Financing Immunization
GAVI Financing
Task Force
Terms of Reference
Financing Task Force
As adopted at the GAVI Meeting of the Proto-Board
Seattle, Washington 12-13 July 1999
Background
Over the last year the key issues confronting
a re-vitalized vaccine and immunization initiative were identified
through a broad consultation. It is expected that this will lead
to the launch of a new global partnership in the fall of 1999. The
objective of the new coalition is to reduce vaccine preventable
disease by making new vaccines of public health importance available
to all, and the specific goals are:
- Improved access to sustainable immunization
services,
- Expanded use of all existing cost-effective vaccines,
- Accelerated development and introduction of new
vaccines, and
- Expanded R&D efforts for vaccines and related
products needed especially for developing countries
The key issues include the need to address financing,
strengthen advocacy for immunizations, strengthen co-ordination
at the country level and strengthen research and development for
priority vaccines in developing countries. Three Task Forces have
been established on advocacy, global financing and country level
co-ordination and a Task Force on R&D is being reviewed.
The Task Force on Financing will be responsible for
increasing the understanding of why there is inadequate funding
for vaccines and immunisation in the poorest countries and identifying
and assessing strategies which will improve the capacity of countries,
donors and development Banks to finance the improvement and expansion
of national immunisation programs. The task force will also identify
and assess strategies for stimulating research development required
for the production of new vaccines especially targeted for use in
the developing world.
Addressing the financing gap requires the involvement
of all the partners in immunization including ministries of finance,
ministries of health, Bilaterals, industry, WHO, UNICEF, NGOs such
as the Gates CVP or Rockefeller, and development Banks. Financing
of immunization varies tremendously from country to country. Some
governments are financing all of the national needs and give a very
high priority in the budget to vaccine and immunization needs. Other
countries rely heavily on donors even when there is no promise of
long-term support. The importance of external financing varies widely
depending on the countrys relative and absolute capacity to
finance their needs, particularly the introduction of new vaccines.
Addressing the financing gap will likely be a combination
of the following:
- increasing national budgets and mobilizing additional
in country resources by examining options such as community based
prepayments, cross subsidization form other programs, insurance
programs, increased contributions from local governments, increase
participation of NGOs and the private sector, and improved program
management and efficiency, to finance national needs given the
differing wealth of countries and exploring;
- targeting donor resources towards the neediest
countries and highest priority vaccine or infrastructure uses;
- increasing the awareness and use of credits and
loans available for immunization priorities through health projects
with the World Bank or the regional development Banks;
- identifying and developing new financing mechanisms
such as a Vaccine Fund;
- exploring strategies to ensure vaccines are affordable
for countries given differences in wealth;
- Ensuring new vaccines are developed and scaled-up
in ways that enable affordable prices to be set.
Task Force membership
USAID co-leader
World Bank co-leader
Developing country representative (s)
Representative from Industry (2)
UNICEF
WHO
Gates CVP: cost-effectiveness expert
Health economists: academia
Process
The Task Force members, with the World Bank
and USAID co-leading, will be responsible for developing a global
agenda and a workplan to address the question posed to the Task
Force. The Task Force will ensure the priority activities outlined
in the Agenda are addressed through the partner agencies. The Task
Force will monitor progress against the Agenda and will periodically
review and revise the Agenda. The Bank and USAID, with other partners
will identify a coordinator to manage the Task Force, share information,
organize meetings, and do research and analysis as requested by
the Task Force. The Task Force is expected to meet roughly four
times per year. Core members will be requested to attend all Task
Force meetings and specialists will be invited to participate in
meetings addressing specific topics. The Task Force is expected
to be in existence for a limited duration and will review its role
and terms of reference in one years time.
Support for the Task Force will be provided by the
Secretariat.
Outcomes/outputs
Short term
In preparation for the proposed launch of the Global
Coalition, the Financing Task Force will prepare an estimate of
the costs of each of the quantified milestones. It is still unclear
the role of the Task Force vis-à-vis the development of the Vaccine Fund.
Long term
The Task Force is responsible for identifying, analyzing
and providing recommendations on financing policy issues and for
identifying and potentially filling information needs in the financing
and economic domain. The Task Force will periodically review the
range of financing issues which need to be addressed and, through
a prioritization exercise, develop the Task Forces workplan
for the coming 1-2 years. The preliminary list of issues which the
Task Force should address include:
Increase affordability and availability of vaccines
- Analysis of options for stimulating research
and develop of products targeted for use in the developing world;
- Identification and analysis of new and existing
mechanisms for ensuring vaccines are affordable for the children
in the poorest countries (including market segmentation and differential
pricing);
- Analysis of current constraints to vaccine procurement;
- Review and identification of new procurement options;
- Analysis of methods of influencing production costs
Increase National Investments in immunization programs
- Assessment of option available to countries to
use to sustainably increase national funding of immunization programs;
- Assess the utility of targets for expected minimum
levels of financing responsibility from governments and other
national sources;
- Development of a module providing guidance on
the key financing components to be assessed in an immunization
program;
- Analysis of the role and impact of existing expenditure
review mechanisms such as public expenditure reviews and national
health accounts;
- Identification of mechanisms to ensure that the
data necessary for financial decisions at the country-level (e.g.
cost-benefit) are available;
- Assessment of financial impacts of health reform
strategies on national immunization programs;
Optimization of external investments
- Development and implementation of new international
mechanisms for financing immunization programs;
- Assess the utility of establishing targets for
external funding of immunization programs given the country and
the component of the program to be supported (e.g., vaccines or
infrastructure)
- Identify and disseminate information on Best Practices
for financing such as the World Bank project in Bolivia;
- Analysis of the implications of donor financing
patterns and approaches;
- Identify mechanisms and/or workplan to assess resource
flow patterns and their impact;
- Establishment of mechanism to ensure that
that data needed for decisions related to financing ( e.g., cost
benefit analysis, vaccine forecasts) are available;
Areas which are NOT the responsibility
of the Task Force
Fund Raising (a collective responsibility)
Data collection for monitoring (responsibility of the GAVI Secretariat
to explore)
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