A Case Study Assessing Gavi’s Co-financing Policy as a Tool for Country Ownership Open Access
Frimpong, Marcia (Spring 2019)
Abstract
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
Accountability38
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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