Characteristics of the regions studied.

Despite available funding mechanisms for COVID-19 vaccination programs, disparities persisted in certain areas. This study aimed to track the sources, allocation, and utilization of provincial and district-level government expenditures on the COVID-19 vaccination program in Indonesia to identify financial gaps affecting vaccination coverage. This study used a mixed-method approach to track the expenditure of Indonesia’s COVID-19 vaccination program in 2021 and 2022 using the System of Health Accounts (SHA) framework. We collected expenditure data and conducted focus group discussions and in-depth interviews with government representatives from targeted provinces and districts. Case studies were conducted in four Provincial Health Offices (PHOs) and four District Health Offices (DHOs) in Indonesia. The results of expenditure tracking show significant variation in the expenditure for the COVID-19 vaccination program across subnational levels, based on factors such as fiscal capacity, political commitment, national and regional priorities, access challenges, geography, existing immunization infrastructure, and private sector engagement. Despite these variations, most of the programs were primarily funded by the National or Regional Budget, with subnational governments highly dependent on central government budget transfers. The largest expenditures generally included funding for the cold chain, distribution, vaccinator incentives, and per diem.This study found that Indonesia’s complex health financing mechanism, coupled with limited fiscal capacity, struggles to ensure equitable vaccination delivery, especially in underserved areas. The budget transfer process from central to subnational levels is inadequate to account for vulnerabilities like geographical challenges. These disparities underscore the need for more coordinated and flexible health financing mechanisms during pandemics. Developing resource allocation guidelines and improving national-to-local resource distribution during health crises are essential for better outcomes.

尽管新冠疫苗接种项目已设立相关筹资机制，但部分地区仍存在接种资源分配不均的问题。本研究旨在追踪印度尼西亚省、区级政府在新冠疫苗接种项目中的支出来源、分配与使用情况，以识别影响疫苗接种覆盖率的资金缺口。本研究采用混合研究方法，结合卫生账户体系（System of Health Accounts, SHA）框架，对印度尼西亚2021至2022年的新冠疫苗接种项目支出进行追踪。研究团队收集了相关支出数据，并与选定省份和区县的政府代表开展焦点小组讨论与深度访谈。本研究在印度尼西亚的4个省级卫生办公室（Provincial Health Offices, PHOs）及4个区级卫生办公室（District Health Offices, DHOs）中实施了案例研究。支出追踪结果显示，印度尼西亚次国家级层面的新冠疫苗接种项目支出存在显著差异，其影响因素包括财政能力、政治承诺、国家与区域优先级、可及性障碍、地理条件、现有免疫接种基础设施以及私营部门参与程度。尽管存在上述差异，多数项目的资金主要来源于国家预算或区域预算，次国家级政府高度依赖中央政府的预算转移支付。主要支出项通常涵盖冷链系统建设运维、疫苗配送、接种人员激励以及出差津贴。本研究发现，印度尼西亚复杂的卫生筹资机制加之有限的财政能力，难以确保疫苗接种的公平可及，尤其在服务资源匮乏的地区。中央向次国家级政府的预算转移支付流程，未能充分考量地理条件限制等各类脆弱性因素。这些差距凸显出，在大流行期间亟需建立更具协调性与灵活性的卫生筹资机制。制定统一的资源分配指南、完善卫生危机期间国家至地方的资源分配流程，是提升接种成效的关键举措。