20 results on '"Saxenian H"'
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2. Sustainable financing for Immunization Agenda 2030
- Author
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Saxenian, H., primary, Alkenbrack, S., additional, Freitas Attaran, M., additional, Barcarolo, J., additional, Brenzel, L., additional, Brooks, A., additional, Ekeman, E., additional, Griffiths, U.K., additional, Rozario, S., additional, Vande Maele, N., additional, and Ranson, M.K., additional
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- 2022
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3. Design, content and financing of an essential national package of health services
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Bobadilla, J.-L., Cowley, P., Musgrove, P., and Saxenian, H.
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Medical care, Cost of -- Evaluation ,Medical care -- Models - Abstract
A minimum package of public health and clinical interventions, which are highly cost-effective and d with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package coul eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expendi should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost interventions against a larger number of diseases and conditions., Introduction No country in the world can provide health services to meet all the possible needs of the population, so it is advisable to establish criteria for which services to [...]
- Published
- 1994
4. Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries
- Author
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Saxenian, H., primary, Hecht, R., additional, Kaddar, M., additional, Schmitt, S., additional, Ryckman, T., additional, and Cornejo, S., additional
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- 2014
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5. Design, content and financing of an essential national package of health services
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Bobadilla, J. L., Cowley, P., Musgrove, P., and Saxenian, H.
- Subjects
Adult ,Male ,National Health Programs ,Health Policy ,Financing, Organized ,Health Planning ,Income ,Humans ,Female ,Public Health ,Health Expenditures ,Child ,Developing Countries ,Poverty ,Research Article - Abstract
A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.A minimum package of highly cost-effective public health and clinical interventions could be provided in low-income countries for about US$ 12 per person per year and in middle-income countries for about $22. This package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years old and 10-18% of the burden in adults. The two estimates of the package were calculated in two ways and then compared. One approach was based on the cost of specific activities, estimated from existing studies in many countries of service delivery costs by type of intervention. In the other approach, costs were estimated for a prototype district health system able to deliver the minimum package, consisting of a district hospital, health clinics, and outreach activities. In communities with moderate or high mortality, a few causes typically account for a large share of deaths. In 1990 an estimated 55% of the burden of disease was concentrated in children under 15 years old, with 660 million disability-adjusted life years (DALYs) lost. Just 10 disease conditions cause 71% of this loss. Except for congenital malformations, all these causes correspond to very cost-effective interventions, at less than $100 per DALY. Protein-energy malnutrition and vitamin-A deficiency can produce death or disability directly or through other diseases with a total loss 5-6 times larger when their indirect effect is included. The cost of the package would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that poor populations have access to these services with additional public expenditures either to extending coverage to the non-poor or to expansion beyond the minimum to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases.
- Published
- 1994
6. Investing in health wisely. The role of needs-based technology assessment.
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Jamison, Dean T., Saxenian, Helen, Bergevin, Yves, Jamison, D T, Saxenian, H, and Bergevin, Y
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- 1995
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7. Incentives and provider payment methods.
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Barnum, Howard, Kutzin, Joseph, Saxenian, Helen, Barnum, H, Kutzin, J, and Saxenian, H
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- 1995
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8. A quantitative analysis of sources of changes in government expenditures on health, 2000 to 2015: what can we learn from experience to date?
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Saxenian H, Bharali I, Ogbuoji O, and Yamey G
- Abstract
Background: Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs). It is critical to understand how much governments have devoted to health from domestic sources and how much growth might be realistic over time. Methods: Using data from WHO's Global Health Expenditure Database, we examined how the composition of current health expenditure changed by financing source and the sources of growth in health expenditures from 2000-2015 across different income groups. We disaggregated how much growth in government expenditures on health from domestic sources was due to economic growth, growth in government spending as a share of GDP, and reallocations in government expenditures towards health. Results: Lower MICs (LMICs) and upper MICs (UMICs), as a group, saw a significant reduction in out-of-pocket expenditures and a significant growth in government expenditures on health from domestic sources as a share of current health expenditures over the period. This trend indicates likely progress in the pathway to UHC. For LICs, these trends were more muted. Growth in government expenditure on health from domestic sources was driven primarily by economic growth in LICs, LMICs, and UMICs. Growth in government expenditure on health due to increased government spending as a share of GDP was high in UMICs. For the high-income country group, where economic growth was relatively slower and government spending was already high with strong tax bases, the largest driver of growth in government expenditure on health from domestic sources was reallocation of the government budget towards health. Conclusions: Dialogue on domestic resource mobilization needs to emphasize overall economic growth and growth in the government spending as a share of GDP as well as the share of health in the government budget., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Saxenian H et al.)
