Immunization, Vaccines and Biologicals

Debt Relief Initiatives and Immunization Financing

Forty of the poorest and most heavily indebted countries are currently eligible to benefit from debt relief under the Heavily Indebted Poor Countries (HIPC) Initiative, the Multilateral Debt Relief Initiative (MDRI), and some additional bilateral debt relief programmes. These initiatives have a double objective: First, to lower the debt burden of eligible countries giving fresh impetus to investments and growth, and second, to free up resources for higher public spending on poverty reduction.

When compared with the past and present public spending on health, the cumulative annual amounts of savings made from different debt relief initiatives are important to many HIPCs.

Moreover, for the first time, the provision of debt relief is explicitly linked with the goal of poverty reduction and the attainment of the United Nations Millennium Development Goals: The beneficiary governments have pledged to reallocate the budgetary savings from debt relief to priorities which are in line with the national poverty reduction strategy. The health sector and in particular, the immunization programme are expected to benefit considerably from additional governmental budget allocations.

WHO work on debt relief

Why this study?

- The need to scale up health and immunization financing

- Potential magnitude and features of released debt relief funds

- Lack of information on the amounts, management and use of funds

In 2006, a working group at WHO began in-depth assessment of current debt relief initiatives for low income countries, to find out whether these initiatives provide a real opportunity to scale up health and immunization financing in beneficiary countries. The work undertaken by the working group and technical experts was part of a greater effort by WHO and the GAVI Alliance to explore and propose ways of raising and disbursing both foreign and domestic financial support for immunization and the health system.


The main objective of this work was to analyze and document the experience of countries benefiting from current debt relief initiatives and to assess the financial impact of these resources on the health sector and immunization programme. The findings should ultimately feed into clarifications and recommendations to WHO and national health authorities on how debt relief may be used to scale up health financing and priority interventions.

Approach and case studies

Currently, there is limited information on the link between debt relief and poverty reducing expenditures. Where data exists, it is often at aggregate level and does not allow deriving solid conclusions for the health sector. It was therefore decided that country case studies were the appropriate methodology for the purpose of obtaining more detailed quantitative and qualitative information on the evolution of public health expenditure following recent debt relief initiatives.

Country case studies are based on data and information mainly gathered through literature reviews, data collection tools, and country visits. These visits enabled the WHO working group to interview and consult key officials from the ministry of health (including staff from the Expanded Programme on Immunization), the ministry of finance, and development partners such as the World Bank, the International Monetary Fund, the African Development Bank, bilateral donors, and NGOs.

Case studies for eleven countries have been completed. Summaries of these case studies and country data sheets are now available.