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Applying lessons learned from the USAID family planning graduation experience to the GAVI graduation process.
Health Policy and Planning. 2015 Jul; 30(6):687-95.As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.
New York, New York, Population Council, Center for Poplicy Studies, 1985 Aug. 42 p. (Center for Policy Studies Working Papers No. 113)This analysis of family planning program funding suggests that current funding levels may be inadequate to meet projected contraceptive and demographic goals. Expenditures on organized family planning in less developed countries (excluding China) totaled about US$1 billion in 1982--about $2/year/married woman of reproductive age. Cross-sectional analysis indicates that foreign support as a proportion of total expenditures decreases with program duration. Donor support to family planning in less developed countries has generally declined from levels in the late 1970s. This is attributable both to positive factors such as program success and increased domestic government support as well as requirements for better management of funds and the worldwide economic recession. Foreign assistance seems to have a catalytic effect on contraceptive use only when the absorptive capacity of family planning programs--their ability to make productive use of resources--is favorable. The lower the stage of economic development, the less visible is the impact of contraceptive use or fertility per investment dollar. On the other hand, resources that do not immediately yield returns in contraceptive use may be laying the foundation for later gains, making increased funding of family planning programs an economically justifiable investment. The World Bank has estimated that an additional US$1 billion in public spending would be required to fulfill the unmet need for contraception. To increase the contraceptive prevalence rate in developing countries to 58% (to achieve a total fertility rate of 3.3 children) in the year 2000 would require a public expenditure on population programs of US$5.6 billion, or an increase in real terms of 5%/year. Improved donor-host relations and coordination are important requirements for enhancing absorptive capacity and program performance. A growing willingness on the part of donors to allow countries to specify and run population projects has been noted.