Introduction: Since the expanded program on immunization (EPI) was introduced in low-income countries in 1974, delivery of vaccines to children in need in these countries has largely depended on donor funding. Gavi introduced co-financing in attempts to address the problem of donor dependency in immunization programs in lowincome countries. This study examines the perception barriers that hinder the generation of a desired increase in domestic revenue allocation for immunization programs of recipient low-income countries.
Methods: Document review was conducted for the period 2010 to 2014 in the 4 countries implementing Gavi cofinancing arrangements for at least 4 years. Key informant interviews of 12 participants with a role in immunization planning and budgeting process were conducted in the same 4 countries. Descriptive analysis of quantitative and qualitative data was performed to determine co-finance patterns and contributing factors.
Results: Findings showed largely sustained levels of co-financing by countries without any significant increase in co-financing levels. Findings from qualitative analysis identified 2 concerns that represented perceived barriers of generation of new money among recipients participating in the co-financing arrangement; these were: understanding of the proposed co-financing solution and the capacity to contribute.
Conclusion: Findings show that desired increasing levels of co-financing by countries receiving matching grants has not been respected. This does not bode well for realization graduation from donor grants, and donor dependency may continue. The main contributing factors according to the findings are lack of consensus and shared common understanding among stakeholders of how co-financing arrangement is expected to work and what is expected of stakeholders, and lack of fiscal space to accommodate more immunization costs in the midst of other legitimate competing needs and budgetary constraints.