The amount of money spent on a good or service during a particular period of time. For example, the amount of money spent on vaccines in a year.

Financial costs: The amount of money spent on a good or service. Often used in a financial plan.

Financial planning: A process that allows you to manage your programme's finances efficiently.

Financial plan: The document that results from the financial planning process. A financial plan can help you plan strategically and use your finances efficiently.

Financial sustainability: The ability of a country to efficiently and reliably use domestic and supplementary external resources to improve the accessibility, use, quality, safety and equity of its immunization services on an ongoing basis.

Financial sustainability plan (FSP): A structured approached, first developed for use in GAVI/VF-countries, to assess a programme’s financing challenges and describe the strategic approach by a government and donors to supporting medium- and long-term programme objectives.

Financing: Refers to the amount and sources of money for an activity or programme. Interchangeable with "funding." Compare with economics.

Financing gap: The difference between the amount of money you need to run your programme achieving programme objectives and the money you expect to receive. Narrowing the gap is a primary purpose of financing strategies.

Financing profile: An analysis of financial data that shows individual sources of funding as a percentage of a programme’s total funding.

Financing sources: Entities that provide funding for an immunization programme, including governments, multilateral and bilateral agencies and private donors.

Financing strategies: Actions taken to achieve a programme’s financial goals. For example, reducing vaccine wastage is a strategy to improve programme efficiency. Two other areas strategies are organized around are resource mobilization and reliability of funds.

Fiscal reforms: Changes governments make in the way money is managed nationally, for example, in how the tax system works or in whether local or national government maintains responsibility for certain programmes. See decentralization.

Fixed costs: Costs that do not vary with fluctuations in volume, frequency or activity. For example, administrative salaries will remain the same whether 100 or 200 children are immunized

Funding: Refers to the amount and sources of money for an activity or programme. Interchangeable with "financing." Compare with economics.

GAVI: Global Alliance for Vaccines and Immunization, a public-private partnership that includes national governments, UNICEF, WHO, the vaccine industry and other partners that focuses on increasing access to vaccines in developing countries.

Good Manufacturing Practices (GMP): A detailed set of standards agreed to by WHO and regional and national regulatory agencies to assure the quality of medicines and biological products.

Grants: Money, technical assistance or equipment transferred between nations or organizations with no expectation of repayment.

Health sector: The portion of a nation's economy and services that deal with health.

Health sector strategic plan (HSSP): A plan for delivering health services that describes overall goals and objectives, prioritizes programmes and serves as a framework for more detailed planning.

Highly Indebted Poor Countries II (HIPC II): A programme of accelerated debt relief managed by the World Bank. Countries that meet certain criteria and adhere to requirements may receive HIPC II debt relief.

ICC (Interagency Coordinating Committee): An ICC is a committee of immunization partners involved in funding and providing immunization services in a country. The ICC ensures that all individuals and groups work together to develop multi-year plans, develop and support immunization policy, monitor activity, and ensure adequate funding and resources for immunization.

IEC: Information, Education and Communication, for example materials used for social mobilization and advocacy.

Indicators: Measures established to determine how well a programme is performing. Indicators are usually monitored at regular intervals and compared to a standard, or baseline. For example, to measure external programme support, a manager may choose to track levels of donor funding over a period of time to identify either increases or decreases.

Indirect costs: Resources that support a service, but that are not directly involved in providing that service, such as building maintenance costs.

Inflation rate: The percentage increase, usually calculated annually, in the prices of goods and services.

Inputs: Supplies or equipment needed to run your programme. They include vaccines, injection supplies, vehicles and staff salaries.

Know-how: Knowledge and experience about vaccines and their production that vaccine producers acquire over time.

Marginal analysis: A process that examines the costs and benefits of changes to a programme or service, relative to a baseline or existing norm.

Market divergence: The increasing trend for developed countries to use one set of generally more expensive vaccines, and developing countries to use a different set of generally cheaper vaccines. Ten to 20 years ago, both groups of countries used largely the same vaccine products.

Market segments: Groups of customers, usually defined by wealth, with similar needs and buying patterns. For example, industrialized countries make up one segment of the vaccine market while low- and middle-income countries make up separate segments.

Mature market: Environment for vaccine sales which is characterized by multiple and competing manufacturers of the same product. Additional characteristics include expired product patents and excess production capacity.

Microplans: Detailed planning documents developed at the sub-national, generally district, level.

Multilateral agency: An agency, such as WHO or the African Development Bank, whose membership and governance structure comprises several countries and that acts independently to fulfill its mandate.

Multi-year plan: Usually refers to the 5-year strategic/activity plan of an immunization programme.

National Regulatory Authority (NRA): A regulatory agency established by a national government to assure that the pharmaceuticals used in the country are safe and effective. NRAs often are part of the country’s drug regulatory agency, but some countries have separate agencies for the control of vaccines and biological products.

Operational costs: Costs that must be paid every year, such as expenditures for salaries, vaccines, fuel, equipment maintenance, staff training and costs of monitoring and disease surveillance. Also called recurrent costs. Compare with capital costs.

