70 percent of the world’s children live in the 75 poorest countries of the world
GAVI partners decided early on to use the resources of The Vaccine Fund in the poorest countries of the world. In 2000, GAVI invited all countries with less than $1000 per capita annual Gross National Income - to submit proposals for financing.
By 2001, 53 countries were already approved for support, and by the end of 2003, 69 out of 75 eligible countries have been approved for support from the Vaccine Fund -- a brisk pace for a brand new international aid program.
To be eligible for any kind of country support from The Vaccine Fund, countries must have:
- Annual gross national income (GNI) of less than US $1000 per capita
- National coordination of funding and technical input through an inter-agency coordinating committee for immunization (ICC), or equivalent collaboration mechanism
- A recent assessment of the system to deliver immunization services
- A multi-year plan for immunization that incorporates recommendations from the assessment
- A strategy to improve safety of injections
Countries that meet the above criteria may apply for the following support:
- Countries where more than 80% of children receive full immunization against diphtheria, tetanus and pertussis (DTP3) can apply for support to provide hepatitis B, and Haemophilus influenzae type b (Hib), or yellow fever vaccines, as long as they are appropriate considering the country’s disease burden (hepatitis B is recommended for use globally).
- Countries with DTP3 coverage between 50% and 80% can apply for the above vaccine support and financial support to increase access to immunization under the performance grants program.
- Countries with less than 50% DTP3 coverage can apply for financial support to increase access to immunization and yellow fever vaccine. Once countries have achieved at least 50% DTP3 coverage they qualify for the hepatitis B and Hib vaccines as well.
- All eligible countries can apply for supplies and funding to improve safety of all immunization injections.
Examples of programs around the world:
One-third of the world’s individuals infected with hepatitis B live in China. Every year, as many as 280,000 Chinese die from liver cancer and other liver ailments caused by hepatitis B.
China’s participation in GAVI has raised the profile of its hepatitis B program and accelerated the introduction of 500 million auto-disable syringes. Re-use of needles and syringes has been a leading cause of hepatitis B infection here. In addition, the project is stimulating domestic production of auto-disable syringes.
In 2002, China matched GAVI and the Vaccine Fund’s contribution to its national efforts - a program first-- bringing total immunization resources to US$ 75 million dollars and marking the country’s long-term commitment to this endeavor. Following a five-year period of GAVI support, China will assume all programme costs, and provide the hepatitis B vaccine free of charge to all newborns, including those born in China’s poorer rural provinces. Thus, over the next five years, as a result of this ‘first-of-a-kind’ funding arrangement, more than 35 million Chinese babies will be immunized against hepatitis B.
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In Ghana, the launch of GAVI galvanizes national political commitment to immunization as a healthcare priority. Ghana has used its cash disbursements from GAVI and the Vaccine Fund to computerize its healthcare facilities to improve recordkeeping. At low-performing sites, performance incentives have been established. Introduction of the new, pentavalent vaccines --DTP-hepatitis B-Haemophilus influenzae type b - allowed a broad-based, technical review of the knowledge and skill of healthcare workers.
In addition, Ghana has become the first country to undertake its own long-term immunization plans that phase in local funding as GAVI funding diminishes. Ghana made this decision after working on its financial sustainability plan, recognizing that commitment of its own funding would both extend the length of support from GAVI and the Vaccine Fund, and could encourage other funders to help the country maintain its vaccine programme.
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In Kenya, the minister of health implemented GAVI’s performance-based approach in local districts using GAVI funds to distribute checks to every district medical officer, based on the districts’ immunization rates, promising additional funds when immunization rates rise. The impact of this strategy is not yet known. Nevertheless, the Kenyans have created a decentralized, performance based payment system that bypasses usually back-logged, government channels, and suggests a possible framework for future international health care programs.
Data quality audits have motivated workers and streamlined the management of district health offices. Record-keeping is more systematic, employing new tools to improve performance: tracking outstanding issues, regularizing supervisory visits, posting reports publicly.
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This year marks the second in which the Tanzanians have exceeded their immunization targets in the administration of the tetravalent vaccine - DTP, plus hepatitis B. The Tanzanians manage the expansion of their immunization programme systematically. Poorly performing districts that nevertheless held latent promise were allocated GAVI funding that provided per diem payments to healthcare workers. In turn, the workers used the cash to buy bicycles and petrol enabling them to reach more chidren in remote districts.
The immunization program in Tanzania is also one of the first to benefit from debt-relief; the national government invested US$1 million in its immunization program with funds re-captured by HIPC - the Highly Indebted Poor Countries initiative.
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In Tajikistan, the local inter-agency coordinating committee, established in order to qualify for GAVI/Vaccine Fund resources, now meets regularly and is a dynamic forum that grapples with long-term plans to rebuild the country’s health care delivery system. The business-like GAVI framework has helped to mitigate a climate that was once dependent upon the Soviet system and ignite a new sense of enterprise and self-help.
In part, because of GAVI requirements, the country’s health officials have taken critical steps to move from the ponderous, outdated model of vertical, centralized health care to a more flexible approach that responds to local realities. Extraneous immunization posts are being closed. The overarching healthcare delivery system is rationalized, a process of de-centralization has begun in earnest.
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