Volume 3.4, December 2011

Volume 3.3, September 2011

Volume 3.2, July 2011

Volume 3.1, March 2011

 

Immunization Financing News

Volume 3.4, December 2011

View in PDF: English, Français

Regional SIF Briefings for District Councils and the District Health Management Teams in Sierra Leone

Madagascar Holds Its Third SIF Briefing

SIF Program Participates in Third WHO African Regional Conference on Immunization (ARCI)

Uganda Harnessing Media and District-Level Support for Immunization Financing

Rotary and Lions Clubs Team up to Support Nepal's Immunization Program

West African Health Budget Officers Master CMYP Tool for Immunization

Republic of Congo (Brazzaville) Joins SIF Program

Letter from the SIF Program Director

Regional SIF Briefings for District Councils and the District Health Management Teams in Sierra Leone

The Advocacy Program for Sustainable Immunization Financing was launched in Sierra Leone soon after the Government introduced the decentralization program, which for the health sector entailed the devolution of administrative, fiscal, and programmatic responsibilities to the 13 districts, focusing on the District Councils and District Health Management Teams. This also meant that key decisions pertaining to allocation of funds were now to be made at the district level. The Sabin Vaccine Institute recently organized meetings with the District Councils (DCs) and District Health Management Teams (DHMTs) to sensitize them about the importance of immunization and the need for Sustainable Immunization Financing. The meetings were proposed by the Sierra Leonean delegates who attended the Sabin Colloquium on SIF in Addis Ababa last March.

Two meetings were held. The first took place in Makeni, on 10 November 2011, for the districts of the North Province (Bombali, Kambia, Koinadugu, Port Loko, and Tonkolili), Kono district in the Eastern Province and the Western Area. The second was held in Bo, on 11 November, 2011, for the districts of the Southern Province (Bo, Bonthe, Moyamba, Pujehun), and Kailahun and Kenema in the Eastern Province.

The 56 participants were drawn from all the District/City Councils and DHMTs nationwide, and the meetings were chaired by the Deputy Chairman of the Parliamentary Health Committee, Hon. Jumu. He emphasized the need for collective action to achieve SIF, especially amongst the three key stakeholders, namely Parliament, Ministry of Health and Ministry of Finance. Brief presentations were made by the Chairlady of the Parliamentary Health Committee, Hon. Mrs. Bintu Myers; the UNICEF Program Officer, Ms. Regina Saffa; the Assistant Secretary in the Ministry of Finance, Mr. Sam Aruna; the EPI Manager, Rev. Dr. Thomas Samba; the Senior Program Officer, Sabin Vaccine Institute, Dr. Clifford Kamara; and the Assistant Public Relations Officer in the Ministry of Health, Mr. Morlai Conteh.

Key topics included the need for budgetary decisionmakers at the district level, to be fully briefed about the importance and economic benefits of an essential program like the Expanded Program on Immunization. The need for collective action in the face of a donor-dependent health sector was also discussed. The enhanced role of District Level personnel in the planning and budgeting process; strategic partnerships; commitment of Ministry of Finance; and the important role that the press should play in efforts to achieve SIF in Sierra Leone were also covered.

The main recommendations from the briefings included:

  • Ensuring regular meetings between all stakeholders and organization of fundraising activities for EPI at all levels;
  • Strengthening collective action, especially between Parliamentarians, District Councils, District Health Management Teams, MoHS and MoFED; collaborating with other stakeholders including the UN agencies, development partners, the private sector, CSOs, and the media;
  • Parliamentary participation in the formulation of the health sector budget, to ensure the EPI is adequately funded;
  • Supporting legislation to increase and maintain the EPI budget;
  • Developing Council EPI plans with a budget line for immunizations; activities should include sensitization of communities and advocacy for SIF, with allocation of a proportion of the district budgets to immunization.

These meetings continue Sierra Leone’s efforts to achieve SIF. Participants pledged to take the message back to their various districts and ensure that the recommendations are implemented. The Sabin Vaccine Institute’s SIF Program will continue supporting the districts in achieving SIF in Sierra Leone.

Madagascar Holds Its Third SIF Briefing

From 23 to 25 November, 2011, SIF Senior Program Officer MAMBUMA-DISU Helene joined her government and parliamentary counterparts in Antananarivo, Madagascar for that country’s third Sabinsupported SIF briefing. The event drew 37 participants. Topics addressed were: a) follow up on the Addis Ababa Action points, b) structure advocacy messages for a stronger routine immunization program investment case, and c) discuss updating the country’s immunization legislation to assure sustainable immunization financing. Earlier this year, Dr MAMBU-MA-DISU worked with a team headed by Dr. RAKOTOMANGA Louis Marius, national EPI Manager, Ms. RAKOTOVAO Nadine, health officer in the Ministry of Finance and Hon. RAJOELINA Aro Tafohasina Herinalinjaka , Member of Parliament, to prepare an immunization financing white paper for the country’s Conseil des Ministres.

“Things are moving along”, said Dr. MAMBU-MA-DISU. “The political problems now seem to be receding and the other external partners are back in touch with the EPI Program. Still, a lot of ground was lost in the past two years and it will take a lot of effort to make it up”, she added. Both immunization spending and vaccine coverage fell during the crisis. This year’s advocacy work will hopefully lead to a routine immunization budget increase in 2012.

