The Institute for Advanced International Studies (IAIS) at the University of World Economy and Diplomacy implemented a focused research project on the sustainable financing of Uzbekistan’s national immunisation programme, supported by World Health Organization (WHO) grant and conducted from 21 February to 29 June 2023. The initiative set out to distil actionable lessons from international experience and to ground policy choices in rigorous comparative evidence, with a view to safeguarding high and equitable vaccination coverage as external assistance recedes.

The study surveyed lower- and middle-income country practices, identifying leading examples such as Sri Lanka, Bolivia, Costa Rica, El Salvador, Mongolia and Vietnam, and developed deep-dive case notes on Moldova, Azerbaijan, Armenia, Georgia, Bhutan, Ghana, Indonesia, Sri Lanka and Vietnam. It compared financing architectures (general-tax/NHS models, mixed systems with national insurance, and public insurance–led purchasing), procurement pathways (including pooled procurement through UNICEF Supply Division), and revenue instruments (earmarking, national lottery proceeds, and trust funds). The analysis also examined incentive mechanisms (capitation and pay-for-performance) and their role in sustaining coverage.

Methodologically, the project distinguished the two principal cost blocks and traced how countries budget, purchase and account for these across central and sub-national levels. Particular attention was paid to transition dynamics from Gavi co-financing to full domestic funding, and to governance arrangements that clarify roles between ministries of health, insurance funds and purchasing agencies in order to avoid service gaps or perverse incentives.

For Uzbekistan, the research underscored the imperative to consolidate domestic fiscal space as Gavi eligibility recedes, while lowering out-of-pocket exposure through predictable budget lines and smart purchasing. Evidence-informed options highlighted by the project include: leveraging pooled procurement, codifying immunisation within benefits packages, and strengthening information systems (unique immunisation IDs and an integrated e-platform) alongside targeted provider incentives and communications. The project culminated in a policy report setting out international patterns and a set of tailored recommendations for legislative, budgeting and programme management reforms.

Project details

Funding: World Health Organization (WHO) grant

Duration: 21 February – 29 June 2023

Research team: Sherzod Abdullaev, Akram Umarov, Laylo Tashpulatova, Kamola Safaeva, Khulkar Karimova, Abbos Bobokhonov, Rustam Makhmudov, Mekhriniso Abdurasulova, Mikhail Strokan

* The Institute for Advanced International Studies (IAIS) does not take institutional positions on any issues; the views represented herein are those of the author(s) and do not necessarily reflect the views of the IAIS.