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FSP Section 3 - Table 3.1Baseline Costing and FinancingBaseline Year is the most recent fiscal ear for which data on actual ex enditures and financin are available rior to an GAVI / Vaccine Fund su ort this will likel be 2001 .Please refer to Annex III for definitions of each cost component, step by step instruction on how to complete this table with simplified methodologies to calculate each variable (including methods for shared

Cost Category TOTALGovernment

(Central)Government

(Local)PrivateSector

CommunityParticipation

Donor Pool (i f applicable) UNICEF WHO

Required Information[A] Routine Recurrent Cost US$ US$ US$ US$ US$ US$ US$ US$

Vaccines (routine vaccines only)-Traditional 6 antigens-New and underused vaccines

Injection suppliesPersonnel

-Salaries of full-time NIP health workers (central, provincial and district levels)-Per-diems (other incentives) for outreach vaccinators/mobile teams N

TransportationMaintenance and overheadShort-term trainingIEC/social mobilizationMonitoring and disease surveillanceOther routine recurrent costs

(please specify)(please specify)(please specify)

Subtotal Recurrent Costs -$ -$ -$ -$ -$ -$ -$ [B] Routine Capital Cost

VehiclesCold chain equipmentOther capital costs (please specify)

Subtotal Capital Costs -$ -$ -$ -$ -$ -$ -$ [C] Supplemental Immunization Activities

Polio NID-SNIDVaccinesPer diemsOperational costsOther costs (please specify)

Measles CampaignsVaccinesInjection suppliesPer diemsOperational costsOther costs (please specify)

Other (MNTE, Yellow Fever, Meningitis)VaccinesInjection suppliesPer diemsOperational costsOther costs (please specify)

Subtotal Supplemental Immunization Activities -$ -$ -$ -$ -$ -$ -$

Optional informationShared Personnel costs

-Salaries of part-time NIP health workers (central, provincial and district levels) N-Other Incentives/bonuses

Other Shared costs (please specify)BuildingOther EquipmentLong-term trainingOther optional information

(please specify)(please specify)(please specify)

Subtotal CapitalGRAND TOTAL ($) -$ -$ -$ -$ -$ -$ $ GRAND TOTAL (%) 100% % % % % % %

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FSP Section 3 - Table 3.2Current Year Costing and FinancingThe current year is the most recent fiscal year for which data on actual expenditures and financing are available after initiation of including GAVI / Vaccine Fund support (this is likely to bePlease refer to Annex III for definitions of each cost component, step by step instruction on how to complete this table with simplified methodologies to calculate each variable (including methods for shared c

Cost Category TOTALGovernment

(Central)Government

(Local)PrivateSector

CommunityParticipation

Donor Pool (if applicable) UNICEF WHO

Required Information[A] Routine Recurrent Cost US$ US$ US$ US$ US$ US$ US$ US$

Vaccines (routine vaccines only)-Traditional 6 antigens-New and underused vaccines

Injection suppliesPersonnel

-Salaries of full-time NIP health workers (central, provincial and district levels)-Per-diems (other incentives) for outreach vaccinators/mobile teamsTransportationMaintenance and overheadShort-term trainingIEC/social mobilizationMonitoring and disease surveillanceOther routine recurrent costs

(please specify)(please specify)(please specify)

Subtotal Recurrent Costs -$ -$ -$ -$ -$ -$ -$ [B] Routine Capital Cost

VehiclesCold chain equipmentOther capital costs (please specify)

Subtotal Capital Costs -$ -$ -$ -$ -$ -$ -$ [C] Supplemental Immunization Activities

Polio NID-SNIDVaccinesPer diemsOperational costsOther costs (please specify)

Measles CampaignsVaccinesInjection suppliesPer diemsOperational costsOther costs (please specify)

Other (MNTE, Yellow Fever, Meningitis)VaccinesInjection suppliesPer diemsOperational costsOther costs (please specify)

Subtotal Supplemental Immunization Activities -$ -$ -$ -$ -$ -$ -$

Optional informationShared Personnel costs

-Salaries of part-time NIP health workers (central, provincial and district levels)-Other Incentives/bonuses

Other Shared costs (please specify)BuildingOther EquipmentLong-term trainingOther optional information

(please specify)(please specify)(please specify)

Subtotal CapitalGRAND TOTAL ($) -$ -$ -$ -$ -$ -$ $ GRAND TOTAL (%) 100% % % % % % %