KEYWORDS:
financing, sustainability, GAVI, Vaccine Fund

BACKGROUND:
The GAVI Vaccine Fund requires that its beneficiary countries submit a financial sustainability plan (FSP) within two years of receiving assistance. The first set of FSPs was due November 30, 2002.

OBJECTIVE:
Draw lessons from the preparation of several of the first set of Vaccine Fund FSPs.

METHOD:
The authors provided technical assistance to the preparation of FSPs for Tanzania, Cambodia, Zanzibar, Uganda, Kyrgyzstan, Ghana, Malawi, and Rwanda. From this work the authors were able to draw a number of lessons concerning the requirements, the content of the FSPs, and the political process set in motion.

RESULT:
Many of the countries struggled to put together the technical analyses required in their FSPs. The Guidelines provided by the Vaccine Fund were unclear about certain definitions and methods to be used to project costs and financing needs. The FSP preparation process stimulated a useful technical and political process in many of the countries, involving the immunization program, Ministry of Health, Ministry of Finance, and donor and lender partners. The cost and financing implications of using the pentavalent DTP, hepatitis B, and hib vaccine were a shock to many of the countries.

CONCLUSION:
The Vaccine Fund should improve the Guidelines for FSP preparation in a number of ways to make the process easier and more focused on the choices to be made. The technical and political dynamic that results from the FSP process should lead to a greater likelihood of financial sustainability for the countries assisted by the Vaccine Fund.

LEARNING OBJECTIVES:
To understand how the Vaccine Fund FSP process works in practice; to learn the lessons drawn from the first round of FSP preparation; and to understand the major financial sustainability challenges created by the Vaccine Fund.