National immunization programs, and immunization partners, may need to consider new strategies and new funding sources in order to mobilize sufficient funding for immunization following the Gavi transition. This two-page LNCT brief outlines some of the key challenges found across LNCT countries with decentralized systems and offers several promising strategies for NIPs to support increased resource mobilization and effective service delivery.
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The Learning Network for Countries in Transition (LNCT) is a country-driven network dedicated to supporting countries as they transition away from Gavi support to full domestic financing of their national immunization programs (NIP) through a peer learning approach. As Gavi support decreases and countries take on a higher proportion of the financing of immunization, they must mobilize not only the funding needed for vaccines, but also funding for critical operational costs, including cold chain and logistics, service delivery, health promotion, and more. Mobilizing adequate resources and promoting efficient spending to sustain high immunization coverage is a high priority for many LNCT countries. In countries with decentralized health systems, responsibility for these functions (and the requisite funding) rests not only with authorities at the national level, but also with subnational authorities.
In decentralized health systems, decision-making authority and responsibility for critical immunization program functions may reside at the subnational level or may be shared between national and subnational levels. For example, the national level may be responsible for vaccine delivery to district offices, but then rely on district and facility staff to ensure distribution to service delivery points. Similarly, the national level may develop health worker trainings and train trainers at regional levels, but district budgets are required to deliver that training to frontline health workers.
As LNCT countries transition to fully self-financing their immunization programs, program managers in decentralized health systems may need different strategies than their counterparts in more centralized health systems to ensure adequate resource mobilization and effective program management. The NIP may need to engage additional stakeholders and/or support subnational EPI managers to develop new skills in order to mobilize adequate financing and high-quality services. It is important that national immunization program managers understand funding allocation and disbursement processes, as well as bottlenecks, so they can identify opportunities to improve funding availability at subnational levels.