GAVI Support and Asian Development Bank:
Co-financing and graduation policies
Santiago Cornejo,
Senior Specialist Immunization Financing
Manila, 4 June 2013
Overview
1. Overview of GAVI support in ADB countries
2. GAVI co-financing policy, performance &
projections
3. Priorities in 2013-2014
4. Tailored approach to graduating countries
5. GAVI graduation in ADB countries
GAVIs work in ADB countries
23 out of the 73 GAVI countries are countries with ADB operations
8 in SEARO: Bangladesh, Bhutan, India, Indonesia, Myanmar, Nepal, Sri Lanka and Timor-Leste
7 in WPRO: Cambodia, Kiribati, Lao PDR, Mongolia, Papua NG, Solomon Is and Vietnam
6 in EURO: Armenia, Azerbaijan, Georgia, Kyrgyz Rep., Tajikistan and Uzbekistan
2 in EMRO: Afghanistan and Pakistan
9 out of the 23 are graduating countries
GAVIs work in ADB countries
Total amount committed to these 23 countries $2.6 billion until 2015
$1.3 billion already disbursed
Includes countries with GAVIs largest commitments
Pakistan: Over $800 million
Bangladesh: Over $550 million
India: Over $300 million
Afghanistan: Over $200 million
Other countries with over $100 million: Indonesia, Myanmar, Nepal and Vietnam
GAVIs work in ADB countries
Type of support committed to the 23 countries
Pentavalent vaccine: 23/23 countries
Pneumococcal vaccine: 10/23 countries
Rotavirus vaccine: 3/23 countries
Measles vaccine: 5/23 countries (3 with Measles-Rubella campaigns too)
HPV vaccine: Lao
Health Systems Strengthening: 21/23 countries
Summary of support to the region
In relative terms they are good performing countries
Indonesia, PNG and Timor-Leste
In SEARO/WPRO:
No applications for Rotavirus vaccine support
5 for PCV (Bangladesh, Kiribati, Lao, Nepal and PNG)
Financial sustainability concerns
Future portfolio of interest for the region: HPV, JE and Typhoid
Overview
1. Overview of GAVI support in ADB countries
2. GAVI co-financing policy, performance &
projections
3. Priorities in 2013-2014
4. Tailored approach to graduating countries
5. GAVI graduation in ADB countries
History of financial sustainability
Dec 2005: Board decision for co-financing
2006: approved
2008: implemented
2010: revised
2012: implemented
2001: Although self-sufficiency is the ultimate goal, in the nearer term
sustainable financing is the ability of a country to mobilise and
efficiently use domestic and supplementary external resources on a
reliable basis to achieve current and future target levels of
immunisation performance.
Co-financing policy and objectives
Co-financing signifies that countries share a portion of the cost of their new vaccines and
safe injection devices co-procurement
Overall objective: putting countries on a trajectory towards financial sustainability
Intermediate objective: enhance country ownership of vaccine financing
Basic facts about GAVI
DATE
How the co-financing policy works
Source: GAVI Alliance 2012
Policy implications for different country
groupings
Low Income: country ownership
Low per dose amount (US$ 0.20) that is not to be a bottleneck to introduction
Intermediate: moving towards financial sustainability
Starting at US$ 0.20 and then steady increases by 15% per year
Graduating: financial sustainability
Gradual ramp up over five years (1+4) to reach projected price after GAVI support ends
Not eligible for new GAVI support
Co-financing: fulfilment of commitments
Projections
Projections including estimated new approvals
Total co-financing : US$687 million
Total co-financing graduating countries: US$169 million
Year 2012 2013 2014 2015 2016
Eligible Countries
(US$ million) $54 $82
$105 $126 $151
Graduating
Countries
(US$ million)
$9
(14%)
$19
(19%)
$39
(27%)
$58
(31%)
$44
(22%)
Total
(US$ million) $63 $101 $144 $184 $195
Source: GAVI Alliance, 2012
Fiscal space analysis
Vaccine spending as % of government health expenditure
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
0.8%
0.9%
1.0%
2013 2014 2015 2016 2017 2018 2019 2020
va
cc
ine
s a
s %
of
GG
HE
average graduating average intermediate average LIC average 52
Overview
1. Overview of GAVI support in ADB countries
2. GAVI co-financing policy, performance &
projections
3. Priorities in 2013-2014
4. Tailored approach to graduating countries
5. GAVI graduation in ADB countries
Priorities under GAVIs Business Plan Goal: Increase
and sustain allocation of national resources to immunisation
Monitoring and reporting on country co-financing performance
Coordination of Alliance partners through a Task Team
Tracking immunisation resource flows on global and country level
Support to WHO for National Health Accounts
Better understanding of immunisation costing and financing
