Issue of generalizability
Currently, the immunization financing database includes data from a few selected countries. It would not be prudent to generalize the findings from this small set of countries. They are not necessarily representative of the broader set of low-income countries, nor to all GAVI countries. Likewise, the time series data is not long enough to make any valid inferences about trends. Currently there are only two years of retrospective data for each country.
Treatment of shared costs
While it is recommended that countries estimate the shared costs of their programme, the guidelines for developing an FSP do not make it a requirement. Only programme specific costs are required. Although the latter are easier to estimate, by excluding shared inputs to the programme, the costing and financing data will tend to underestimate: (a) the true government contribution to the national immunization programme since many of the shared inputs to the immunization programme are funded using national resources (especially for personnel costs) and, (b) the total cost of the national immunization programme if many inputs are frequently shared with other programmes.
While there are clear disadvantages of using programme specific costs, some argue that monitoring programme specific cost financing by governments is more revealing in terms of how governments and other partners are mobilizing additional resources for immunization and it is in line with the way GAVI has defined financial sustainability.
Treatment of financing sources
Given the difficulties in tracking the exact source of financing, countries are asked to report only the source of financing closest to the end use. Therefore, transfers of bilateral donor agency resources to multilateral agencies (such as WHO or UNICEF), or to a health fund or the national treasuries (through pooled funds or budget support) are not attributed to the donor countries. This is of particular, and growing, significance in countries receiving bilateral aid through sector-wide approach (SWAp) programmes and national budget support. In addition, again because of the focus on programme-specific costs, the contribution of the national government to the immunization programme is not fully accounted for - figures presented do not include spending on key inputs such as personnel and facilities, which are shared across multiple health programmes.