Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process

Abstract

As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success.

The future of routine immunization in the developing world: challenges and opportunities

“…Strong NRAs are necessary if countries are to self-procure and ensure a reliable supply of quality vaccines. 17 …”

“…Upon graduation, the countries will need to self-finance all their vaccines. 17 Although Gavi facilities this transition, countries will face global market vaccine prices, joining some 40 middle-income countries that were never eligible for Gavi support. The uncertainty of future vaccine prices is an impediment to planners and legislators, particularly as they write new or revise existing vaccine legislation obligating their governments to finance the programs.…”

“…Effective national procurement and regulatory authorities: National procurement and regulatory bodies have a role to ensure that governments purchase safe, effective vaccine products at the lowest possible cost. 17 Investments in the ability of countries to manage procurement and supply are important to countries nearing graduation. 17 This is largely because, depending on the source of vaccine (ie, procurement through a United Nations Agency, self-procurement, or domestic vaccine producer), countries need to strengthen the management of procurement including product pricing strategies.…”

“… 17 Investments in the ability of countries to manage procurement and supply are important to countries nearing graduation. 17 This is largely because, depending on the source of vaccine (ie, procurement through a United Nations Agency, self-procurement, or domestic vaccine producer), countries need to strengthen the management of procurement including product pricing strategies. National regulatory functions vary depending on procurement mechanisms.…”

Monitoring and Evaluating the Transition of Large-Scale Programs in Global Health

“…Among programs funded by the United States Government (USG), the transitions of large-scale health programs have been called “graduations” and have been occurring at least since the 1980s with the graduation of family planning assistance programs in Latin America and the Caribbean. 3 , 4 However, transitions are gaining both momentum and interest. For example, reauthorization of the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2008 reinforced the notion that transition must be handled carefully, with the introduction of Partnership Frameworks, which aimed to ensure PEPFAR programs were sustainable through a renewed focus on “country capacity, ownership and leadership.” 5 , 6 Transitions of PEPFAR programs are ongoing in sites such as South Africa and the Caribbean and are expected to be initiated in other countries in the near future.…”