Cash-for-vaccination rates ‘exaggerated’

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Cash-for-vaccination rates ‘exaggerated’

By Jack in London

Published: December 12 2008 01:39 | Last updated: December 12 2008 01:39

Developing countries funded by donors on the basis of their success in

boosting immunisation rates have exaggerated their results, according to a

study published in the Lancet on Friday.

At the most extreme, Niger and Mali claimed child immunisation rates twice

as high as the levels confirmed by independent surveys, found research led

by Murray at the Institute for Health Metrics and Evaluation at

the University of Washington in Seattle.

The study raises concerns about the operation of the UN-backed Global

Alliance on Vaccines and Immunisation (Gavi). The organisation which pools

donor countries’ funds to support immunisation and has paid out more than

$100m (€77m, £68m) through its Immunisation Support Services programme,

which offers $20 per child vaccinated to countries with which it works.

It also casts doubts on performance-based funding, an approach to rewarding

results that has become increasingly fashionable across a broad range of

programmes to assist the developing world in recent years.

Variants of the system are used by international institutions including the

Global Fund to fight Aids, TB and Malaria, and are being promoted by the

World Bank with support from donors including the Norwegian government.

The research comes at an embarrassing time, as Gavi attempts to raise

further money to boost vaccination programmes and as development assistance

more generally is under threat during the economic downturn.

“In the presence of incentives, you get a not surprising tendency to

over-report success,” said Prof Murray. “The solution is independent,

contestable verification.” His study showed immunisation rates by 2006 in

193 countries for diphtheria, tetanus and pertussis were 74 per cent,

against 90 per cent reported by Gavi.

Partly in response to his findings, Gavi hosted a meeting with international

donors in London this week, including the UK and Norway. n Lob-Levyt,

head of Gavi, said there was some evidence to suggest over-reporting of

immunisation rates by countries, but he stressed there was no indication

that performance-related funds had been siphoned off and stolen. He said it

had been used to support government health programmes.

The new study also had limitations, he said, because it was based on

questionnaires to individuals asked to recall when and which immunisations

had been given in the past; and because it was historical it could not be

used by managers to improve performance.

Copyright The Financial Times Limited 2008