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- 2021
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9. Vaccine procurement in the Middle East and North Africa region: Challenges and ways of improving program efficiency and fiscal space.
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Kaddar M, Saxenian H, Senouci K, Mohsni E, and Sadr-Azodi N
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- Africa, Northern, Efficiency, Organizational, Humans, Middle East, Immunization Programs organization & administration, Vaccines supply & distribution
- Abstract
Improving vaccine procurement performance has been a priority concern of national health authorities in the Middle East and North Africa (MENA) region for years particularly in terms of its role in accessing new vaccines and assuring a steady supply of quality vaccines at affordable prices. This article reviews the vaccine procurement mechanisms in the MENA region; analyzes the factors and drivers affecting demand for and supply of vaccines; discusses the main challenges; and suggests measures which can increase efficiency gains and generate the budgetary room to introduce life-saving vaccines. Based on in-depth analysis of available data and interviews with key informants at the regional and country level, this paper explains why most of the current strategies do not sufficiently recognize the specific characteristics of vaccine markets and best practices in procurement given these markets. The paper suggests potential efficiency gains for governments and global partners from pooling demand and moving from transaction-based purchasing to strategic purchasing in order to strengthen immunization services and introduce more life-saving vaccines., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2019
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10. Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017.
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Saxenian H, Sadr-Azodi N, Kaddar M, and Senouci K
- Abstract
Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region's population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria-pertussis-tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization., Competing Interests: Competing interests: None declared.
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- 2019
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11. A quantitative analysis of sources of changes in government expenditures on health, 2000 to 2015: what can we learn from experience to date?
- Author
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Saxenian H, Bharali I, Ogbuoji O, and Yamey G
- Abstract
Background: Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs). It is critical to understand how much governments have devoted to health from their own sources and how much growth might be realistic over time. Methods: Using data from WHO's Global Health Expenditure Database, we examined how the composition of current health expenditure changed by financing source and the main sources of growth in health expenditures from 2000-2015. We also disaggregated how much growth in government expenditures on health from domestic sources was due to economic growth, growth in the tax base, reallocations in government expenditures towards health, and the interactions of these factors. Results: Lower MICs (LMICs) and upper MICs (UMICs), as a group, saw a significant reduction in out-of-pocket expenditures and a significant growth in government expenditures on health from domestic sources as a share of current health expenditures over the period. This trend indicates likely progress in the pathway to UHC. For LICs, these trends were much more muted. Growth in government expenditure on health from domestic sources was driven primarily by economic growth in LICs, LMICs, and UMICs. Growth in government expenditure on health due to a strengthened tax base was most important in UMICs. For high-income countries, where economic growth was relatively slower and tax bases were already strong, the largest driver of growth in government expenditure on health from domestic sources was reallocation of the government budget towards health. Conclusions: Given these findings from 2000-2015, discussions about a government's ability to reallocate to health from its overall budget need to be evidence based and pragmatic. Dialogue on domestic resource mobilization needs to emphasize overall economic growth and growth in the tax base as well as the share of health in the government budget., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Saxenian H et al.)
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- 2019
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12. Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health.
- Author
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Watkins DA, Yamey G, Schäferhoff M, Adeyi O, Alleyne G, Alwan A, Berkley S, Feachem R, Frenk J, Ghosh G, Goldie SJ, Guo Y, Gupta S, Knaul F, Kruk M, Nugent R, Ogbuoji O, Qi J, Reddy S, Saxenian H, Soucat A, Jamison DT, and Summers LH
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- Delivery of Health Care economics, Health Expenditures statistics & numerical data, Healthy People Programs standards, Humans, Universal Health Insurance, Delivery of Health Care standards, Global Health, Health Policy trends, Mortality, Primary Health Care standards
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- 2018
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13. Transforming Global Health by Improving the Science of Scale-Up.
