Strengthening domestic resources to deliver life-saving commodities
As countries transition away from donor funding to domestic sources of financing, the ‘pre-financing’ tool is supporting them to deliver supplies on time to tens of millions of children each year.
The Vaccine Independence Initiative (VII) is a pre-financing tool managed by UNICEF, offering a support mechanism for countries utilizing their own domestic resources for procurement of health-related supplies. The tool helps countries bridge temporary short-term funding gaps, which might otherwise lead to supply shortages and stock-outs.
The flexible credit terms of the VII allow governments to pay after delivery, as opposed to the UNICEF standard advance payment requirement. For example, if a country has planned and budgeted for a commodity but is experiencing temporary cash flow delays, the VII can allow the procurement to proceed, accelerating the availability of supplies by at least four to six months.
The size of the fund has been scaled up over time – quadrupling from $8.9 million in 2015 to $35 million in 2019. Originally focused on vaccines, the VII has evolved to meet demand and now also supports procurement of other commodities such as medicines, bed nets, nutrition products and cold chain equipment. By 2019, the VII support to countries had increased tenfold, compared to the 2012–2014 period. Looking forward, UNICEF anticipates further growth of pre-financing support to more than $200 million per year.
Tens of millions of children benefit from VII support to countries each year. Between 2015 and 2019, the VII facilitated the on-time delivery of 565 million doses of vaccines, 100,000 cartons of ready-to-use therapeutic foods and nearly 400,000 packs of antiretroviral drugs (ARVs).
The long-term vision for VII is that participating countries ‘graduate out’ from VII support. However, in the next five-year period, an increased demand for VII support is expected, especially as governments move forward on their commitments to meet the Sustainable Development Goals and scale up domestic financing.
Spotlight on the Congo
In 2019 the Government of the Congo became a formal subscriber to the VII to facilitate the procurement of medicines and health products for children, and to help address the downward trend in immunization coverage. With the VII support, the country carried out an immunization campaign in March 2019, during which 2.4 million children were vaccinated against measles and rubella, achieving 97 per cent of the national target. The Government also used the campaign as a platform to provide Vitamin A and deworming tablets to children. Thanks to on-time procurement of vaccines for this campaign and other routine immunization services, VII helped increase the country’s national immunization coverage. For example, coverage of diphtheria-tetanus-pertussis (DTP3) increased from 69 per cent in 2017 to over 79 per cent at the end of 2019.
The Congo also used the VII mechanism to procure other essential health commodities, including antimalarial and ARV medicines. Following three consecutive years of supply shortages, VII made it possible to purchase a six-month stock of ARV drugs for nearly 27,000 patients, as well as HIV tests to support the relaunch of the country’s Prevention of Mother-to-Child Transmission of HIV programmes. The country also acquired diagnostic tests and treatment for 100,000 malaria cases. With the supplies and programmes securely in place, the Ministry of Health met its goal of providing free access to vaccination and treatment for HIV and malaria.