PEPFAR: Exploring Co-Financing as a Tool for Domestic Resource Mobilization
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Appendix Table
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| Gavi, the Vaccine Alliance (Gavi) | Global Environment Facility (GEF) | Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) | Green Climate Fund (GCF) | Millenium Challenge Corporation (MCC) | Pandemic Fund (PF) | |
| Institutional Definition | Share of total costs of vaccines borne by countries (not applied to Gavi funding for health systems/ immunisation strengthening). | Financing that is additional to GEF project financing and supports implementation of a GEF-financed project or program and achievement of its objective(s) and excludes recurrent expenditures. | Pooled domestic public and domestic private contributions that finance the health sector and national strategic plans supported by the Global Fund. Goal is to leverage additional domestic financing. | Financial resources, whether public or private, in addition to the GCF proceeds to implement GCF funded activity or project. | Contributions from countries toward meeting MCC objectives. These must be additional to government spending allocated towards Compact’s objectives. | Co-financing is financial resources from Implementing Entities or other sources in addition to the PF grant.
Co-investment is financial resources and linked non-monetary policy commitments from countries in addition to PF grant. |
| Applies To | All countries seeking support. | All applicants. | All countries seeking support. |
All countries seeking support. | All countries seeking Compact funding. | All applicants. |
| Policy Details | Countries required to share in cost of vaccine procurement for routine vaccination. Amount varies by country-income classification and transition status from Gavi eligibility. Countries divided into: initial self-financing ($0.20/dose); preparatory transition (first year at $0.20/dose; thereafter, price fraction increases by 15%/year); accelerated transition (price fraction increases by 15% in year 1, then linearly to 100%). | Co-financing target set at overall GEF portfolio level, not individual program or project level, where no minimum amount specified. Overall portfolio target is co-financing to GEF project financing of at least 7:1 and 5:1 for portfolio in Upper-Middle Income Countries and High-Income Countries. | Countries required to demonstrate progressive government expenditure on health (variable by share of domestic government spending on health and disease burden) and increasing co-financing of Global Fund supported programs. No specific amounts specified.
At least 15% of funding conditional on increases in co-financing (variable by country income classification). For LICs, additional domestic investments should be at least 50% allocation tied to co-financing; for MICs, it is 100%. |
Co-financing information should be included in funding proposals and used as part of criteria for assessment. No minimum amount specified. | Countries required to co-finance their Compacts. Specific co-financing amounts vary by country income classification and whether Compact is first, second, or concurrent as follows: 1st compact LIC (No minimum), 1st Compact LMIC (7.5%),
2nd Compact LIC (7.5%), 2nd Compact LMIC (15%); Concurrent LIC or LMIC (required but no minimum specified). |
Implementing entities encouraged to identify co-financing for projects.
Governments encouraged to commit to progressively increasing co-investments over time. Can be scaled to country income classification. Applications scored in part on this basis. No specific amounts specified. No minimum amount specified. |
| Source(s) of co-financing | Must be non-Gavi funding. | Can be from any source including funding from domestic governments, donors, civil society, and in-kind support. | Domestic public resources can include government revenues, government borrowings, social health insurance, and debt relief proceeds including Debt2Health arrangements with the Global Fund.
Domestic private contributions include only those from domestic corporations and philanthropies. |
No specific sources that must be complied with. | Financial and in-kind country resources. Financial can include country government resources, as well as other financial instruments including cash, grants, loans, securities, guarantees. Cannot be USG (except DFC loan) or count toward other donor co-financing requirements. | Co-financing sources: implementing entities, governmental donors, philanthropies, and the private sector.
Co-investment sources: Domestic government resources, buy down of interest rates, and repayments of loans. |
| Waivers/ Flexibility |
Waivers or adjustments can be made in exceptional circumstances (e.g., humanitarian or fiscal crises). | Exceptions can be made in cases of emergency or unforeseen circumstances. | Waivers can be made in exceptional circumstances (e.g., fiscal or humanitarian crises). | Not specified, but GFC co-financing principles state that “Co-financing may not always be achievable or realistic”. | Waivers of certain requirements on case by case basis, but requirement for lower middle income countries is statutory and cannot be waived. | Exceptions can be made for countries in or at risk of debt distress. |
| Monitoring/ Compliance | Requirement fulfilled through actual co-purchasing of doses with Gavi and is condition for receiving support. A country in default will not be approved for new vaccine support, and funding disbursements for health system and immunization strengthening may be suspended. | Secretariat collects data and information on expected and actual co-financing mobilized at the portfolio and recipient country level and reports annually. | A letter outlining co-financing commitments and signed by the Ministry of Finance or other government authority is mandatory prior to grant approval. Compliance based on verified budget execution and budget allocation data provided by the country, through national expenditure assessments, or by audited financials. Failure to comply factored into subsequent allocations and Secretariat, at its discretion, may withhold proportional share of disbursements or reduce annual grant amounts. | Accredited entities monitor and report on co-financing at the project level. Secretariat monitors and reports on overall co-financing at the funded activity and portfolio level based on the information provided by accredited entities. | Must be verifiable by country records. Monitored by MCC and authorized agent. Additionality must be demonstrated. MCC may conduct on-site monitoring and verification. Audit reports must include co-financing information. If country not in compliance, MCC may withhold, reduce, suspend or terminate assistance. | Documented in annual project reports.
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| Source documents:
Global Environment Facility Global Fund
Green Climate Fund
MCC
Pandemic Fund
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