This report presents the lessons learnt and recommendations from an evaluation of Gavi’s support to Bosnia and Herzegovina and its transition after funding ended. The evaluation was conducted by the Curatio International Foundation in 2014
This evaluation assesses the financial and programmatic sustainability and overall results of Gavi supported immunisation activities in Bosnia and Herzegovina (BiH). It is important to note that Gavi’s graduation policy did not exist at the time that BiH funding ended. Therefore, BiH did not experience a graduation phase similar to current Phase III Gavi graduating countries. Gavi support to BiH concluded when the time-limited multi-year period for which support had been approved came to an end in 2011.
In 2014, the Curatio International Foundation conducted an evaluation on how BiH managed the transition away from Gavi’s support and what the impact was of this transition on the sustainability of the national immunisation programme.
OBJECTIVE AND APPROACHES
This evaluation assesses the financial and programmatic sustainability of Gavi-supported immunisation activities through an in-depth analysis of the immunisation programmes’ performance before, during and after the completion of Gavi’s time-limited support to BiH. The recommendations and lessons learned from the evaluation are expected to inform possible future amendments to the Gavi’s Graduation Policy.
Curatio focused the evaluation on three main areas:
- planning (pre-Gavi support)
- implementation (support received during Gavi period)
- outcomes (post-Gavi support)
To perform this assessment, the Curatio International Foundation implemented a mixed methods approach, using both quantitative and qualitative methods, including:
- A desk review of key documents pertaining the Gavi support to BiH
- Key informant in-depth interviews were conducted during site visits across BiH
- Quantitative data analysis
FINDINGS AND RECOMMENDATIONS
Curatio concluded that Gavi support was relevant and timely for BiH’s needs and essential for funding and strengthening immunisation programmes during the early stages of the support. The majority of activities planned under the Multi-Year Strategic Plan (MYSP) for Immunisation and the Financial Sustainability Plan (FSP) were implemented, though some of the programmatic targets were not fully met and the effectiveness of implementation varied across the MYSP and FSP objectives.
Overall, the transition from Gavi support to domestic funding of immunisation programmes was smooth. The majority of Gavi supported activities continued, even after Gavi funding ended, except for the implementation of the in-country injection safety policy. In addition, the evaluators have found that attempts to introduce additional new vaccines are constrained by the scarcity of financial resources. It was also noted that BiH is paying higher price for Pentavalent vaccines (5-20 times higher than UNICEF/Gavi prices) posing serious concerns for the country long-term programmatic and financial sustainability.
Curatio developed several recommendations specific to the country as well as for Gavi to consider among which the need to enhance country coordination mechanism, to increase the predictability and sustainability of long-term financing for national immunisation programmes or to assist countries to make efficient procurement choices.
The Vaccine Alliance’s responses to key recommendations are outlined in the accompanying Management Action Plan.