Most countries successfully maintained or further improved key outcomes compared to their expected performance following transition from Gavi assistance

A new study in Global Health: Science and Practice examines country performance on vaccination coverage and post-neonatal mortality in countries no longer receiving assistance from Gavi, the Vaccine Alliance (Gavi) between 2000 and 2018. Researchers used 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.

Key findings

• Despite context-specific differences in vaccination coverage among countries after transitioning from Gavi assistance, most countries successfully maintained or further improved key outcomes compared to their expected performance.

• Unstable or decreasing vaccination coverage before becoming fully self-financing may be considered risk indicators, particularly among countries facing governance challenges.

• Annual fluctuations in vaccination coverage may have a limited impact on the overall trajectory of post-neonatal mortality when the rate is relatively low.

Key implications

• Synthetic control, a quasi-experimental method, can be used to evaluate large-scale global health program transitions. The results can inform approaches to safeguard and further gains achieved with external financial assistance, thereby maximizing the potential for success.

• International donors should assess contextual externalities and risks to potentially slow down the process of transitioning countries from assistance when needed.

• Country actors can leverage mechanisms for post-transition technical assistance and accountability and provide guidance to transitioning countries.

• Gavi can systematize post-transition assessments and evaluations that engage the expertise and experience of countries that no longer receive its support.

The study recommends 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.