countdown to 2015: tracking progress in child survival. london, 13-14 december 2005 1 thinking big:...

1 Countdown to 2015: Tracking Progress

in Child Survival. London, 13-14 December 2005

Thinking Big: Going into Action for Child Survival

Sustainable Financing for Health:

Where does the risk lie?

Julian Lob-LevytExecutive Secretary – GAVI Alliance



Sustainable Financing for Health

• A big push for health systems• Predictable, secure financing through

the International Finance Facility for Immunization (IFFIm)

• Innovation to advance new technology• Global Health Partnerships post-2005:

added value, harmonisation and alignment

• Where does the risk lie?



GAVI / Immunization

ImprovedHealth

Outcomes

ImprovedEconomic

Growth

ImprovedEducational Outcomes

(MDG 4 – Child Mortality) (MDG 1 – Poverty)

(MDG 2 – Primary Schooling)

Health, Economic Growth & The Millennium

Development Goals

Bloom, Canning & Weston;

World Economics 2005

Commission for

Macroeconomics &

Health, 2001

Copenhagen Consensus,

2004

The Evidence Base



The Challenge: Current Health Spending

$2,263

$36 $17$0

$500

$1,000

$1,500

$2,000

$2,500

Industrialized Less Developed Least Developed

US$ per person, per year

Source: CGD Making Markets for Vaccines Presentation April 2005



Results: GAVI Support Received by Countries

21

74 74

118109

8

1323

35 48

10

17

2627

0

50

100

150

200

2001 2002 2003 2004 2005*

US

$ (m

illio

ns)

Injection SafetySupport

ImmunizationServices Support

New VaccinesSupport

29

184179

114

97

Total

*Projected to year end



Results: Increased Financing

0

0.5

1

1.5

2

2.5

3

2000 2005

US

$ (b

illio

ns)

Immunization spending has more than doubled in GAVI countries

Source: WHO/UNICEF, GIVS costing



Results: Reaching More Children

Yellow fever

0

25

50

75

100

2000 2001 2002 2003 2004 2005*

Nu

mb

er o

f C

hild

ren

(m

illio

ns)

HepB3

Hib3

YellowFever

Cumulative Number of Children Reached in GAVI-Supported Countries

*projected

Source: WHO/UNICEF

~14 m

~90 m

~14 m



Democratic Republic of Congo

Results:

0%

10%

20%

30%

40%

50%

60%

70%

2001 2002 2003 2004

• DR Congo will receive over US$ 6 million in ISS reward for reaching additional children

• Despite a history of conflict, coverage is increasing

Percent Coverage of Third Dose of DTP (2001

– 2004)

Source: Joint Reporting Form



Gates Foundation

Annual income

$0

$50

$100

$150

$200

$250

$300

$350

2000 2001 2002 2003 2004 2005

Government donors

$4

$93$112 $105

$169

$303 projected

Millions US$

Traditional income through GAVI



The International Finance Facility for Immunization

(IFFIm)How to leverage additional funding

for health:• Donors make long term binding

commitments (20 years)• IFFIm uses pledges to raise funds through

bonds• Anticipated to be funded at $4 billion over

10 years, increases near term resources• Commitments by UK, France, Italy, Spain,

Sweden and Norway



Allocation of IFFIm funds :

• Focus on the poorest (less than $1000 GDP per capita) 72 countries where disease burden is greatest

• Two windows of support:

1) Providing new and underused vaccines• Providing support to combination vaccines (DTP + Hep

B), (DTP+Hep B + Hib)• Accelerating introduction of new vaccines – rotavirus

and pneumococcus, and HPV

2) Building capacity in developing country health systems for the delivery of immunization services and maternal and child health



Funding Immunization: Predictable Financing

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

$4.00

$4.50

15 YearsPredictableFinancing

15 YearUnpredictableFinancing

Impact of Predictability of Price: Assumed Price Trajectory for Pentavalent

Vaccine

Source: CGD Working Paper “The costs and benefits of front-loading and predictability of immunization”



Linking Vaccine Initiatives

System strengthening and support

DTP + Hib/HepB/YF+ Rota/Pneumo

+ Malaria/HIV/TB ?

GAVI + Country Investments

APCs/ADIPs* Long-term AMCs**

IFFIm

Confidence in a viable long-term developing country vaccine market

Purchase Now Long-term CommitmentInvestment in Near-Term

* Advance Purchase Commitments supporting Accelerated Development and Introduction Programmes (ADIPS)

** Advance Market Commitments for HIV, malaria and/or TB vaccine

R&D for New Vaccines

PPPs, biotech, pharmaR&D InvestmentPush Incentives

Market Pull



Global Health Partnerships:

Demonstrating added value?

• High Level Forum outcomes• GHPs only make sense:

– Within broader strategy of scaling up health systems

– With long term, predictable funding for countries

– If focus is in line with country-driven priorities and budgetary processes

– If priorities are based on clear evidence – If we are prepared to take risks



Global Health Partnerships: Harmonisation and

Alignment

• Integrating at the country and district levels

• Demonstrating results and learning • Challenge and Innovation• Broadening partnerships: civil society• Country-driven approaches



Where does the risk lie?

• A big push for health involves risk• The risk of not thinking big• Risk for donors• Risk of not prioritising social sectors• Hiding behind harmonisation?



In conclusion• Unite around clear focus and simple priorities

– 10.5 million deaths, most preventable and treatable – its not rocket science, but needs bucket loads of dollars. The MDG can be met. But do donors get it?

• You – we, cannot solve all the worlds problems • Locate that focus within broader upstream

agendas• Integrate that focus at the country level• Take risks, be opportunistic, be innovative• Quick wins and digestible measurable results

will mobilise resources. Aid works.



Thinking Big: Going into Action for Maternal & Child Survival

countdown to 2015: tracking progress in child survival. london, 13-14 december 2005 1 thinking big:...

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