A Case Study Assessing Gavi’s Co-financing Policy as a Tool for Country Ownership Open Access

Frimpong, Marcia (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/5h73px04g?locale=en


Gavi’s co-financing policy is intended to strengthen country ownership of vaccine financing thus leading to financial sustainability, long-term programmatic impact, and increased immunization coverage.  We conducted a systematic review of the term country ownership in the health and  development discourse and literature specific to Gavi to define and a conceptualize a framework to assess how country ownership is operationalized via the Gavi co-financing policy. Country ownership was measured by a country’s ability to meet a set of indicators under the following defined drivers of country ownership: accountability, commitment, partnership and capacity. We applied the indicators in a case study of Ghana, a country that is in transition from full dependence on Gavi for vaccines to complete independence.  Gavi financing has resulted in increased immunization coverage in Ghana and the country is considered a success story in the Gavi network. Among the four drivers, Ghana has systems and processes that effectively meet the indicators under commitment and accountability. It was difficult to measure capacity and partnership was low. Accountability was evident in some areas but not others according to the indicators used. The following recommendations were made to address some of the deficiencies: update national health policy to reflect current national priorities to better align with cMYPs, increase collaboration between the MoFEP and MoH to draft a viable vaccine financing proposal and approach, create legislation that makes financing of vaccines and immunization a priority, and lastly strengthen the national logistics system. 

Table of Contents

Table of Contents

Chapter 1: Introduction          1

Problem Statement    1

Purpose           2

Research Question and Aims  2

Significance Statement           3

Gavi: The Organization           3

Gavi Eligibility and Transition Policy   4

Financial Sustainability and the Co-Financing Policy8

Case Study Country: Ghana    11

Background on Ghana12

Ghana: Health System and Financial Flows    14

Summary         16

Chapter 2: Literature Review17

Country Ownership    17

PEPFAR and Shifting Paradigms: A Model for Country Ownership in Global Health?           23

Country Ownership and Gavi27

Conceptual Framework: A Potential Model for Operationalizing Country Ownership         30

Chapter 3: Methodology        32

Systematic Review      32

Systematic Review Limitations           34

Gavi Document Review          34

Document Review Limitations & Advantages34

Case Study      35

Data Analysis  35

Case Study Limitations           37

Chapter 4 – Results Case Study          38


A1: cMYP Aligned to National Health Plan and Strategy       38

A2: Inclusion of Vaccine and Immunization Delivery Requirements in the Development of Health Financing Strategies   39

A3: Resource Tracking by Improved Reporting on Immunization Expenditure         39

Commitment  39

C1: Prioritization of Domestic Funding: Increasing Allocation in National Health Budget    39

C2: Increasing Domestic Political Will41

C3: Increasing Resources to Vaccination and Finance all Vaccine Needs      41

Partnership     43

P1: Align Immunization Financing to Health Financing          43

P2: Coordination between MoH, MoF, and Parliament         43

P3: All Relevant Stakeholders Involved          44

Capacity          44

C1: Presence of Decision-Making Body (ICC/NITAG/HSCC)   44

C2: Platform for Vaccine Procurement          45

C3: Operational Annual Plan or Budget Execution     46

Summary of Findings  46

Chapter 5: Discussion48

Strengths and Limitations of Analysis51

Implications for Ghana           52

Chapter 6: Conclusion and Recommendations          53

References      54

Appendices     59

Appendix A: List of Documents Included in Data Analysis     59

Appendix B: Document Analysis Notes and Ratings  61

Appendix C: Procurement Method    66

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