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Financing Immunization Programs During Transition

Gavi defines a successful transition as one in which countries have successfully expanded their national immunization programs with vaccines of public health importance and sustain these vaccines post-transition with high and equitable coverage of target populations, while having robust systems and decision-making processes in place to support the introduction of future vaccines.

Ensuring the financial sustainability of immunization programs to meet these goals requires securing new domestic resources for immunization and strengthening the planning, budgeting, and financial management capacity of immunization programs. LNCT countries are exploring a variety of strategies to increase the financial resources they have available for immunization and strengthen financial management for immunization, including developing advocacy strategies to highlight the value of immunization investments to lawmakers and other financial decision-makers, engaging private sector resources for immunization, developing electronic funds management systems that link spending to results, and changing the way immunization programs are planned and budgeted. At the same time, many LNCT countries are undergoing wider health financing reform, and immunization programs are adapting to systemic changes such as the expansion of social health insurance or fiscal decentralization.

LNCT focuses on the following core immunization financing functions for transitioning countries:

  • Working within the macro-fiscal context to ensure sustainable immunization financing during transition: Understanding, engaging with and planning within larger economic and fiscal trends affecting immunization resources, including health reform initiatives such as the introduction or expansion of national social health insurance.
  • Maintaining political will and commitment during transition: Successfully advocating for domestic resources for immunization to Parliament and other decision-makers in the context of limited fiscal space for health.
  • Strengthening public financial management and immunization budgeting for transition: Conducting adequate long-term planning, and budgeting of immunization programs while providing enough transparency and flexibility to allow immunization programs to make strategic spending decisions in pursuit of health priorities.
  • Immunization expenditure tracking for transition planning: Understanding how effectively immunization budgets are executed and how immunization funds are spent to aid planning of immunization policy and services as well as to improve transparency and accountability.
  • Evaluating cost and cost-effectiveness of immunization programs: Evaluating the long-term cost and cost-effectiveness of routine immunization and new vaccine introduction to make informed decisions about which vaccines and immunization activities are right for the country.

Explore the Data

Explore the dashboard below to see how LNCT countries compare to each other in terms of immunization performance, service delivery and supply. Hover over an indicator for additional information. (Weak internet connection? Download the dashboard as a PDF here.)

Managing the Gavi transition

Gavi’s vision for a successful transition is one in which countries have successfully expanded their national immunization programs with vaccines of public health importance and sustain these vaccines post-transition with high and equitable coverage of target populations, while having robust systems and decision-making processes in place to support the introduction of future vaccines.

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Strengthening immunization program performance for transition

Ensuring the sustainability of immunization programs post-transition requires maintaining or strengthening core immunization program functions during and after transition. These include collecting, analyzing, and using program, coverage and surveillance data to make decisions; establishing and regularly consulting advisory bodies to improve governance and decision-making; ensuring an adequate pipeline of skilled immunization professionals at all levels of the health system; and advocating for immunization in the context of larger health program changes, such as primary healthcare reform.

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Affordable and Sustainable Vaccines for Transition

Ensuring the sustainability of immunization programs post-transition requires ensuring a vaccine supply that is adequate, safe, reliable, and affordable.

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Partners Working in this Area

Working within the macro-fiscal context to ensure sustainable immunization financing during transition

Ensuring a sustainable immunization system post-Gavi transition requires understanding the broader government and health financing context and analyzing fiscal space for health. In some countries, Gavi transition will take place alongside broader health system or health financing reform. For example, many LNCT countries are simultaneously introducing, reforming, or expanding national social health insurance schemes, and have identified understanding how immunization services fit into these schemes as a high-priority topic for Gavi transition.

Click the button below to find key training resources for Ministry of Health or Finance staff looking to learn more about immunization financing. You can also find information about the macroeconomic context of transitioning countries, the financial risks transitioning countries face, and guidance for countries exploring various immunization financing structures, including social health insurance.

Maintaining political will and commitment during transition

With an estimated $16 return on every $1 investment, immunization is one of the best health investments in terms of value for money. Gavi transitioning countries may have limited fiscal space for health due to a low tax base and competing priorities. For ministries of health to successfully implement immunization policy, they must advocate for sufficient immunization resources and effective laws, policies, and processes to Parliament and other government agencies, such as the Ministry of Finance or subnational governments. Political commitment is critical in planning for future introductions of new vaccines, which require substantial costs up-front; ensuring that funds from the national budget are released on time to avoid gaps in coverage; allocating sufficient budget for operational costs critical for service delivery; and establishing legislation, regulations and procedures that allow for the efficient procurement of safe vaccines and the implementation of the immunization program.
LNCT country representatives have expressed an urgent need for data and materials to make a strong case for increased government spending on vaccines, operations, and service delivery for routine immunization to maintain or expand existing coverage during Gavi transition.

Click the button below to access materials demonstrating the value of immunization that can be adapted depending on country goals and target audience along with other key resources.

Strengthening PFM and immunization budgeting for transition

Budget structure, planning, and execution plays an important role in determining the efficiency, quality, and cost-effectiveness of health service delivery. Conducting adequate long-term planning and budgeting of immunization programs in collaboration with immunization program staff is a critical step toward ensuring that immunization programs have the resources they need to achieve coverage goals during Gavi transition. Additionally, some LNCT countries are undergoing larger governance and institutional reforms that affect public financial management in the health sector. For example, some are shifting to new budget structures, such as output-based or program-based budgets, and payment mechanisms that incentivize high service quality and preventative services as they transition off donor funds. Others are undergoing fiscal decentralization and looking at ways to strengthen planning, budgeting, transparency and accountability at the sub-national level.

Click the button below to find a collection of key resources and tools for immunization budgeting and public financial management.

Immunization expenditure tracking for transition planning

Understanding how effectively immunization budgets are executed and how immunization funds are spent is a crucial component of immunization public financial management and accountability. It also plays a key role in planning immunization policy and services. Many LNCT countries are in the process of developing electronic funds management systems and linking these to immunization performance indicators. Some LNCT countries that are undergoing fiscal decentralization are exploring how to use these systems to ensure transparency and accountability at the sub-national level.

LNCT is collaborating with Abt Associates, which assists countries to use System of Health Accounts (SHA) data to inform immunization policy and plan immunization programs, to facilitate learning between transitioning countries on this topic. To learn more, you can view the recording of Abt and LNCT’s webinar on this topic, or access other key resources by clicking the button below.

Evaluating cost and cost-effectiveness of immunization programs

Countries transitioning off Gavi support need to make informed decisions about the long-term cost and cost-effectiveness of routine immunization programs and the introduction of new vaccines as they become available. We have collected resources to help immunization program planners and National Immunization Technical Advisory Group (NITAG) members use evidence-based decision making to select the vaccines and immunization activities that are right for their countries.

Click on the button below to find the Immunization Costing Action Network (ICAN)’s Immunization Delivery Cost Catalogue, which provides unit costs of vaccine delivery given different delivery strategies, guidance or standards for costing study design, including information from Harvard’s EPIC studies, and other key resources from our partners.

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