Fifth
GAVI Board Meeting, 21-22 June 2001, London, England
June 2001
NEW GAVI Policy
User Fees and Financing Essential Immunization Services
Beginning in September 2002, countries that have received
support from GAVI/The Vaccine Fund will be submitting plans to the
GAVI Board indicating how they will assure the long-term financial
sustainability of improved immunization programs. These financial
sustainability plans are to be signed by the Minister of Finance
in each country.
The GAVI Financing Task Force is currently facilitating
a process of drawing upon partners and countries to develop financial
sustainability guidelines for consideration by the GAVI Board. In
the interim, however, there are indications that some countries
are proposing immunization user fees as a means to finance the introduction
of new vaccines and improved immunization programs as outlined in
their applications to GAVI/The Vaccine Fund.
In 2000, the GAVI Financing Task Force undertook
a major review of all information and documentation on user fees
for immunization and preventive health services. Research findings,
multilateral agreements and policies of the World Bank and United
Nations agencies all indicate that user fees discourage people from
seeking vaccination for themselves and their children and are a
disincentive to the utilization of preventive health services, in
general.
In addition to the deleterious effect of user fees
on peoples decision to use appropriate preventive health services,
user fees do not support national and international goals for more
effective immunization systems and expanded vaccine coverage. This
finding flows from the following:
- The positive externalities of immunization to
the wider community justify public expenditure to promote widespread
protection against disease and to stop disease transmission. As
such, immunization programs should be a high priority for national
government investment.
- One principal and positive externality
protecting unvaccinated individuals through decreased disease
transmission can only be achieved with high levels of immunization
coverage.
- There is no national or regional data to demonstrate
that user fees help achieve high levels of routine immunization
coverage.
- Vaccination is a preventive health intervention,
and is more sensitive than curative services to the discouraging
effects of user fees.
- Policies exempting the poor from user fees are
difficult to administer.
Given the aforementioned concerns and the importance
of conveying an interim message to countries, the Financing Task
Force requests the GAVI Board to issue a policy statement to the
following effect:
The GAVI Board recognizes that countries are
exploring a variety of mechanisms to fund essential and routine
immunization services. User fees have been shown to be a disincentive
to the utilization of preventive health services including immunization,
in particular. The GAVI Board therefore recommends that in the
absence of compelling country or regional data unequivocally documenting
their value, user fees should not be levied in publicly financed
national immunization services.
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