SIF Program Participates in Third WHO African Regional Conference on Immunization (ARCI)

Windhoek, Namibia was the setting for this year’s WHO/AFRO ARCI Meeting. The event, which took place on 5-7 December 2011, drew over 200 participants. Representing Sabin were SIF Program Director Mike McQuestion, Program Officer Mariya Savchuk and Senior Program Officers Clifford Kamara, Diana Kizza Mugenzi and Jonas Mbwangue. Sabin also sponsored five peer exchangers from Madagascar and Uganda who presented their advocacy work during an immunization financing session.

The overarching theme to this year’s ARCI was polio eradication. In 2011, just four African countries reported polio cases. The eradication goal is now within the Region’s grasp. Another highlight was the near disappearance of meningitis in Burkina Faso following that country’s mass meningitis immunization campaign a year ago. Only four cases of the disease have been reported in 2011. However, participants expressed their concerns about stagnant and declining routine immunization program performance in a number of African countries.

In the immunization financing session, Sabin peer exchanger Dr. RAKOTONIRINA Simon told of Madagascar’s efforts to right its EPI program following three years of political strife. Accompanying him were his Ministry of Finance and Budget counterpart Dr. RAKOTOVAO Nadine and parliamentarian Hon. Dr. RAJOELINA Aro Tafohasina Herinalinjaka, both of whom attended Sabin’s Colloquium on SIF in Addis Ababa, Ethiopia last March.

Introducing the Ugandan presenters, Diana Kizza Mugenzi described her immunization financing advocacy work in three of the country’s regions. Local Government Representative James Byamukama then gave a riveting description of his district’s immunization program. Like other countries, Uganda’s districts rely on federal transfers to finance their health services. District-level immunization program performance is often limited by both technical capacity and insufficient health budgets.

WHO has designated 2012 as the Year for Strengthening Routine Immunization Programs. The Sabin team will accordingly intensify its advocacy work in this area, realizing that good technical and budget performance are the heart of every country’s national immunization investment case.

Uganda Harnessing Media and District-Level Support for Immunization Financing

In August, Sabin and the Ugandan Ministry of Health organized a media briefing that brought together over 30 media managers and editors from radio stations, newspaper and television media houses to discuss the concerns, need and opportunities for mass media to communicate immunization financing issues.

The Ministry’s Information-Education-Communication and Health Promotion Commissioner, Dr Paul Kaggwa told the editors that “immunization programs must develop and employ strategies for proactive, evidence-based, professional communications and public advocacy.” The Ugandan media, he added, have strong capacity and have proven time and again their ability to influence decision-makers in Uganda. In other presentations, WHO Representative Dr Joaquim Saweka and Uganda National EPI Program Deputy Manager Dr Jacinta pointed out that vaccine coverage in Uganda is declining. They called for a coordinated effort to salvage the situation.

Following the briefing, the ten media stations offered to place public service announcements on immunization issues at no charge. Journalists subsequently visited a number of Ugandan health districts to observe polio and measles outbreak control activities firsthand.

A second Ugandan advocacy strategy involves legislation. A Sabin-supported desk review of district-level immunization bylaws was completed in late 2010. Results showed wide variations in both the coverage and intent of existing legislation. “In Uganda, each of the 111 districts writes its own by-laws”, explained Kampala-based SIF Senior Program Officer Diana Kizza Mugenzi. “We found that many districts lack immunization-related legislation while others need to update what they have.” Routine immunization is financed in part through federal grants to the districts. District Health Teams and District Development Councils allocate health funds according to local needs. In line with the country’s decentralization process, the Ugandan Ministry of Health recommended that Sabin work with the Ministry of Local Government, the district councils and the district health teams to follow up the study. Analyzing the by-laws will entail detailed local assessments of immunization operations and needs with the various district-level stakeholders.

Kizza Mugenzi and her counterparts began working in nine districts- three in each of three regions. Their immediate aim is to ensure that the districts work together to craft health by -laws that allocate adequate budgets for routine immunization activities. The districts are quickly taking stock of their situations. The legislative work falls onto the local Government Councilors who sit on the District Councils. But the revisions will take time. Any new or revised by-laws they propose must be shown to be compatible with federal constitutional provisions before they can be implemented.

Some of the by-laws have been effective. In Kiboga District (Central Uganda), Councilor (LC-5) Mr. Andrew Ntege reported that an ordinance passed in 2003-2004 was about imprisoning parents who didn’t take their infants for immunization. The district relied on a single mobile government van to collect parents and their kids from the villages and take them to health centers for immunization. “Most parents had a bias about immunization”, continued Mr. Ntege, “so they would hide their children. But because of this ordinance, parents started to voluntarily take their kids for immunization. They developed a positive attitude towards immunization”.

In nearby Gulu District, reported District Medical Officer Grace Anena, an existing by-law mandates that parents present immunization cards for their children at school registration. Vaccinations are sometimes administered to children as old as 15 years to satisfy the requirement.