Collaboration with Gates in 6 country case studies
Priorities under GAVIs Business Plan Goal: Increase
and sustain allocation of national resources to immunisation
Customised support to priority underperforming countries, including advocacy
Funding WHO/UNICEF to support 12 countries
Advocacy for co-financing and financial sustainability of immunization programmes
Collaboration with the African Development Banks trust fund on Value for Money in Health
Support to Sabin Institute for the engagement of Parliamentarians
Development of tools
Special focus on graduating countries
Overview
1. Overview of GAVI support in ADB countries
2. GAVI co-financing policy, performance &
projections
3. Priorities in 2013-2014
4. Tailored approach to graduating countries
5. GAVI graduation in ADB countries
GAVIs work with graduating countries
Close monitoring of co-financing performance
Access to GAVI prices after graduation
Continuous update of fiscal space analysis
Multi-partner visit for development of in-depth assessment and transition plans in priority
countries
Advocacy activities at country, regional and global levels
Sharing experiences and lessons learned
Country assessments & Transition plans
Purpose of multi-partner visits: in-depth assessment, development of transition plan and advocacy
Areas of assessment:
Financial planning, costing, budgeting, disbursement
Procurement
Resource mobilisation and advocacy
Vaccine market intelligence and analysis
Stakeholder analysis (e.g. parliamentarians)
Transitions plans are developed to tackle bottlenecks from the assessments
Global monitoring of implementation of the transition plans
Preliminary findings of graduating country
assessments
In the immediate future fiscal space is not the main problem for these countries
Other health donors also phasing out
Weak planning, budgeting and execution
Misunderstandings of national procurement rules; potentially incompatible with global solutions
Very limited understanding and analysis of vaccine options and pipeline
NRAs & NITAGs need improvements
Overview
1. Overview of GAVI support in ADB countries
2. GAVI co-financing policy, performance &
projections
3. Priorities in 2013-2014
4. Tailored approach to graduating countries
5. GAVI graduation in ADB countries
GAVIs graduation in ADB countries
9 out of the 23 countries with ADB operations are GAVI graduating countries
7 out of the 9 countries shouldnt have challenges to sustain these vaccines post-GAVI support
Armenia, Azerbaijan, Georgia Indonesia, Kiribati, Mongolia and Sri Lanka
GAVI already supporting Bhutan to strengthen Trust Fund
Soon to conduct assessment in Timor-Leste and could face some challenges
2 soon to graduate countries: PNG & Uzbekistan
Fiscal space in selected graduating countries
(Current Portfolio)
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
2013 2014 2015 2016 2017 2018 2019 2020
va
cc
ine
s a
s %
of
GG
HE
Papua New Guinea Timor-Leste
Fiscal space in selected graduating countries
(Potential Future Portfolio)
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
1.8%
2.0%
2013 2014 2015 2016 2017 2018 2019 2020
va
cc
ine
s a
s %
of
GG
HE
Papua New Guinea Timor-Leste
Potential areas of collaboration in graduating
countries
In-country collaboration on financial sustainability
Joint missions and financial sustainability assessments and advocacy in selected
countries
PNG, Timor-Leste
Other countries?
Regional advocacy on new vaccines in Asia-Pacific
Summit on New Vaccines
Thank you
27
Photo credits:
Country groupings in 2012
Low income Intermediate Graduating
Afghanistan, Bangladesh, Benin,
Burkina Faso, Burundi, Cambodia,
CAR, Chad, Comoros,
DRC, Eritrea, Ethiopia, Gambia,
Guinea, Guinea-Bissau, Haiti,
Kenya, DPRK, Kyrgyz
Republic, Madagascar, Malawi,
Mali, Mozambique, Myanmar,
Nepal, Niger, Liberia, Rwanda,
Sierra Leone, Somalia, Tajikistan,
Tanzania, Togo, Uganda,
Zimbabwe
Cameroon, Cote dIvoire, Djibouti, Ghana, Mauritania,
Nicaragua, Nigeria, Lao
PDR, Lesotho, Pakistan,
Papua New Guinea, Sao
Tome and Principe,
Senegal, Solomon Islands,
Republic of Sudan, Timor
Leste, Uzbekistan, Vietnam,
Yemen, Zambia
Angola, Armenia,
Azerbaijan, Bhutan,
Bolivia, Congo
Rep., Cuba,
Georgia, Guyana,
Honduras,
Indonesia, Kiribati,
Moldova, Mongolia,
Sri Lanka, Ukraine
Underlined countries were identified as priority countries in 2012
Projections
Projections including estimated new approvals
Total co-financing : US$687 million
Co-financing of graduating countries: 24%
Year 2012 2013 2014 2015 2016
Eligible Countries 86% 81% 73% 69% 78%
Graduating
Countries
14%
19%
27%
31%
22%
Total
(US$ million) $63 $101 $144 $184 $195
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