With support from Merck Sharp & Dohme Corp., ThinkWell is seeking to: 1) Improve understanding of health financing structures, flows, and innovations; 2) deliver a deeper understanding of how political economy and prioritization processes impact overall health financing, immunization budget, and decision-making envelopes in these countries; and 3) identify ways that private sector/industry stakeholders can work with countries in the region as a thought partner to help share best practices/lessons learned in innovative financing and strengthen financing for sustainable health systems.
Breaking New Ground
This exploration of financing for immunization focuses not on the cost of vaccines or the programs, but more so on the public sector decision-making processes associated with budgeting, prioritization, social health insurance and domestic revenue generation. The project moves beyond the understanding of current situations at country level to a synthesis of key factors in the region.
Many middle-income countries are either graduating from Gavi in the near future or are already ineligible for support. Despite dwindling external support in the region, many of these countries have limited public immunization packages and/or have stagnated, or even decreasing, immunization coverage rates. The process that leads to financing decisions, and the factors that impact upon them, are often complicated, but understanding them will be key to protecting and strengthening immunization programs.
To better understand the factors affecting immunization financing in the region, ThinkWell performed a cross-country analysis of six representative countries in the region to identify key factors influencing immunization program financing and prioritization across Asia Pacific. This framework is now being pressure tested in two Latin American markets.
The landscaping yielded four major trends that are affecting financing for immunization:
1. Diversified domestic revenue for health – countries are increasingly reliant on domestic revenue to finance their health budgets
2. From input financing to strategic purchasing – Countries are moving away from input financing towards strategic purchasing
3. Decentralization – heterogeneity in the locus of control within countries across the region
4. Changing dynamics of prioritization – slow movement from political to evidence-based prioritization
The changing landscape offers many opportunities for engagement in countries across the globe looking to secure and strengthen their immunization programs and understanding these changes will aid in that mission. Our final report discusses some of these opportunities. The different degree to which the six countries in the cross-country analysis experience and advance the different trends provides a multitude of lessons learned and opportunities for knowledge sharing. The next step will be to open a dialogue between countries and stakeholders to share relevant experiences and work together to strengthen immunization financing.
Though there is much interest among immunization financing stakeholders in innovative financing mechanisms, little is known across this broad spectrum of actors regarding how different mechanisms function and how they could be applied to positively influence financing for sustained and growing national immunization programs. ThinkWell has developed an Innovative Financing for Immunization resource guide that helps to answer these questions and can be used by immunization programs across the globe to further efforts towards improved financing.
Public insurers play major health financing roles in countries across the globe. How these actors can be leveraged to improve sustainable immunization financing is still not fully explored by many countries, particularly those markets outside of Europe. Through purchasing health and immunization services in a strategic manner, public insurers can both bring in additional resources for immunization programs and help improve efficiency and performance of immunization programs. The Strategic Purchasers and Immunization: How to Leverage these Major Players for Public Program Improvements resource guide provides specific ways for an insurer to strategically engage with public immunization programs. This guide helps the reader to better understand how their purchaser functions within their country and health system context and highlights exemplary models that have used public insurance mechanisms to sustain and grow immunization programs.
For public immunization programs that face resource mobilization and performance challenges, leveraging a partnership between private and public actors can unlock the strengths of both sides to create positive outcomes. This resource guide provides a useful framework for how to bring together public and private motivations in designing solutions to address challenges. The Public-Private Partnerships: Why, What, and How for Sustainable Immunization Financing resource guide provides an overview of the different categories and models of PPPs and illustrates these with real-life examples from health and non-health sectors across the globe. For private sector actors interested in pursuing tangible solutions for government partners, this resource guide will help define what good could look like, guide the reader through selecting a particular model, and then support the adaptation of that model to their particular needs.