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LNCT Resource: Mobilizing Resources for Immunization in Decentralized Health Systems: A Desk Review of LNCT Country Experiences

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. LNCT developed two resource products to illustrate how countries can mobilize adequate resources and promote efficient spending to sustain high immunization coverage in decentralized health systems. This resource document extensively outlines different types of decentralization contexts, roles and responsibilities, and funding allocation and disbursement bottlenecks in decentralized health systems with rich examples from LNCT countries.

View the brief as a PDF in English or below by topic by clicking on each tab header. You can also view the two-page LNCT brief, which outlines some of the key challenges found across LNCT countries with decentralized systems along with several promising strategies for NIPs to support increased resource mobilization and effective service delivery.

Introduction

The Learning Network for Countries in Transition (LNCT) is a country-driven network dedicated to peer learning to support countries as they transition away from Gavi support to full domestic financing of their national immunization programs (NIP). 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. In countries with decentralized health systems, responsibility for these functions (and the requisite funding) rests not with central authorities, but also with subnational authorities. Mobilizing adequate resources, and promoting efficient spending, to sustain high immunization coverage is a high priority for many LNCT countries.

Key Messages
  • In decentralized health systems, decision-making authority and responsibility for critical immunization program functions may reside at subnational level or shared between national and subnational levels.
  • National immunization program managers must understand funding allocation and disbursement processes, as well as bottlenecks, so they can identify opportunities to improve funding availability at subnational levels.
  • Countries with decentralized systems experience common challenges that constrain immunization program performance including coordination between national and subnational levels, management and budgeting capacity, and funding for key immunization functions.
  • Promising strategies to address these challenges include developing effective systems for training, communications, and coordination at all administrative levels, strengthening capacity for program management at subnational levels, monitoring subnational immunization expenditures, and supporting subnational immunization managers to advocate for increased funding.

Countries undertake decentralization in different forms (as defined below) and for various reasons, including to increase responsiveness to local conditions and needs, to allow greater political representation for diverse groups, and to alleviate bottlenecks in decision-making. Decentralization is seldom initiated in the health sector, and rarely is it undertaken in the health sector alone. Often the form of decentralization does not consider the impact on the health system, let alone the impact on one health program.

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 central 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 central level may develop health worker training and train trainers at regional level, but district budgets are required to deliver that training to health workers. Historically, external support for resource mobilization have focused on national budgets. It is important that NIP managers understand funding allocation and disbursement processes and bottlenecks, so they can identify opportunities to improve funding availability. The purpose of this brief is to:

  • Highlight common resource mobilization challenges in LNCT countries with decentralized health systems;
  • Present examples of approaches LNCT countries and other LMICs have employed to address these challenges; and,
  • Identify strategies that immunization program staff at the national and subnational levels can use to advocate for, and increase, the availability of resources for immunization.

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