Evaluating country performance after transitioning from Gavi assistance : an applied synthetic control analysis

Kolesar, Robert John (author), Spruk, Rok (author), Tsheten, Tsheten (author)

Introduction: Over the past decade, international development assistance for health has slowed. As donors seek to increase domestic cofinancing and ultimately transition countries from donor aid dependence, COVID-19 has severely constrained public budgets. The evaluation of sustainability and longer-term impacts of donor withdrawal is increasingly important. We assess vaccination coverage and post-neonatal mortality to estimate country performance of these outcomes among countries that no longer received assistance from Gavi, the Vaccine Alliance (Gavi) between 2000 and 2018. Methods: Using data from all countries receiving Gavi support between 2000 and 2020, we employed a synthetic control method to generate a pre-transition counterfactual with the same characteristics as the observation of interest to predict a future that empirically never existed. The synthetic unit is constructed from the weighted average of other units with good fit to the unit of interest before transition but did not transition. Results: We found substantial heterogeneity after transitioning from Gavi assistance. China, Guyana, and Turkmenistan overperformed their expected coverage rates; Albania, Bhutan, China, Guyana, and Turkmenistan maintained coverage over 90%; and Bosnia and Herzegovina and Ukraine reported precipitous drop-offs that fell well below their synthetic controls. We also observed a vaccination coverage decline in 2020 for several countries after transitioning and most synthetic controls, which we attribute to COVID-19- related service disruptions. Conclusions: We recommend that Gavi adjust its transition model to systematically assess contextual externalities and risk. In addition, countries that no longer receive Gavi assistance can leverage technical assistance and communities of practice to mutually assist each other and other countries advancing toward transition. This could also foster intracountry accountability after transition. We also recommend that Gavi systematize post-transition assessments and evaluations that leverage the expertise and experience of graduated countries to encourage cross-learning.

• Language: English
• Keywords: developing countries, health care, pandemic, development aid
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: EF - School of Economics and Business
• Publication status: Published
• Publication version: Version of Record
• Year: 2023
• Number of pages: 14 str.
• Numbering: Vol. 11, iss. 4
• PID: 20.500.12556/RUL-154017
• UDC: 614
• ISSN on article: 2169-575X
• DOI: 10.9745/GHSP-D-22-00536
• COBISS.SI-ID: 161716739
• Publication date in RUL: 19.01.2024

Record is a part of a journal

• Title: Global health. science and practice
• Shortened title: Glob. health sci. pract.
• Publisher: U.S. Agency for International Development and Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs
• ISSN: 2169-575X
• COBISS.SI-ID: 524568345

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: dežele v razvoju, zdravstveno varstvo, pandemija, razvojna pomoč