On 28 November, Kizza Mugenzi and her colleagues organized an advocacy briefing in Kyenjojo District with the participation of district- and sub-county level councilors. In the briefing, participants discussed the many challenges Kyenjojo District faces in achieving universal immunization coverage. They considered the practicality of district by-laws on immunization and how they would be implemented. The leaders agreed to explore immunization co-financing with local tea plantations. Traveling as a Sabin peer exchanger, Kyenjojo District LG-5 Councilor James Byamukama later described the effort in an immunization financing workshop at the Third African Regional Immunization conference in Windhoek, Namibia (see related story in this issue).

Rotary and Lions Clubs Team up to Support Nepal's Immunization Program

On 20 November 2011, in Kathmandu, Nepal’s Rotary and Lions clubs came together for a workshop on immunization financing. The event, co-sponsored by Sabin and UNICEF, featured presentations by Rotary and Lions officials; Dr. Shyam Raj Upreti, Director of the Ministry of Health and Population’s Child Health Division; Mr. Bodh Raj Niroula, Joint Secretary of Budget and Program Division, Ministry of Finance; Mr. Vidyadhar Mallik, Vice Chairperson of Nepal Poverty Alleviation Fund; and WHO and UNICEF representatives, respectively, Dr. Frank Paulin and Dr.Will Parks. Both Upreti and Mallik participated in previous Sabin advocacy activities and both have emerged as SIF champions.

In his remarks, Dr. Upreti outlined the Ministry’s decentralized primary health care system and ongoing efforts to make the EPI program more efficient. This convergence of private with public immunization stakeholders, remarked Mr. Niroula, portends important increases to the country’s immunization resources.

A poor country, Nepal is nevertheless determined to achieve its sustainable immunization financing goal. The government currently meets about one-third of its routine immunization budget. In its budget speech last July, Nepal’s Finance Minister announced the government would prepare legislation for Parliament’s approval within the current fiscal year assuring public immunization financing. Nepal’s sustainable financing solution will include a new public-private immunization fund, which the Rotary and Lions clubs are already capitalizing. To date, the two organizations have raised some US$ 4000. The Lions clubs have pledged to raise about US$165,000 annually for the fund.

Representing the Rotary Club of Kathmandu North, Mr. Ram Bhandari described how proceeds from the new fund would be earmarked for routine immunization system strengthening. With their combined network of 540 clubs, both organizations are poised to actively participate in routine immunization activities nationwide.

“This fund adds pressure on the government to push for an increased immunization budget”, commented SIF Senior Program Officer Devendra Gnawali, who has worked closely on the project. “We also thank Dr. Sudhir Khanal and UNICEF/Nepal for teaming up with us”, he added.

West African Health Budget Officers Master CMYP Tool for Immunization

On 23-25 November, 2011, budget officers from ministries of health and ministries of finance from 16 West African countries attended an immunization program costing workshop in Ouidah, Benin. Facilitating the event were counterparts from Sabin/SIF, WHO/AFRO, UNICEF and the Agence pour la Médecine Préventive (AMP). The workshop objective was to develop skills for monitoring immunization program expenditures using the WHO/UNICEF Comprehensive Multi-Year Planning (cMYP) tool for immunization. Developed in 2005, the cMYP tool has been used to cost immunization programs in all 65 GAVI-eligible countries.

In recent years there have been similar cMYP workshops throughout Africa and Asia. Ten of the budget officers attending the Ouidah workshop came from five SIF Program pilot countries: Liberia, Mali, Nigeria, Senegal and Sierra Leone. SIF Senior Program Officers Jonas Mbwangue and Clifford Kamara both facilitated the Ouidah workshop.

“Until now, the cMYPs were used almost exclusively by external experts”, commented Mbwangue, who works in Mali and Senegal as well as his native Cameroon. “Countries have to have an up-to-date cMYP costing in order to apply for a GAVI grant. Now we are transferring the technology to the countries so that they can begin monitoring their own program expenditures”.

By all accounts the Ouidah workshop was a success. The budget officers resolved to use the cMYP tool in their countries. “I will be following up with my counterparts who attended this workshop”, reported Kamara, who directs SIF Program activities in Sierra Leone, Liberia and Nigeria.

From an advocacy viewpoint, EPI managers need to monitor and report routine immunization program expenditures in order to justify budget increases. Adding routine expenditures to vaccine coverage and epidemiological analysis has been described as “adding the third leg to the EPI stool”. The cMYP tool can be used for this purpose. But getting it to happen won’t be easy. Reflecting on his efforts in Sierra Leone, Kamara commented “Those who control expenditure data do not want to reveal it. And public health managers don’t like to deal with financial data”.

WHO/AFRO and Sabin are planning a similar workshop for Central African countries next year. SIF Senior Program Officers Jonas Mbwangue and Helene Mambu-Ma-Disu will represent Sabin along with their counterpart budget officers from Cameroon, DR Congo and Republic of Congo.

Republic of Congo (Brazzaville) Joins SIF Program

From 13 to 17 November, SIF Program Director MCQUESTION Mike and Senior Program Officer, MAMBU-MA-DISU Helene went to Brazzaville, capital of the Republic of Congo, one of two African countries set to graduate from GAVI eligibility this year (the other one being Angola) for the introductory visit of the SIF Program. This was done in a joint mission with WHO counterparts Dr. KADDAR Miloud from Geneva and Dr. KONDE Kader, EPI Focal Point at the WHO country Office in Congo Brazzaville. In Parliamentary meetings, both the Speaker of the National Assembly and the Chairman of the Senate expressed their support for the sustainable financing goal. WHO and UNICEF country Representatives, Dr. GAMATIE Youssouf and Mrs. FLACH Marianne, will continue to support the country in its efforts to increase and sustain immunization financing. For his part, national EPI manager, Dr. DIDI Boris, acknowledged the need to more closely monitor his program’s budget allocation, disbursement, use and performance as part of the country’s new output-based budgeting system. Dr. MAMBU-MA-DISU will direct Sabin’s advocacy work in the Republic of Congo.

