Rational for Financial Sustainability Planning within the Immunization Sector

1
Rational for Financial Sustainability Planning
within the Immunization Sector
2
Defining Financial Sustainability

• 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 in terms of access,
  utilization, quality, safety and equity.
• - GAVI Board, London, June 2001

3
The Global Alliance for Vaccines and Immunization
(GAVI)

• Alliance of major partners working to support
  immunization
• Focus on collaboration and coordination to
  support achievement of global milestones
• Reviews country applications for immunization
  support

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What is the Vaccine Fund?

• Organization raising funds to support
  immunization programmes
• Focus on 75 countries of the world with
  GNP/Capita less than 1000
• Supports countries to introduce Hepatitis B, Hib,
  and yellow fever vaccines auto disable syringes
  and strengthening of delivery services

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What do GAVI and the Vaccine Fund do?

• Provide additional resources to increase
  coverage, improve program safety efficiency,
  introduce newer vaccines
• Improve partner coordination and contributions
• Support essential information systems and
  capacity building
• Foster movement toward sustainable financing
• Evolution toward adequacy and reliability in both
  domestic and external resources to meet expanding
  program objectives
• Improvement in program efficiency and financial
  management

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What is the relationship between GAVI and the
Vaccine Fund?

• Partners
• GAVI determines the policies for using the
• resources in the Vaccine Fund
• Vaccine Fund raises money to support GAVI
• policies

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Vaccine Fund Investments

• Additive Catalytic
• Support national plans
• Medium-term - 3 to 5 year commitments
• Assumes a transition of financial responsibility
  from Vaccine Fund to governments and partners
• Recapitalized to support new set of national
  priorities
• Challenge transition of financial responsibility

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Vaccine Fund Catalyzing funding for vaccine
introduction

Government/Partners
5
10
20
Years
9
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (Hep B, Hib, YF)

Government/Partners
5
10
20
Years
10
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (Hep B, Hib, YF)

Government/Partners
5
10
20
Years
11
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (next priorities)
Vaccine Fund (Hep B, Hib, YF)

Government/Partners
5
10
20
Years
12
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (next priorities)
Vaccine Fund (HepB B, Hib, YF)

Government/Partners
5
10
20
Years
13
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (AIDs, Malaria, TB?)
Vaccine Fund (next priorities)
Vaccine Fund (HepB B, Hib, YF)

Government/Partners
5
10
20
Years
14
Vaccine Fund Catalyzing funding for vaccine
introduction
Vaccine Fund (AIDs, Malaria, TB?)
Vaccine Fund (next priorities)
Vaccine Fund (HepB B, Hib, YF)

Government/Partners
5
10
20
Years
15
Percentage Change in Programme Costs with New
Vaccine Introduction
350
299
300
250
increase/decrease in
200
178
routine program costs
following GAVI-VF support
150
112
100
80
50
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19
18
12
13
3
0
Mali
Kenya
Malawi
Ghana
Guyana
Rwanda
Lao PDR
Cambodia
Mozambique
UR Tanzania
DPT-HepB-
DPT-HepB
DPT-HepB-Hib
YF
Hib YF
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Common Problems in Immunization Financing (1)

• Continuous increases in program costs resulting
  from improvements and expansions
• Inadequate, unpredictable national resources
• MOH budgets limited and unprotected from economic
  shocks

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Common Problems in Immunization Financing (2)

• Unpredictable external resources
• Support tied to partner priorities
• Traditional dependence on partners
• Vulnerable to changing partner trends
• Less than optimal attention paid to program
  inefficiencies
• Challenging systems for financial management
• Budgetary allocations based on low vaccine costs

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Meeting the Challenge

• Multiyear plans applications did not include
  rigorous financial analyses nor plans for
  addressing resource gaps
• GAVI requirement 2 years after initial Vaccine
  Fund award
• Established consultative process for determining
  how to support countries improve the financial
  sustainability of immunization efforts

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Overall Approach of FSPs (1)

• Link program objectives/changes to financing
  implications
• Start with program objectives and improvements
• Estimate costs of different scenarios
• Consider financial management and human capacity
  needs
• Consider larger changes in health and
  government/partner financing

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Overall Approach of FSPs

• Provide basic information for all interested
  parties to see and discuss
• Initiate a process of dialogue and planning which
  will need to continue
• Establishes clear picture of financing, human
  resource, and management needs based on good
  data and analyses
• Describes realistic and specific actions that
  will increase likelihood of FS
• Legitimize small steps towards sustainability

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Benefits for Countries

• Understanding program costs and financing
• Identify process and indicators for monitoring
  progress
• Advocacy opportunity - within MOH, with MOF,
  among Partners
• Feeds into and informs broader macroeconomic
  processes (PRSP/HIPC etc.)

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Benefits of FSPs For GAVI Partners/Vaccine Fund

• Understand program costs, financing available,
  resource environment, and resulting financing
  gaps
• Appreciate planned national actions
• Identify additional actions that partners must
  take at both national and global levels
• Assist in efforts to improve vaccine security

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Major Challenges for the FSPs

• Generate sufficient and strategic information not
  be an excessive reporting burden
• Meet government needs but fulfill a GAVI/VF
  requirement
• Be driven by data of reasonable quality not
  bogged down in data requirements
• Be usable in wide range of contexts (e.g. SWAps,
  MTEFs)

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Concerns

• FSPs are too ambitious and complicated
• FSPs estimates should be more accurate
• FSPs are needed for entire health sector
• Country ownership is key
• Sustainability issues are global, not national
• FSPs are inconsistent with country planning and
  budgeting processes

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FSPs are a step

• FSP will kick off the debate and provide data and
  analyses to inform discussions and planning
• Development of an FSPs will not make programs
  financially sustainable
• Start to a process which requires continuing work

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Immunization Financing Strategies and Options
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Immunization Financing Strategies

• 1. Mobilize additional resources from
• national and external sources
• 2. Improve program efficiency to minimize
• additional resources needed
• 3.Increase the reliability of resources

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Mobilizing Adequate Resources

• Increasing government contribution to
  immunization
• Increasing external contribution to immunization
• Identifying new sources of funding (HIPC,
  sub-national governments)

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Sources of Finance for Immunization from DOMESTIC
Resources
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Sources of Finance for Immunization from EXTERNAL
Resources
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2. Improving Programme Efficiency

• Training Staff
• Reducing vaccine wastage
• Improving transparency of funding flows
• Reducing corruption
• Improving efficiency of transportation
• Rationalizing procurement of vaccines and
  equipment

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Reducing Vaccine Wastage

• Implement the WHO open vial policy
• Strengthen vaccine storage and management
• Increase the number of children at each outreach
  session
• IEC to increase attendance
• Modify schedules
• But, there are trade-offs

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3. Increasing Funding Reliability

• Advocating for longer term commitments from all
  funding sources
• Improving financial management to improve,
  timeliness and transparency of allocation and use
  of funds
• Developing a reserve or emergency funding
  mechanism

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Challenges and Constraints

• Increasing funding needs -- population growth,
  program improvements
• Culture of reliance on external funding
• Government commitment not translated into
  funding
• Unreliable donor funding
• Program inefficiency high vaccine wastage,
  sub-optimal allocation of resources
• SWAp, decentralization change funding flows

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Opportunities

• Economic growth and increasing government revenue
• Increasing financing for health sector (PRSP)
• Increasing government commitment to immunization
• Increasing external support
• Improving program efficiency
• SWAp, decentralization change resource decision
  makers
• New donors, NGOs
• Regional development banks