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Kruk ME, Yamey G, Angell SY, Beith A, Cotlear D, Guanais F, Jacobs L, Saxenian H, Victora C, and Goosby E
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- Delivery of Health Care, Health Policy, Global Health economics
- Abstract
In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.
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- 2016
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14. Gavi's Transition Policy: Moving From Development Assistance To Domestic Financing Of Immunization Programs.
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Kallenberg J, Mok W, Newman R, Nguyen A, Ryckman T, Saxenian H, and Wilson P
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- Cooperative Behavior, Developing Countries economics, Global Health economics, Global Health trends, Humans, Immunization economics, Immunization trends, Immunization Programs trends, International Cooperation, Financial Support, Health Policy, Immunization Programs economics, Vaccines economics
- Abstract
Gavi, the Vaccine Alliance, was created in 2000 to accelerate the introduction of new and underused vaccines in lower-income countries. The period 2000-15 was marked by the rapid uptake of new vaccines in more than seventy countries eligible for Gavi support. To stay focused on the poorest countries, Gavi's support phases out after countries' gross national income per capita surpasses a set threshold, which requires governments to assume responsibility for the continued financing of vaccines introduced with Gavi support. Gavi's funding will end in the period 2016-20 for nineteen countries that have exceeded the eligibility threshold. To avoid disrupting lifesaving immunization programs and to ensure the long-term sustainable impact of Gavi's investments, it is vital that governments succeed in transitioning from development assistance to domestic financing of immunization programs. This article discusses some of the challenges facing countries currently transitioning out of Gavi support, how Gavi's policies have evolved to help manage the risks involved in this process, and the lessons learned from this experience., (Project HOPE—The People-to-People Health Foundation, Inc.)
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- 2016
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15. Implementing pro-poor universal health coverage.
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Bump J, Cashin C, Chalkidou K, Evans D, González-Pier E, Guo Y, Holtz J, Htay DT, Levin C, Marten R, Mensah S, Pablos-Méndez A, Rannan-Eliya R, Sabignoso M, Saxenian H, Feachem NS, Soucat A, Tangcharoensathien V, Wang H, Woldemariam AT, and Yamey G
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- Delivery of Health Care methods, Developing Countries, Global Health, Humans, Poverty, Health Plan Implementation organization & administration, Health Services Accessibility
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- 2016
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16. [Global health 2035: a world converging within a generation].
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Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, Bustreo F, Evans D, Feachem RG, Frenk J, Ghosh G, Goldie SJ, Guo Y, Gupta S, Horton R, Kruk ME, Mahmoud A, Mohohlo LK, Ncube M, Pablos-Mendez A, Reddy KS, Saxenian H, Soucat A, Ulltveit-Moe KH, and Yamey G
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- Community Health Planning, Developing Countries, Financing, Government, Financing, Organized, Goals, Health Policy, Health Promotion, Humans, International Cooperation, Investments, Preventive Health Services, Universal Health Insurance, Global Health, Public Health
- Abstract
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. The Commission's report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. First, there is an enormous economic payoff from investing in health. The impressive returns make a strong case for both increased domestic financing of health and for allocating a higher proportion of official development assistance to development of health. Second, modeling by the Commission found that a "grand convergence" in health is achievable by 2035-that is, a reduction in infectious, maternal, and child mortality down to universally low levels. Convergence would require aggressive scale up of existing and new health tools, and it could mostly be financed from the expected economic growth of low- and middle-income countries. The international community can best support convergence by funding the development and delivery of new health technologies and by curbing antibiotic resistance. Third, fiscal policies -such as taxation of tobacco and alcohol- are a powerful and underused lever that governments can use to curb non-communicable diseases and injuries while also raising revenue for health. International action on NCDs and injuries should focus on providing technical assistance on fiscal policies, regional cooperation on tobacco, and funding policy and implementation research on scaling-up of interventions to tackle these conditions. Fourth, progressive universalism, a pathway to universal health coverage (UHC) that includes the poor from the outset, is an efficient way to achieve health and financial risk protection. For national governments, progressive universalism would yield high health gains per dollar spent and poor people would gain the most in terms of health and financial protection. The international community can best support countries to implement progressive UHC by financing policy and implementation research, such as on the mechanics of designing and implementing evolution of the benefits package as the resource envelope for public finance grows.