Letter from the SIF Program Director

Dear Colleague,

As 2011 comes to a close, we at Sabin want to reconnect with all of our Sustainable Immunization Financing champions, take stock of where we are and share some ideas for the coming year.

If you have ever attended one of our SIF briefings, if you ever participated in a Sabin-sponsored peer exchange, or if you are otherwise working toward our common goal of helping countries find their sustainable immunization financing solutions, you are an SIF champion. Another term we could use is institutional entrepreneur - you are one of those individuals who create and defend the innovations needed to improve the performance of your organization or institution.

In Addis Ababa, last March, at the first Sabin Colloquium on SIF, we heard champions representing 13 of our countries propose innovations for achieving the SIF goal. Most of the delegations, we are pleased to report, have followed through with those action points. SIF champions are advocating for bigger immunization budgets using sound investment cases. They are finding creative ways to bring decentralized governments, mass media contacts and community service organizations into the ranks of immunization stakeholders. All of these innovations are decreasing external dependencies and increasing country ownership of an essential public good- a fully immunized population. So where are we now? The chart below shows mean government routine immunization program expenditures per surviving infant through 2010 for two groups of countries: the 15 SIF pilot countries and the rest of the GAVI-eligible countries. These are the expenditures the governments reported through the WHO/UNICEF Joint Reporting Form. Since 2009, an upward trend in national expenditures is evident for both groups. However, the rate of increase is far too modest for countries to achieve the SIF goal by 2013, as we originally proposed.

That goal, we believe, will cost somewhere around US$20 to $30 per infant. We suspect that governments are underreporting their immunization investments. Knowing the true cost of national immunization programs requires ongoing analysis of actual program expenditures, including shared health system expenditures down to sub-national levels. In some countries, particularly in West Africa, SIF champions are starting this work.

The second area of notable progress is legislation. Parliamentarians and their government counterparts in ten SIF countries are now fashioning new laws that will, among other provisions, guarantee some level of government funding for immunization. These projets de loi are taking champions into new areas of collaborative work. Some projects involve reorganizing immunization programs into higher-level divisions so that their budgets can be more carefully monitored. Others involve creating immunization trust funds which will allow private sector donors to support immunization. In at least one country, SIF champions are revising sub-national by-laws governing immunization financing. (See related story in this issue.)

Throughout the coming year, the Sabin SIF Program team will continue to collaborate with you, the champions. One new tool you can use is our SIF online library (www.sabin.org/sif). Here you will find recent articles we have identified, in English and French, on selected SIF -related topics. Just send us an email (sif@sabin.org) and we will provide you the password. We invite you to submit other articles you find useful to your SIF advocacy work. We will add them to the library.

We look forward to seeing you again soon and we wish you all the best in 2012.

On behalf of the SIF Team,

Mike McQuestion

SIF Program Director

 

Immunization Financing News

Volume 3.3, September 2011

View in PDF: English, Français

Sustainable Immunization Financing Program Progress

European Region Countries Moving toward Sustainable Immunization Financing

Bas Congo - One of Four DRC Provinces Co-Financing the National Immunization Program

SIF Participation in the Sub-Regional Working Group Meeting in Abidjan

SIF Program Participates in WHO South-East Region Immunization Meetings

SIF Update from Liberia

SIF Sabin News Highlights

SIF Immunization Champion

Sustainable Immunization Financing Program Progress

Since late 2008, SIF has been operating in twelve African, and three Asian pilot countries.

Using a collective action approach, SIF invites key stake holders- especially parliamentarians, and senior officials from ministries of health and finance- to come up with innovative immunization financing solutions. Here is an update on the Program. As shown in the table below, SIF has collaborated in fourteen of its fifteen pilot countries to carry out parliamentary briefings. Ten pilot countries have participated in SIF-supported international peer exchanges. Outputs from these activities range from declarations and action plans with strategic aims to revenue generation proposals to legislation creating national immunization trust funds.

To date, 10 out of the 15 pilot countries have increased their routine immunization budgets. Immunization legislative projects are underway in Cameroon, DRC, Kenya, Nepal, Sierra Leone, Sri Lanka and Uganda. The proposed legislation will assure that a budget line dedicated to immunization financing will be visible to parliament and protected by law.

In the past year, advocacy activities have become more country-specific. SIF has helped organize 7 sub-national immunization financing briefings in four countries. Specific advocacy activities have been inserted into the cMYPs of ten pilot countries. Three countries have developed few or no SIF advocacy activities: Nigeria, Rwanda and Ethiopia.