Opportunity cost: The cost of an opportunity that is missed in order to produce something else. For example, a country that chooses to produce one product misses the opportunity to produce another type of product.

Outsourcing: Contracting with outside agencies or businesses to provide services that would otherwise be conducted by staff inside of an organization or programme.

PAHO: Pan American Health Organization, a regional office of the World Health Organization. PAHO's mission is to improve the health of the peoples of the Americas and strengthen the region's national and local health systems, including immunization programmes. Among its operations is a revolving fund for vaccine procurement.

Patents: Form of intellectual property rights granted to inventors of new products or technologies, including vaccines. Patents can be given for the vaccine itself, its components or the manufacturing process. Patents allow companies the exclusive right to produce and sell the vaccine for a set period of time, potentially 20 years.

Pie chart: A graphic representation of data, often percentages, as pieces in a round chart; called a pie chart because the pieces resemble slices of pie.

Poverty reduction strategy paper (PRSP): A document that describes a country’s macroeconomic, structural and social policies and programmes in an effort to promote growth, reduce poverty and identify external financing needs. PRSPs are prepared by governments in association with development partners such as the World Bank and the International Monetary Fund.

Programme costing: An estimate of the actual value of goods or services a programme uses.

Programme-specific costs: Costs that apply only to immunization services, such as vaccines, in-service training and direct programme management. Compare with shared costs.

Proprietary pediatric vaccines: Newer vaccines that are made typically by a single producer and protected by exclusive patents. They include varicella, pneumococcal conjugate and rotavirus vaccines.

Resource mobilization: The process of obtaining the money, personnel and equipment necessary to run an immunization programme.

Resource requirements: Financial (e.g., money) or non-financial (e.g., trained staff) inputs needed for the immunization programme to operate at anticipated levels.

Revolving fund: A fund established to carry out specific activities, which, in turn, generate payments to the fund that are used to carry out the activities again at a later time.

Sector-wide approach (SWAp): An organizational approach used by some governments in which donor support and funding is pooled to support a comprehensive vision for the health sector. This compares with traditional approaches, which generally are structured according to health intervention (e.g., Immunization; Malaria, etc).

Shared costs: Costs shared by more than one service, such as the costs of health facilities and staff that provide immunization services as well as other health services. Shared costs often represent the largest part of a government’s contribution to an immunization programme, but they can be difficult to measure. Compare with programme-specific costs.

Short-term training: Training of less than a year for staff of immunization programmes.

Social cost: See economic cost.

Social health insurance: System of funding elements of health care provision in which the government pools contributions from across the population.

Social mobilization: Refers to actions, such as advocacy and community education, that raise awareness among people and influence them so that they have their children immunized.

Spreadsheet: A computer programme that lists financial data in rows and columns to make calculations and adjustments to totals based on new data.

Sub-national: Levels of government below the national or central government.

Supplemental immunization activities (SIAs): Immunization activities conducted in addition to the routine immunization programme. For example, campaigns to eliminate polio.

Technical efficiency: Refers to achieving a programme objective for the least cost. For example, managers may want to know the most technically efficient, or least expensive, strategy to improve coverage. Some factors that affect technical efficiency include low vaccine wastage, good stock management, and preventive maintenance on the cold chain.

Tiered pricing: A method of pricing vaccines according to the income levels of countries. Under tiered pricing, wealthier countries generally are charged more than low-or middle-income countries for the same vaccines.

Transaction costs: The costs in money and time incurred when accomplishing a task, such as procuring vaccine.

Trust fund: An amount of money invested such that the interest generated can be used for a specific benefit. The interest received on a regular basis is used for the intended benefit (e.g., procuring vaccines or medicines) without decreasing the main pool of money, thereby providing a long-term source of financing.

UNICEF: United Nations Children's Fund, a United Nations agency that focuses on the rights of children worldwide. One of UNICEF's priorities is childhood immunization.

Unit cost: The cost per item; in this case, the cost per dose of vaccine.

Useful life: In capital costs, the length of time a product (e.g. vehicle or refrigerator) can be anticipated to operate before it is likely to need replacement.

User fees: Fees charged to users of goods or services. For example, fees charged to patients for curative services. User fees are not recommended for immunization.

Vaccine Fund: A fund established to encourage countries with a per capita GNP of $1,000 or less to strengthen their immunization programmes and introduce new and under-used vaccines. Awards are based on country proposals made to the the Board of the Global Alliance for Vaccines and Immunization (GAVI).

Value: The worth or price, often expressed as a sum of money, of goods and services.

Variable costs: Costs that vary directly or proportionally with changes in volume or activity. For example, the cost of syringes increases or decreases depending on the number of children immunized.

Volume: The number of doses of vaccine purchased during a specific period.

WHO: World Health Organization, the United Nations agency for health.

WHO pre-qualification: A procedure for the initial evaluation of vaccines that ensures quality by assessing the vaccine and the national regulatory authority in the country of manufacture. UN agencies accept only products that are on the WHO pre-qualification list.