- Published
- 2015
17. Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries.
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Saxenian H, Hecht R, Kaddar M, Schmitt S, Ryckman T, and Cornejo S
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- Developing Countries statistics & numerical data, Financing, Government economics, Financing, Government organization & administration, Humans, Immunization Programs economics, Infant, United Nations organization & administration, Developing Countries economics, Healthcare Financing, Immunization Programs organization & administration, International Cooperation
- Abstract
Over the 5-year period ending in 2018, 16 countries with a combined birth cohort of over 6 million infants requiring life-saving immunizations are scheduled to transition (graduate) from outside financial and technical support for a number of their essential vaccines. This support has been provided over the past decade by the GAVI Alliance. Will these 16 countries be able to continue to sustain these vaccination efforts? To address this issue, GAVI and its partners are supporting transition planning, entailing country assessments of readiness to graduate and intensive dialogue with national officials to ensure a smooth transition process. This approach was piloted in Bhutan, Republic of Congo, Georgia, Moldova and Mongolia in 2012. The pilot showed that graduating countries are highly heterogeneous in their capacity to assume responsibility for their immunization programmes. Although all possess certain strengths, each country displayed weaknesses in some of the following areas: budgeting for vaccine purchase, national procurement practices, performance of national regulatory agencies, and technical capacity for vaccine planning and advocacy. The 2012 pilot experience further demonstrated the value of transition planning processes and tools. As a result, GAVI has decided to continue with transition planning in 2013 and beyond. As the graduation process advances, GAVI and graduating countries should continue to contribute to global collective thinking about how developing countries can successfully end their dependence on donor aid and achieve self-sufficiency., (Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.)
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- 2015
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18. Global health 2035: a world converging within a generation.
- Author
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Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, Bustreo F, Evans D, Feachem RG, Frenk J, Ghosh G, Goldie SJ, Guo Y, Gupta S, Horton R, Kruk ME, Mahmoud A, Mohohlo LK, Ncube M, Pablos-Mendez A, Reddy KS, Saxenian H, Soucat A, Ulltveit-Moe KH, and Yamey G
- Subjects
- Delivery of Health Care economics, Delivery of Health Care trends, Developing Countries, Global Health economics, Health Expenditures trends, Humans, International Cooperation, Universal Health Insurance trends, Global Health trends
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- 2013
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19. An analysis of how the GAVI alliance and low- and middle-income countries can share costs of new vaccines.
- Author
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Saxenian H, Cornejo S, Thorien K, Hecht R, and Schwalbe N
- Subjects
- Capital Financing organization & administration, Cooperative Behavior, Cost Allocation organization & administration, Developing Countries, Vaccines economics
- Abstract
Immunization is one of the "best buys" in global health. However, for the poorest countries, even modest expenditures may be out of reach. The GAVI Alliance is a public-private partnership created to help the poorest countries introduce new vaccines. Since 2008 GAVI has required that countries cover a share of the cost of vaccines introduced with GAVI support. To determine how much countries can contribute to the cost of vaccines--without displacing spending on other essential programs--we analyzed their fiscal capacity to contribute to the purchase of vaccines over the coming decade. For low-income countries, external financing will be required to purchase vaccines supported by GAVI, so co-financing needs to be modest. Relatively better-off "intermediate" countries could support initially modest but gradually increasing co-financing levels. The countries soon to graduate from GAVI can generally afford to follow a rapid path to self-sufficiency. Co-financing for these countries needs to ramp up so that national budgets fully cover the costs of the new generation of vaccines once GAVI support ends.
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- 2011
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20. Optimizing health care in developing countries.
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Saxenian H
- Subjects
- Data Collection, Financing, Government, Poverty, Developing Countries economics, Health Expenditures statistics & numerical data, Health Planning economics
- Published
- 1994
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