European Region Countries Moving toward Sustainable Immunization Financing

On 5-8 July 2011, SIF Program Director Mike McQuestion participated in a WHO/EURO workshop on immunization financing. The meeting, held in Istanbul, Turkey, drew twenty-two participants from eleven WHO/EURO Member Countries. Participants analyzed immunization program costs using the WHO comprehensive Multi-Year Plan costing tool, considered ways to make their programs more efficient and prepared advocacy presentations they can use in their national health budget deliberations. In his presentation, McQuestion described how the SIF Program supports advocacy efforts in its African and Asian pilot countries. The EURO Region must find sustainable financing solutions soon. Four of the eleven participating countries are about to graduate from GAVI eligibility because their per capita GDPs have passed US$1500.

Bas Congo - One of Four DRC Provinces Co-Financing the National Immunization Program

In a recent example of sub-national advocacy, SIF Director Mike McQuestion and Senior Program Officer Helene Mambu-Ma-Disu traveled to Matadi, capitol of DRC’s Bas Congo Province in August 2010 to brief provincial parliamentarians about immunization financing. Earlier, Governor Simon Floribert Mbatshi-Mbatsha, whom SIF met earlier in Kinshasa, had pledged to finance kerosene for the cold chain and vaccine transport costs for the province. These welcome budget increases, however, were soon overshadowed by polio and measles outbreaks which affected four DRC provinces, including Bas Congo. The outbreaks caused 19 polio cases and hundreds of measles cases in the province. On 8-10 August 2011, Dr. Mambu-Ma-Disu returned to Matadi for a two-day semiannual review of the provincial immunization program. Some participants wanted to blame the outbreaks on insufficient external partner funding. “I disagreed”, recalls Dr. Mambu. “I told the 30 district medical officers that they were too dependent on others. I explained to them that the province needs to increase its own immunization budget. They need to own their own EPI program!”

Indeed, in 2011 the Bas Congo provincial parliament approved an even bigger immunization budget. But in the turmoil of the outbreaks, the funds had not been disbursed. Dr. Mambu brought this to the attention of Governor Simon Floribert Mbatshi-Mbatsha and the funds were soon disbursed. Today Bas Congo is one of four DRC provinces co-financing the national immunization program.

SIF Participation in the Sub-Regional Working Group Meeting in Abidjan

Senior Program Officers of the SIF Program, Helene Mambu and Clifford Kamara, participated in the second Sub-Regional Working Group meeting in Abidjan, Cote d’Ivoire, 25th 26th August, 2011. Funded by GAVI and hosted by WHO and UNICEF, the primary goal of this WG was to support the GAVI eligible countries in Central and West Africa to achieve and maintain high immunization coverage rates, with optimal utilization of the available GAVI windows of support.

During the meeting, Helene and Clifford presented a brief overview of the Colloquium on Sustainable Immunization Financing organized last March by the Sabin Vaccine Institute in Addis Ababa, Ethiopia. Over a hundred participants attended the meeting, including delegates from the SIF program countries (Parliamentarians and senior officials from Ministries of Health and Finance), representatives of the partner agencies (WHO, UNICEF, the World Bank, the Bill and Melinda Gates Foundation, and GAVI), as well as two Parliamentarians from Latin America who shared their experiences on how sustainable immunization financing was achieved in their countries, emphasizing the crucial role played by immunization-related legislation. This culminated in the signing of the Addis Ababa Declaration, which emphasizes the need to strengthen the role of parliamentarians, explore innovative financing mechanisms, and encouragement of the enactment of relevant SIF-related legislation.

Participants at the SRWG meeting lauded the efforts of the SIF program, and agreed that this first-of-its-kind colloquium could prove useful in our efforts to achieve sustainable immunization financing in the countries of Central and West Africa. The SRWG committed to continue, and to further strengthen cooperation with the SIF program to achieve this important goal.

SIF Program Participates in WHO South-East Region Immunization Meetings

On August 2nd, SIF Senior Program Officer Devendra Gnawali represented Sabin at a High Level Ministerial Meeting on routine immunization, in New Delhi, India. The meeting, organized by WHO Regional Office for South-East Asia, brought together health ministers, parliamentarians, development partners and journalists from the Region’s eleven Member States. The meeting focused on the need to intensify routine immunization programs in the year 2012. Last year, immunization programs failed to reach about 23.5m children worldwide. Of these, 10m live in SEARO Member Countries. Only five SEARO Member Countries have met the target of reaching 90% coverage nationally and at least 80% coverage in all health districts. Inadequate financing is one factor limiting immunization program performance.

Among the participants were delegates from two SIF pilot countries, Nepal and Sri Lanka, several of whom had earlier participated in SIF-sponsored briefings in Kathmandu, Nepal, Colombo, Sri Lanka, Phnom Penh, Cambodia and Addis Ababa, Ethiopia. During the panel discussions, Hon. Ms. Dharmashila Chhapagain, Nepal’s State Minister for Health & Population, described how parliamentarians from her country are working with the government to write a new National Immunization Act that will secure immunization as a right for all Nepali children and guarantee an adequate budget for the national immunization program. H.E. Mr. Maithripala Sirisena, Health Minster of Sri Lanka, informed the group that Sri Lanka will carry out national and provincial level parliamentary briefings to secure sustainable immunization financing and intensify routine immunization during the coming months. Notably, a joint inter-ministerial and parliamentary committee has been created to focus specifically on immunization budgets and performance. A series of Sabinassisted provincial parliamentary briefings began on 25 August with participation of peers from Cambodia and Nepal. The High Level Ministerial Meeting generated a six-point "Delhi Call to Action", in which SEARO Member Countries agreed to intensify their routine immunization programs in 2012. Participants committed to providing high-level political advocacy and oversight for the intensification effort and ensure financial sustainability thereafter.

