Gavi s Sustainability and Transition Approach

Transcription

1 Gavi s Sustainability and Transition Approach Santiago Cornejo Director, Immunisation Financing and Sustainability 13 June

2 Countries tend to face various programmatic and financing challenges at different development stages Schematic representation of main programmatic and financing bottlenecks to immunisation along the development continuum Weaker health and immunisation system foundations Acute fiscal constraints Stronger systems but with institutional capacity gaps in key areas Growing domestic resources, but inadequate allocative efficiency and prioritization Some gains at risk Missed opportunities for broader impact and efficiencies Income per capita These are not absolute categories: actual country realities sit somewhere on this continuum First wave of transitioning countries aligned with this model

3 Evolving needs require evolving types of engagement and support Early engagement: Building foundations for sustainability Post-transition Health systems and immunisation strengthening (HSIS) Targeted Country Assistance (TCA) Fixed, low cofinancing level Health systems and immunisation strengthening, but diminishing support for recurrent costs TCA / Transition grants Growing co-financing requirements Targeted support to mitigate post transition risks and support continued transformation and pricing Preparing for transition

4 Eligibility, transition and co-financing policies provide the institutional framework for Gavi s engagement WB Low-Income country threshold $1,005 GNI pc Eligibility threshold: $1,580 GNI pc variable duration variable duration 5 years years Low-income country threshold Eligibility threshold End of Gavi financing

5 Country co-financing level and serve as key mechanism for domestic resource mobilization and financial sustainability WB Low-Income country threshold $1,005 GNI pc Accelerated transition Eligibility threshold: $1,580 GNI pc Fully self financing 100% of vaccine cost Preparatory transition Initial self financing variable duration variable duration 5 years years Low-income country threshold Eligibility threshold End of Gavi financing

6 Gavi s sustainability approach: key components Financial and programmatic sustainability: Domestic financing is key, but it is not enough Programmatic sustainability requires critical national capacities, e.g., capacity for planning and budgeting, capacity to procure vaccines at competitive prices, etc. Integrate sustainability in the design of Gavi s engagement with countries Getting the sequencing of interventions right is key: Addressing systemic bottlenecks early on Adapting support to needs and reflecting the transition status: No support for recurrent costs in the last phase of transition Leveraging existing systems where possible and needed 6

7 16 countries have already transitioned and 9 countries are still in transition 7

8 Before and after Gavi: DTP3 coverage DTP3 coverage comparing 2016 to 1999 Immunisation coverage (%): Before Gavi support (1999) Latest coverage data available (2016) (Source: WEUNIC, 2016) 8

9 Before and after Gavi: new vaccine introductions (Pentavalent, PCV, Rotavirus, HPV, up to 2017) 9

10 Before and after Gavi: government expenditures on routine immunisation (US$ per child on immunisation comparing pre & post transition) Annual financing by country per child (US$): Amount on pretransition year, different for each country Latest amount data available (2017, includes selffinanced programme amounts) 10

11 Findings on transition observed so far 1. Immunisation financing: fiscal space does not seem to be the main challenge in most of the first-wave countries Critical issues are weak planning, budgeting and execution processes and broader financing of the sector 2. Programme performance: generally high coverage programmes, but important capacity gaps were observed on vaccine introductions Also a subset with low coverage (e.g. PNG, Congo Rep, Nigeria, Angola) 3. Institutional capacities: critical gaps and areas for strengthening (e.g., regulation, procurement, supply chains, data systems)

12 Findings on transition observed so far 4. Common concerns about losing supportive environment that is associated with being part of the Alliance Anti-vaccination lobby Technical assistance post-gavi Prioritisation of immunisation 5. Greater realisation that engagement with sub-national levels is critical for sustainable coverage and equity, which requires engagement with a wide range of stakeholders Within the ministry of health and across ministries (e.g. MoF) National and subnational authorities and parliamentarians Across external partners (e.g. The World Bank, Global Fund) Civil society, communities and private sector 12

13 Gavi s extensive partnership with private sector FINANCIAL CONTRIBUTION LEVERAGED INVESTMENT PARTNERSHIP SHARED VALUE PARTNERSHIP FINANCING PRIVATE SECTOR AND FUNDIND MECHANISMS EXPERTISE Single or multiyear financial pledge in support of Gavi programmes that may be matched by Matching Fund (e.g. corporate or foundation philanthropic support, INFUSE Pacesetters) Financial pledge accompanied by corporate expertise or programmatic intervention with potential match by Matching Fund (e.g. demand generation, INFUSE Pacesetters) Co-investment by the partner and Gavi core funding to develop a sustainable, scalable solution (e.g. supply chain services, data management systems, INFUSE Pacesetters)

14 Gavi s extensive partnership with private sector PRIVATE SECTOR PARTNERSHIPS CAN PLAY A GREATER ROLE IN TRANSITION Supply Chain Data Management Demand Generation

15 Important lessons Sustainability has two components: financial and programmatic Early engagement and planning Addressing health systems bottlenecks and institutional constraints Progressive phasing out of support Provide predictability and transparency Flexibility to adapt and adjust approach (Evolving or learning agenda) There is no silver bullet: getting the basics right is key There is no substitute for appropriate regular planning, budgeting, disbursement and execution Prioritization, prioritization and prioritization Wide-ranging inclusion of stakeholders 15

16 THANK YOU

17 Gavi s theory of change Supporting the country s population to be healthier and more productive generates greater prosperity for the country, enabling it to finance its primary health programmes 17

18 Partnering with the private for innovation scale up Developed using Gates Grand Challenge grant supported by the BMGF Scaled deployment 13,000 ColdTrace devices across India with Gavi HSS Accelerated by INFUSE, through support from Google.org and Elma matched by the Gavi Matching Fund 2013 Pilot in Haiti and Kenya Deployment across 12 states in India as part of evin Scaling across Tanzania, Kenya, Mozambique and Senegal 18