FSP Section 3 - Table 3.

1 Baseline Costing and Financing

Baseline Year is the most recent fiscal year for which data on actual expenditures and financing are available prior to any GAVI / Vaccine Fund support (this will likely be 2001). Please refer to Annex III for definitions of each cost component, step by step instruction on how to complete this table with simplified methodologies to calculate each variable (including methods for shared costs) and suggestions as to where to find the data.
Cost Category TOTAL Government (Central) Government (Local) Private Sector Community Participation Donor Pool (if applicable) UNICEF WHO GAVIVaccine Fund DFID USAID JICA Other Bilaterals (Specify) CVP Rotary Other NGOs (Specify) EU World Bank Other Donors (Specify)

Required Information [A] Routine Recurrent Cost Vaccines (routine vaccines only) -Traditional 6 antigens -New and underused vaccines Injection supplies Personnel -Salaries of full-time NIP health workers (central, provincial and district levels) -Per-diems (other incentives) for outreach vaccinators/mobile teams Transportation Maintenance and overhead Short-term training IEC/social mobilization Monitoring and disease surveillance Other routine recurrent costs (please specify) (please specify) (please specify) Subtotal Recurrent Costs [B] Routine Capital Cost Vehicles Cold chain equipment Other capital costs (please specify) Subtotal Capital Costs [C] Supplemental Immunization Activities Polio NID-SNID Vaccines Per diems Operational costs Other costs (please specify) Measles Campaigns Vaccines Injection supplies Per diems Operational costs Other costs (please specify) Other (MNTE, Yellow Fever, Meningitis) Vaccines Injection supplies Per diems Operational costs Other costs (please specify) Subtotal Supplemental Immunization Activities

US$

US$

US$

US$

US$

US$

US$

US$

US$ NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA $ NA NA NA $

US$

US$

US$

US$

US$

$ NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

$ NA

Optional information Shared Personnel costs -Salaries of part-time NIP health workers (central, provincial and district levels) -Other Incentives/bonuses Other Shared costs (please specify) Building Other Equipment Long-term training Other optional information (please specify) (please specify) (please specify) Subtotal Capital GRAND TOTAL ($) $ GRAND TOTAL (%)

NA NA NA NA NA NA NA NA NA NA 100% $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % $ % -

FSP Section 3 - Table 3.2 Current Year Costing and Financing

The current year is the most recent fiscal year for which data on actual expenditures and financing are available after initiation of including GAVI / Vaccine Fund support (this is likely to be 2002) Please refer to Annex III for definitions of each cost component, step by step instruction on how to complete this table with simplified methodologies to calculate each variable (including methods for shared costs) and suggestions as to where to find the data.
Cost Category TOTAL Government (Central) Government (Local) Private Sector Community Participation Donor Pool (if applicable) UNICEF WHO GAVIVaccine Fund DFID USAID JICA Other Bilaterals (Specify) CVP Rotary Other NGOs (Specify) EU World Bank Other Donors (Specify)

Required Information [A] Routine Recurrent Cost Vaccines (routine vaccines only) -Traditional 6 antigens -New and underused vaccines Injection supplies Personnel -Salaries of full-time NIP health workers (central, provincial and district levels) -Per-diems (other incentives) for outreach vaccinators/mobile teams Transportation Maintenance and overhead Short-term training IEC/social mobilization Monitoring and disease surveillance Other routine recurrent costs (please specify) (please specify) (please specify) Subtotal Recurrent Costs [B] Routine Capital Cost Vehicles Cold chain equipment Other capital costs (please specify) Subtotal Capital Costs [C] Supplemental Immunization Activities Polio NID-SNID Vaccines Per diems Operational costs Other costs (please specify) Measles Campaigns Vaccines Injection supplies Per diems Operational costs Other costs (please specify) Other (MNTE, Yellow Fever, Meningitis) Vaccines Injection supplies Per diems Operational costs Other costs (please specify) Subtotal Supplemental Immunization Activities

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

US$

Optional information Shared Personnel costs -Salaries of part-time NIP health workers (central, provincial and district levels) -Other Incentives/bonuses Other Shared costs (please specify) Building Other Equipment Long-term training Other optional information (please specify) (please specify) (please specify) Subtotal Capital GRAND TOTAL ($) $ GRAND TOTAL (%)

100%

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %

$ %