On 3-4 August, Gnawali attended a follow-up meeting of the SEARO Regional EPI managers. Among the themes addressed was sustainable financing for routine immunization programs. In the discussions, Gnawali described how Sabin works with its SIF countries to achieve this goal, first by targeting high-level advocacy briefings for parliamentarians and other elected officials and then by encouraging the development of locally appropriate financing solutions. Working in small groups, participants highlighted the challenges faced by routine immunization programs. They agreed that immunization could be used as an advocacy tool for increasing health system financing in their respective countries.

SIF Update from Liberia

Six delegates represented Liberia at the Sabin SIF Colloquium in Addis last March. They formulated four short-term action points:

  1. Develop legislation for sustainable immunization financing
  2. Conduct advocacy and awareness at the executive, legislative, country and district levels for sustainable immunization financing
  3. Create a line item to be included in the fiscal year budget to support immunization
  4. Complete introduction of health insurance bill that will support immunization processes in Liberia In a follow-up visits last May and August to Monrovia, Senior SIF Program Officer Cliff Kamara met with the Liberian delegates to see how best to insert the action points into the country’s 2011- 2012 SIF game plan. Regarding Point #1, Congressional SIF champion Hon. Edwin Gaye and his fellow members of the Standing Health and Social Welfare Committee have begun drafting a proposed law that will guarantee the government’s routine immunization budget. They are also considering ways to engage the private domestic sector in immunization financing.

On the Ministry of Health side, a series of five sub-national advocacy workshops is planned for later this year. Participants will include immunization managers and local officials from Liberia’s 15 counties. “Decentralization is a big priority now in Liberia”, commented Kamara. “Funds are being transferred to the counties for the first time. Each one will be making its own EPI budget. The SIF advocacy workshops will add more energy to that decentralization process.”

SIF Sabin News Highlights

  • A Sabin-commissioned study completed last December showed that several Ugandan districts have their own immunization laws. The Ugandan Ministry of Health and Ministry of Local Government are currently considering strategies to codify and harmonize immunization legislation at national and local government levels.
  • Senior Program Officers Helene Mambu-Ma-Disu and Clifford Kamara participated in the second WHO/GAVI Sub-Regional Working Group meeting in Abidjan, Cote d’Ivoire, 25th 26th August, 2011. Their presentation summarized the proceedings of the Sabin Colloquium on SIF, which took place last March in Addis Ababa, Ethiopia.
  • On 13-15 September 2011, Senior Program Officers Helene Mambu-Ma-Disu and Jonas Mbwangue participated in a UNICEF/GAVI regional consultation on the role of civil society organizations in immunization in francophone Africa.
  • On 17-19 September 2011, Senior Program Officer Devendra Gnawali represented the SIF Program at the 32nd ASEAN Inter-Parliamentary General Assembly, in Phnom Penh, Cambodia.
  • On 13-14 September 2011, SIF Director Mike McQuestion represented the Program at the Measles Advocacy 10th Annual Meeting, at the Red Cross International Headquarters in Washington, DC. His presentation can be found here.

SIF Immunization Champion

For this Summary Digest, we would like to highlight Hon. Bintu Myers, Chairlady, Parliamentary Health Committee, Sierra Leone as our immunization champion. As Chairlady of Sierra Leone’s Parliamentary Health Committee, Hon. Bintu Myers has collaborated with the Sustainable Immunization Financing program in Sierra Leone since its introduction in 2008. Hon. Myers has attended SIF parliamentary briefings and participated in SIF peer exchanges in her own country as well as neighboring Liberia. She led the Sierra Leone delegation at the Sabin Colloquium on SIF in Addis last March. From the onset, Hon. Myers recognized the benefits of immunizations and the need to ensure that the national immunization program is sustainably financed. She is no stranger to the difficulties associated with financing health services in a post-conflict country like Sierra Leone, where there had been a virtual collapse of the government and devastation of the country’s economy. Hon. Myers has led efforts to increase government funding for immunization and has been instrumental in ensuring an increased budgetary allocation to the national immunization program, thereby ensuring that the program could meet its GAVI vaccine co-financing obligations.

Currently, Hon. Myers is advocating for the introduction of immunization -related legislation and the analysis and dissemination of immunization financing data from the country’s thirteen health districts. The SIF program is pleased to recognize Hon. Bintu Myers as a Champion for SIF. We know she will continue to support efforts to achieve SIF in Sierra Leone and other countries in the sub-region, bringing countries closer to their sustainable immunization financing goals.

