Financial Sustainability of National Immunization Programs: Financial Sustainability of National Immunization Programs Update and Role of World Bank December 2003


What is an FSP ?: What is an FSP ? A financial sustainability plan is an integral part of multi-year immunization plan, health sector plan and government budget Costs to achieve national program goals? Sources of financing ? Gap (timing and magnitude) ? Workplan with ACTIONS to: Mobilize resources for immunization increase national budget secure multi-year donor funding Improve program efficiency Improve reliability of resources integrate FSP into national plans improve reliability of disbursements


Financial Sustainability Plans  are national tools: Financial Sustainability Plans are national tools FSP Preparation 2002: 11 countries 2003: 19 countries 2004: 33 countries 2005: 4 countries Review/vetting/support FSP Implementation by MOH/MOF 2003: 11 countries 2004: 30 (11 + 19) countries 2005: 66 countries 2006: 68 countries


Lessons on Financial Sustainability: Lessons on Financial Sustainability Dramatically increasing national knowledge, ownership and financial commitments Cambodia, Kenya, Rwanda, Ghana, Tanzania Highlighting financial implications of new strategies and goals Sustainability depends on integrating FSPs into national planning and budget Sustainability depends on partner support for national efforts Efficiency-related strategies (e.g., wastage) Linking costs with program strategies and objectives Integration in national planning/budgeting Political dialogue


The World Bank: The World Bank Background: World Bank structure Development priorities based on Country Assistance Strategies (CAS) which includes health sector Governments determine lending priorities with country teams Lending instruments: Project (focused) Sector support (health-wide) PRSCs: Povery Reduction Strategy Credits – general budget support Technical support HDNHE (central unit) leadership and technical health support DEC provides analytical and research support WBI provides training and capacity building support


The World Bank and Immunization: The World Bank and Immunization Bank lending increasingly supports sector or national budget with growing focus on social sector (health) Addresses system wide barriers Support national priorities --- including immunization Immunization outcomes (DPT3 and measles coverage) are indicators for PRSPs and trigger conditions for PRSCs Measles an indicator for the Child Health MDG IDA Credit Buy-Down piloted for polio eradication Country and regional analytical work on best practices, costing, reaching the poor…


The World Bank and Financial Sustainability: The World Bank and Financial Sustainability Fully committed to supporting immunization and ensuring financial sustainability President Wolfensohn, GAVI Board Mtg July 2003 Financial Sustainability Support Analytical Technical assistance for FSP preparation and implementation Global financing strategies and mechanisms


World Bank Support for Financial Sustainability- Analytical: World Bank Support for Financial Sustainability- Analytical Lead role in preparing FSP preparation and implementation guidelines Lead effort for national investment case framework Exploring links between FSPs, MBB and costing tools Contribute to training courses and mat’l Regional analysis District level variations in immunization coverage (South Asia and Africa) Financing and new vaccine introduction (Latin America) Equity and poverty (Africa and South Asia)


World Bank Support for Financial Sustainability - FSPs: World Bank Support for Financial Sustainability - FSPs Engaging country teams to: Help lead FSP preparation in India, China and Indonesia (Big 3) Vet FSP drafts and support implementation activities in countries Highlight immunization during policy dialogue with MOF/MOH Integrate FSPs into national plans and budgets Explore financial support through loans/credits Address national issues such as financial management activities (East Asia)


World Bank Support for Financial Sustainability -- Global Financing: World Bank Support for Financial Sustainability -- Global Financing Developed IDA Credit buy-down Piloted in polio eradication projects Expanded pilot in health under discussion IDB and ADB interested in mechanism Exploring capital market mechanisms with Gates Foundation and VF Out of the Box UK International Financing Facility Other options World Bank responsible for analysis and paper “Innovative Financing to achieve the MDGs”


Going forward: Going forward Develop guidelines for implementation and national investment case Fund lessons learned analysis and sharing between countries Support governments Country-level dialogue -- resource allocation and priorities Integrating FSPs into national plans and budgets Broader systemic issues – financial management and disbursement, budget allocation Support FTF transition of activities to partners by building capacity and raising awareness Financial sustainability depends on engagement of partners – must be integral to all immunization efforts