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