 

Immunization Financing News

Volume 3.2, July 2011

View in PDF: English, Français

SIF Program Begins a New Round of Country-Specific Advocacy Activities

Innovations Drive the SIF Program

Post Colloquium, Madagascar Moves on Action Points

Sri Lanka Implements Phnom Penh and Addis Action Points

SIF Sabin News Highlights

SIF Immunization Champion

SIF Program Begins a New Round of Country-Specific Advocacy Activities

A midterm evaluation has given Sabin and its partner agencies an in-depth look at the SIF Program and a set of recommendations for the coming three years. The study, conducted by the Boston Consulting Group during February-April 2011, assessed Program management and field advocacy activities in six of the fifteen SIF pilot countries. In all, eighty-one informants were interviewed by the four-person BCG team. On 9 May 2011, the BCG team presented its findings in a meeting at Sabin Headquarters in Washington, DC. Attending were senior Sabin staff, four of the five SIF Senior Program Officers and counterparts from GAVI, the World Bank and the Bill & Melinda Gates Foundation. Summarizing, BCG team leader Francois Rigoud stated that the SIF Program has established “proof of concept”. The countries value the new emphasis on advocacy that Sabin has brought. Particularly useful were the “game plans” the evaluators asked the Program Officers to prepare for their countries. In the BCG analysis, 10 of the 15 countries are moving toward the sustainable immunization financing goal.

With an SIF Program platform established, the BCG team recommended a more intensive, country-specific approach. Drawing from their game plans, the SIF Program Officers developed a new planning tool . They are using the tool with their national counterparts to tailor their next round of Sabin-supported immunization financing advocacy activities. The plans, which will be implemented from August 2011 to July 2012, depart from the action points each country formulated in the March, 2011 Sabinorganized Addis Colloquium. The Program Officers are using the tool to map those points onto the activities and milestones in the SIF Program protocol. The resulting activities are also being inserted into the respective comprehensive EPI Multi-Year plans (cMYPs). To help increase national immunization funding, Cameroon, DR Congo and Nepal will organize briefings for subnational elected officials on immunization financing. Taking a page from Uganda, Madagascar and Nepal will study existing health legislation. In most countries, parliamentarians are preparing new legislation that will establish new sources of immunization revenue. More peer exchanges among the legislators are being planned among the SIF countries. Sri Lanka, Nepal and Madagascar have formed interinstitutional committees to implement the action plans.

Innovations Drive the SIF Program

An immunization manager looks at program expenditures along with vaccine coverage and epidemiological data. Her finance ministry counterpart, curious to see how efficiently the program is working, awaits her report. Down the street, members of the parliamentary health and budget committees consider recent immunization program performance data as they scrutinize next year’s proposed health budget.

After years of delay, the president called on the health minister to jump start the national decentralization program. The minister starts with immunization. He realizes that financing for the immunization program is precarious. He needs to find new revenue sources. Elected officials from the country’s ten provinces have agreed to co-finance the program but there is no revenue-sharing mechanism. Nor is there a way for private firms to invest. The ministry of finance develops a public-private partnership mechanism that will solve this problem. Immunization will be elevated from a program to an MoH division, thereby assuring a failsafe budget line. A single fund will receive and manage federal, subnational government and private funds. A public-private board of directors will oversee both fund and immunization program operations.

These are examples of the innovations SIF countries are pursuing as they strive to make their immunization programs sustainably financed. In each case, health managers, finance experts, business leaders and legislators are coming together to devise the new financing methods. Sabin documents and shares these innovations among the fifteen pilot countries. The results so far point to what Dobbins et al (2007) call a constructivist policy dissemination process.

What is driving these innovations? Social theory provides some insights.

First, innovations are rare because they entail risk. What motivates individuals to do it? The motives vary. Policymakers know that new financing arrangements are needed before external funding dries up or there will be a political price to pay. Line ministry managers are keen to advance their careers or to use the immunization case to push their other agendas. By championing immunization, elected officials show their constituents they are doing their jobs. Businesses know they can garner corporate social responsibility credits by contributing. But there is another incentive that motivates them all. Participation in this collective action for SIF brings inner rewards. Who would not like to think that they’ve contributed to something as transcendental as a program that continuously saves young lives? The power of this collective action was on display at the Sabin SIF Colloquium in Addis Ababa last March.

At the organizational level, mixing up public servants and engaging new stakeholders alters their institutional environments. As outside expectations change, organizations are more likely to innovate. They do so in order to legitimize themselves, ie, to adjust to the new environment (Di Maggio and Powell 1981). But are the innovations the right ones? Will they actually solve the immunization financing problems? Learning theory predicts they will. In the collective action process, actors within institutions monitor and learn from each other. They share knowledge and reach common understandings of the problems they face. This sifting and winnowing produces intelligent innovations (Sabel 1994). If the results are positive- if the new practices move the country closer to the SIF goal- then these innovations will likely be institutionalized.

References:

Dobbins, Frank, Beth Simmons and Geoffrey Garrett. 2007. The Global Diffusion of Public Policies: Social Construction, Coercion, Competition, or Learning? Annual Review of Sociology, Vol. 33: 449-472. DOI: 10.1146/annurev.soc.33.090106.142507

DiMaggio Paul and Walter F. Powell. 1981. The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. American Sociological Review, Vol. 48, No. 2 (Apr., 1983), pp. 147-160.

Sabel, Charles F. 1994. Learning by Monitoring: The Institutions of Economic Development. In Neil Smelser and Richard Swedberg, eds., Handbook of Economic Sociology, Princeton: Princeton University Press and Russell Sage Foundation, pp. 137-165.

