Gavi has applied its co-financing policy since 2007. Gavi’s revised co-financing policy was approved by the Gavi Board in December 2010 and the new co-financing obligations took effect in 2012. The overall objective of the co-financing policy is to put countries on a trajectory towards financial sustainability in order to prepare them for phasing out of Gavi support for new vaccines, recognising that the time frame for attaining financial sustainability will vary across countries. The intermediate objective for countries with an extended time frame for achieving financial sustainability is to enhance country ownership of vaccine financing. A total of 68 countries have co-financed Gavi-supported vaccines from 2008 to 2013, with a combined total of US$ 254.7 million for the six-year period.
In 2014, the Norwegian Institute of Public Health conducted an evaluation of the Gavi co-financing Policy.
OBJECTIVE AND APPROACHES
The evaluation focused on assessing the design, implementation and intermediate results of Gavi co-financing policy including the identification of lessons learnt and recommendations. The objective of this evaluation was to help inform the 2014-2015 revision of Gavi policies, including the co-financing policy.
To perform this assessment, the Norwegian Institute of Public Health used five main sources of information:
- literature and document review
- in-depth consultations with identified immunisation financing experts
- e-mail based surveys sent to Ministry of Health officials, UNICEF and WHO country representatives
- in-country interviews with all immunisation-related stakeholders in three countries (Burundi, Ghana and Moldova)
- exploratory data analysis of economic and vaccine-related financial information gathered from Gavi Secretariat, UNICEF Supply Division and extracted from specified databases
FINDINGS AND RECOMMENDATIONS
The following important findings emerge from the evaluation:
- The co-financing policy is an innovative mechanism in the field of global health
- Policy design and revision processes have been characterised by extensive analyses and consultations
- To date, co-financing requirements have been affordable for the partner countries
- The default mechanism is a fair and appropriate mix of penalties and incentives
- The monitoring and support mechanisms are appropriate and effective
- The co-financing policy contributes to country ownership of vaccine financing and sustainable financing of vaccines
Overall, the co-financing policy is a significant contributing factor to country ownership and financial sustainability. However, the evaluators also identified key barriers to the co-financing policy success: significant change to a country’s co-financing amounts or processes can impact policy fulfilment; lack of access to Gavi prices and UNICEF SD procurement services can impact the financial sustainability of graduating countries; and lack of consistency of the co-financing policy across Gavi-supported vaccines weakens country ownership.
The findings, lessons learnt, as well as the recommendations suggested by the evaluators have been used as an important input into the review of the co-financing policy being conducted in 2014-2015.
The Vaccine Alliance’s responses to key recommendations are outlined in the accompanying Management Action Plan.