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Fifth GAVI Board Meeting, 21-22 June 2001, London, England
June 2001
Sustainable Immunization Services
Status
Report on Development of Guidelines for Countries
In June
2000, the GAVI Board charged the Financing Task Force (FTF) to develop
guidelines for Fund-eligible countries as to how improved immunization
programs can be sustained once catalytic support from the Vaccine Fund
ends. The challenge is significant and growing, particularly given the
commitment of GAVI, countries and their partners to move beyond
maintaining today’s immunization programs. GAVI partners must plan now
to sustain the improved immunization programs of tomorrow.
There is an
emerging consensus that while responsibility for immunization rests
fundamentally with the national government, for many of the
lowest-income countries, the sustainability of improved immunization
programs will be a shared responsibility of countries and partners for
some time to come.
Efforts to
date
Using a wide
consultative process involving hundreds of individuals and organizations
in both developing and developed countries, the FTF has:
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Established a 20-member FTF Financial Sustainability Group comprised
of international health and financing experts to support the core FTF;
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Commissioned Dr. Ruth Levine et al., at The World Bank to write
Sustaining Immunization Programs: Issues and Options to clarify the
issues surrounding financial sustainability and provide a framework
for subsequent discussion and debate (in final draft form).
-
Convened a
WHO-CVP-USAID Workshop on Financial Sustainability June 4-6, 2001 with
country teams that included representatives of the MOH, MOF, and
in-country partners from Bangladesh, Benin, Ukraine, and Zimbabwe;
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Developed
a financing ‘briefcase’ exploring the range of financing options
available to countries for immunization financing (in final draft
form).
Financial
sustainability – an updated definition
Traditionally, financial sustainability has been synonymous with
"self-sufficiency," often applied to situations where external donors
sought to induce developing country governments to mobilize domestic
resources for activities that had previously been externally funded. The
FTF considers that interpreting financial sustainability as
"self-sufficiency" is inconsistent with – and for many countries in
direct opposition to – established GAVI milestones and objectives of
increasing coverage and introducing new vaccines.
The ‘new’
emphasis currently being explored by the FTF is to move away from the
single-minded attention to phasing-out external funding, and toward the
question of how to structure the immunization financing package – and
equally importantly, how to use available resources more efficiently –
so that sufficient funding is available on a reliable basis.
Based on
consensus at the recent WHO-CVP-USAID Workshop on Financial
Sustainability, the current working definition of financial
sustainability reads:
Although
self-sufficiency is the ultimate goal, in the nearer term sustainable
financing is the ability of a country to mobilize and efficiently use
domestic and supplementary external resources on a reliable basis to
achieve target levels of immunization performance.
This
definition seeks to capture the following elements:
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Fundamental importance of national commitment and funding for
immunization with self-sufficiency being the ultimate goal;
-
Varying
ability of countries to support their respective immunization programs;
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Focus on
program performance, rather than on inputs;
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Importance
of adequate and reliable resources to ensure that countries are able
to meet immunization performance goals into the future;
-
Focus on
the increasing resource requirements necessary to achieve GAVI goals;
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Importance
of using resources more efficiently.
Next steps
Recent work
of the FTF has highlighted the need to recognize the multiple dimensions
of financial sustainability and for financial sustainability to become
an integral part of future multi-year planning, with progress monitored
as part of annual program and financial reviews.
Over the
coming months, the FTF will:
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refine key
financial indicators (indicators will be few in number, easily
interpretable, readily collected and will likely span several
dimensions of financial sustainability);
-
define
global financing targets (FTF will likely be proposing two global
financing targets – for countries and for donors – for consideration
by the Board at a future meeting);
-
draft
guidelines for country sustainability plans using a wide consultative
process.
The FTF will
also identify GAVI partners that will commit to supporting countries in
the preparation and implementation of financial sustainability plans.
At the
recent WHO-CVP-USAID Workshop, there was consensus that financial
sustainability guidelines should require governments to demonstrate
their national commitment to immunization. In some countries, this may
be a plan to establish (if not already in place) a line item in the
national budget with enacting legislation authorizing a minimum level of
funding. For countries engaged in health sector reform and Sector Wide
Approaches (SWAps) suggestions may be made as to how countries can
ensure that immunization programs are protected, likely through program
performance requirements.
The FTF will
be submit draft financial sustainability guidelines for consideration at
the next GAVI Board meeting.
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