Critical conversations in Public-private partnerships

Dr Ranjana Kumar

1st November 2007

The GAVI Alliance

Public-private partnership bringing together all the major stakeholders in immunization

Launched in 2000

Mission: Save children’s lives and protect people’s health by increasing access to immunization in poor countries

Vaccines and funding to strengthen immunization and health services to 70+ of the poorest countries

2

GAVI partners

Outline of innovations

Raising resources – International Financing Facility for Immunisation, IFFIm

Making vaccines available – Advance Market Commitment, AMC

Facilitating introduction of new vaccines, ADIPs Supporting policy and programme

implementation, Civil Society Organisation partnerships

Programme level impact

Funding innovations

IFFIm: International Finance Facility for Immunisation: using markets differently – a radical shift in scale – US$ 1 billion frontloaded from the capital markets

AMC: Advance market commitment pilot for pneumoccocal vaccine: accelerating access

PPP example: Immunization Services Support (ISS)

Success factors

Monetary resources

Incentivisation principals

Economically minded and committed governments

Rigorous control instance (e.g. independent audit of immunization coverage data to ensure system integrity)

Lessons learnt

New performance based approaches (e.g. performance based funding) in development

significantly increase its efficiency

positively affects people’s commitment through increased self-determination

Partner Contribution

Public Sector Funds managed by

governments

Public and Social Sector

Implementation: Delivery of immunization service in local hospitals or health centres run by local NGOs

Private Sector

Expertise: e.g. business based funding approaches

Social Sector

Advise: The WHO and UNICEF (renewable partner in GAVI Alliance Board) e.g. supported the Ministry of Health of Cambodia with the application process for ISS funds

Implementation: UNICEF is managing the transfer of ISS funds

Background and Objectives

Performance-based and time limited funding for developing countries to improve their health outcomes (i.e. increased vaccination coverage)

ISS money is highly flexible to use; governments and its development partners make local decisions on most effective allocation and use of ISS funds to strengthen their health systems

Additional funding or performance payments are given to countries when they have met or surpassed their self set immunization goals after the investment phase (almost similar to sales representatives receiving a commission bonus after having met their targets)

Results: Speeding availability

GAVI established

HepB - all developing countries

HepB containing combination vaccines

1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005

Hep B licensed

HepB combos licensed M

illi

on

s of

dose

s

0

50

100

150

200

GAVI was designed to reduce the time lag in the availability of vaccines between industrialised and developing countries

Results: influencing the marketVaccine prices drop as new manufacturers enter the market

DPT Hep B vaccines prices have declined by 40%

The growing role of the developing country vaccine manufacturer

Presence of multiple suppliers in the market is critical to vaccinesecurity. In 2006, almost 30% of all the vaccines purchased byUNICEF for GAVI were manufactured in developing countries.

Results to date

Health services Additional children reached

Hepatitis B: 126 million Hib: 20 million Yellow fever: 17 million DTP3: 28 million

Dramatic immunisation coverage increase DPT3: 63% in 1999 to 77% in 2006 44% in 1999 to a 73% in 2006 in Africa

Safe (auto-disable) syringes uptake 1.2 billion syringes

Estimated additional children reached with GAVI support (cumulative 2001-06) Hepatitis B: 126 million Hib: 20 million DTP3: 28 million Yellow Fever: 17 million

Progress to date

• 1.7 million cumulative deaths already averted• It is projected that, by end 2006, more than 2.3 million future deaths will have been prevented (600,000 in 2006 alone).

GAVI prospects and priorities

• A long-term vaccine investment strategy

• Ensuring effective implementation of scaled up resources

• Build on the PPP model and strengthened CSOs participation in GAVI policy-making and programme implementation

• Linking GAVI in with developments in international health architecture and in particular health systems work

• Maintaining GAVI’s position as a leading innovative Global Health Partnership

External validation of the GAVI Alliance business model

“The economic impact and benefits of immunisation have been greatly underestimated; GAVI programmes could earn a rate of return of 18 percent”

David Bloom, David Canning and Mark Weston (Harvard School of Public Health) “The Value of Vaccination”, World Economics, September 2005

“This is the first time that there is hard evidence that one of the major global health programmes is having a real impact.”

"Independent Evaluation of the Impact of GAVI on DTP3 Coverage,” Murray et al. The Lancet, 18 September, 2006