GAVI Board Meeting, 21-22 June 2001, London, England
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 todays 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:
- Established a 20-member FTF Financial Sustainability
Group comprised of international health and financing experts
to support the core FTF;
- 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
- 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;
- 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
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
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:
- Fundamental importance of national commitment
and funding for immunization with self-sufficiency being the ultimate
- Varying ability of countries to support their respective
- Focus on program performance, rather than on inputs;
- 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;
- Importance of using resources more efficiently.
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:
- 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
- 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.