title: Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries.
abstract: Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency.
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland rhecht@resultsfordevelopment.org.
authors: Helen
authors: H
authors: Saxenian
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland rhecht@resultsfordevelopment.org.
authors: Robert
authors: R
authors: Hecht
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland.
authors: Miloud
authors: M
authors: Kaddar
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland.
authors: Sarah
authors: S
authors: Schmitt
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland.
authors: Theresa
authors: T
authors: Ryckman
authors: Consultant to Results for Development Institute, Washington, DC 20005, USA, Results for Development Institute, Washington, DC 20005, USA, World Health Organization, 1211 Geneva, Switzerland, Consultant to World Health Organization, 1211 Geneva, Switzerland, GAVI Alliance, 1202 Geneva, Switzerland.
authors: Santiago
authors: S
authors: Cornejo
mesh_terms: D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D005380:Financing, Government / Q000191:economics / Q000458:organization & administration; D061889:Healthcare Financing; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration*; D007223:Infant; D007391:International Cooperation; D014480:United Nations / Q000458:organization & administration
keywords: GAVI; Immunization; donor assistance policies; health financing; middle-income countries; national self-sufficiency; vaccines