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EIGHT DEVELOPING COUNTRIES TO BE PAID $15M FOR IMMUNIZING MORE CHILDREN
Innovative grants program challenges health systems to be accountable for results
GENEVA, Switzerland - 11 December 2003 - In a groundbreaking new grants program, eight developing countries will receive $15 million in performance-based payments for their achievements in increasing immunization rates. At its meeting on 9-10 December here in Geneva, the Board of the Global Alliance for Vaccines and Immunization (GAVI) approved performance funding to Azerbaijan, Ghana, Mali, Pakistan, Rwanda, Tanzania, Uganda and Tajikistan. These countries’ externally audited health data show that they have succeeded in reaching more of their children with life-saving vaccines in the past three years.
Under the program, countries applied for the grants by submitting to GAVI their long-term strategies to reach more children. The GAVI Board, which bases its decisions on recommendations from an independent expert panel, approved successful applications for three years of investments in the countries’ immunization systems. These funds could be used in any way countries deemed most appropriate; the only requirement was results. In the fourth year, additional funding is only available to countries that have actually reached more children.
For example, when Tanzania first applied to GAVI in 2000, the country was immunizing 950,000 infants annually, or 74% of those born, with three doses of the diphtheria, tetanus, pertussis vaccine (DTP3) - used as an indicator for basic immunization coverage. By 2002, 1.2 million infants, or 89% of those born, had access to DTP3. This success means that in addition to the $2.4 million investment provided between 2001 and 2003, GAVI will provide an extra $3 million for Tanzania in 2004.
“This is groundbreaking territory. Donors have long talked about basing funding decisions on actual performance, but we haven’t seen a lot of real action in this area yet”, said Tore Godal, Executive Secretary of GAVI “GAVI is forging an approach of development aid that is based on mutual respect and accountability.”
To date, 16 countries have each received three years of immunization system investments from GAVI. Eight of them - Armenia, Burkina Faso, Cameroon, Côte d'Ivoire, Haiti, Kenya, Liberia, Madagascar, Mozambique and Sâo Tome - will not qualify for performance-based payments. These countries have not been able to increase their immunization rates in the past three years, or their reported coverage data could not be externally verified. However, as soon as the countries are able to turn around their performance, the funding will start to flow again. In addition, most of these countries had been contacted by GAVI earlier this year to devise a payment plan that reduced the 2003 payment and stretches a portion of the funding into 2004 to ease the transition.
“GAVI partners are actively supporting all countries. Those countries that do not qualify for the performance based payments in 2004 have already received technical and strategic support so that the problems in their systems can be fixed so that more children will have access to vaccines,” said Dr Godal. In addition, a number of the countries are also receiving vaccines such as hepatitis b or yellow fever from GAVI - support which will continue so that children can be protected.
GAVI and its financing arm, the Vaccine Fund, were launched in 2000 to boost falling global immunization rates and reduce the gap in access to newer vaccines. In addition to the performance grants, GAVI is providing hepatitis B, Hib and yellow fever vaccines to countries through the same application process that requires strong planning and commitment to achieve results.
In less than four years, GAVI resources from the Vaccine Fund - coupled with the technical support provided by GAVI partners - have helped countries reach 8 million more children with basic vaccines and more than 30 million children with the newer vaccines. GAVI estimates that more than 300,000 lives will be saved because of the increased efforts. GAVI’s success has prompted newer funds, such as the Global Fund to Fight AIDS, TB and Malaria, to model their programs after the GAVI approach.
Because of the poor state of many developing countries’ information systems, GAVI partners developed a new tool called the data quality audit (DQA) which provides external verification that the immunization data reported to GAVI are correct. Described simply, external audit teams examine health center records and compare them to reports sent to district and national levels, verifying accuracy. Through this mechanism a number of countries have already identified specific problems and are fixing them. Tanzania failed its first DQA conducted in 2001. By 2002, it passed.
Launched with an initial grant from the Bill & Melinda Gates Foundation, The Vaccine Fund has been further financed by nine governments and additional private contributors, bringing its total commitments to $1.2 billion through 2004. With its annual funding to countries on the rise, The Vaccine Fund will need substantial new funding by the end of 2004 to continue supporting GAVI activities.
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