Combining health and social protection measures to reach the ultra ...

InnovationChild immunization:accelerating equitable accessthrough innovative financingArticle by Alan R GillespieIn November 2006, the launch in London, UK of theinaugural US$ 1 billion bond of the International FinanceFacility for Immunization (IFFIm) changed the frame ofreference for development financing. This breakthrough hasbrought radical alteration both to the scale and timeframe ofimmunization programmes, and to the long-term predictabilityof aid funding.IFFIm is a new international development institutiondesigned to accelerate the availability of funds to be used forhealth and immunization programmes. It is the result of aninnovative public-private partnership between thedevelopment sector, finance communities and donorgovernments 1 . It works in partnership with the GAVI Alliance,itself another leading-edge hybrid of public and privateconcerns, working through its partners to implement childhealth and immunization programmes in 70 of the world’spoorest countries 2 . Itself only seven years in existence, theGAVI Alliance has quickly demonstrated that the effectivenessof development assistance depends on making the fundstargeted, and on building flexibility into the process.IFFIm has put unprecedented financial weight behindprompt, near-term action to accelerate vaccine access andhealth system strengthening for the poorest countries. Theplacement of this bond was the first use of the internationalcapital markets to fund grants for one specific developmentpurpose and reflects the aim of the Facility: to frontload aid tohelp meet the Millennium Development Goals. It thereforerepresents two important drives: to get very significantvolumes of aid quickly to where they can be most influential;and to do so within a structure that clearly demonstrates thelong-term and predictable nature of support.The first of these: significant aid, quickly delivered. The firstfull year of IFFIm proceeds will fund critical global infectiousdisease reduction programmes as well as supportingDuring 30 years in the financial markets, assistinggovernments and companies to raise capital, I havenever been involved in any transaction so thoroughlyworthwhile and rewardingimmunization safety and new vaccine programmes in GAVIcountries (see Figure 1) 3 . By the end of 2007, through IFFIm,an estimated 14.5 million additional children will have beenreached with vaccine against hepatitis B, 4.4 million childrenwith vaccine against yellow fever, and 3.8 million childrenwith vaccine against Haemophilus influenzae type b (Hib) 4 .Over the next 10 years, the anticipated IFFIm investment ofUS$ 4 billion is expected in total to provide immunization foran additional half a billion people and save as many as 10million lives.Importantly, IFFIm funds are also helping countries toaddress as quickly as possible health system “bottlenecks”that currently limit their ability to get vaccines to children.To date the IFFIm Board has approved US$ 117 million to beused for health system strengthening. This represents morethan 10% of the inaugural bond amount of US$ 1 billion.Of this, GAVI will have applied US$ 92 million before theend of 2007.Ethiopia provides a good example of how to tackle thesebottlenecks effectively. Ethiopia’s per capita gross nationalincome is US$ 160. It is one of the world’s poorest countries.It shares the “catch 22” plight of most of the countries in thissituation: a high child mortality rate (under five mortality of145 per 1000 live births), critical gaps in the healthworkforce, and the consequent vicious circle of ill health andcontinuing poverty that make it impossible to devote moreresources to health.For Ethiopia, the key is to address inequitable access tobasic health services. Health worker density is currently at0.6 per 1000 inhabitants. The plan to train 30 000 “healthextension workers” is the centerpiece of the healthcomponent of the national poverty reduction strategy. Whenroll-out is completed in 2008 the programme will haveplaced two freshly trained health extension workers in each ofEthiopia’s around 15 000 communities, providing servicesincluding immunization to community members. Beyond thetraining, the programme will also finance establishingmanagement/supervisory capacity and infrastructure such asthe construction of health posts, and supply/distribution/maintenance systems.What is IFFIm’s role in this? Through frontloading thefunding needed to support the five-year plan, the wholeproject has been massively accelerated – and fully funded.096 ✜ Global Forum Update on Research for Health Volume 4