Post Colloquium, Madagascar Moves on Action Points

Madagascar is moving fast to implement the action points its delegates fashioned in the Sabin-sponsored March 2011 Addis Colloquium on Sustainable Immunization Financing. In Antananarivo, a second Sabin-organized workshop on sustainable immunization financing took place on 22 June 2011. Participants included four of the six Addis delegates along with 10 other parliamentarians and 29 government counterparts. Also attending were representatives from WHO and UNICEF. SIF Program Director Mike McQuestion and Senior SIF Program Officer Helene Mambu-Ma-Disu represented Sabin.

The workshop was opened by Dr. TAFANGY Philedon Bernard, Director General for Health. After summarizing the key results of the Addis Colloquium, EPI Manager Dr. RAKOTOMANGA Louis Marius, described the uncertain state of Madagascar’s national immunization financing. At mid-year, he reported, the program faces a funding gap of US$1.3m for the remainder of 2011. Previously approved budgets have not been disbursed by the government due to the prolonged political and economic crisis. Districts face fuel shortages, threatening the integrity of the cold chain. Funds to pay outstanding GAVI co-financing obligations have yet to be identified. Complicating matters, the Ministry of Health routinely allocates a portion of the immunization funds it does receive to support other programs. Dr. RAKOTOMANGA called upon participants to pull together to solve these short-term funding problems. He proposed the creation of a National Consultative Group on Immunization (Groupe Consultatif national d’immunisation) to include representatives of the three key national institutions, the private sector and community service organizations.

Speaking for the Ministry of Finance and Budget, Director of Programming and Budgeting, Mr. RASOLOELISON Lantoniaina, pointed out that immunization is currently overshadowed by other priorities caused by the crisis. The Ministry of Finance and Budget is prepared to disburse more funds for immunization, he added, should the Ministry of Health request such an increase. In addition, there are now unused funds in the Ministry of Health that could be reprogrammed for EPI. Mr. RASOLOELISON encouraged the counterparts from the two ministries to continue working together to solve financial management problems.

Like other countries, Madagascar needs to find new long-term financing sources for immunization. Addis delegate and MP Dr. RAJOELINA Aro updated participants on a second Addis action point: Legislation (projet de loi) that will codify technical aspects and create a national immunization fund. The fund will permit a public -private financing arrangement so that private donors can contribute. The MPs are exploring new revenue sources, including a new mobile telephone tax and financial transaction fees. The Parliamentary Health Committee (Commission de Santé) is now drafting the legislation. The MPs intend to complete the work, introduce and pass the Immunization Law (Loi de vaccination) before the December 2011 elections.

The following day, the Ministry of Health hosted a planning meeting with the National Consultative Group and the Sabin team. Proposed advocacy activities for the coming year were discussed. Representing the Ministry of Finance and Budget were Social Sector Officer (Charge de Secteurs Sociaux) Mr. RANAIVOSON Harifidy Andriambala and Mr. TATAMIARISOA Landry. An important part of the advocacy plan will be analyzing and regularly reporting routine EPI program expenditures. The EPI team will use these results to show budgetary decisionmakers how efficiently the program is being managed. This will complement a new performance-based budgeting approach under development in the Ministry of Finance and Budget, commented Mr. RANAIVOSON. Other Sabin-assisted advocacy strategies will include semi-annual parliamentary briefings, briefings for media and private sector, a study of existing health laws and peer exchanges with other SIF pilot countries.

“Madagascar was the last SIF pilot country to begin but they have already caught up with the others”, commented Dr. Mambu. She plans two more visits to the country in September and December 2011.

Sri Lanka Implements Phnom Penh and Addis Action Points

Sri Lankan SIF counterparts are moving to implement the action points they proposed in the Third Subnational Briefing on SIF (Phnom Penh, Cambodia, 21- 22 October 2010) and the Addis Colloquium (28-29 March 2011), reports Senior Program Officer Devendra Gnawali. A new inter-institutional EPI monitoring committee was recently created by the Ministry of Health. Its members include parliamentarians representing Health and Finance Committees; representatives from ministries of health and finance; a customs official and a representative from a national private health provider association. The EPI Monitoring Committee will meet quarterly and will regularly update parliament on both technical and financial immunization program performance.

A second action point is to better regulate private sector immunization providers. The Ministry of Health is working with a private medical sector regulatory council to craft the regulations. Among other goals, the new regulations will give the Ministry of Health periodic reports on private immunization financing and expenditures.

Sri Lanka will also hold subnational briefings on immunization financing for elected provincial councilors, beginning with four of the country’s nine provinces in August 2011. These will be complemented with a national briefing that will involve all 225 members of parliament. These Sabin-supported advocacy activities have been inserted into Sri Lanka’s new 2012-2016 comprehensive MultiYear Plan (cMYP) for immunization.

With the exception of 2007, Sri Lanka has financed ninety percent of more of its routine immunization program since 2000 (http://apps.who.int/immunization_monitoring/en/globalsummary/indicatorselect.cfm). The country is on track to be the first SIF pilot country to achieve the sustainable immunization financing objective.

SIF Sabin News Highlights

·From March 9-14, 2011, Senior Program Officers Clifford Kamara, Jonas Mbwangue, Helene Mambu-Ma-Disu and Devendra Prasad Gnawali convened in Washington DC for in-service training and a series of briefings at the Sabin Vaccine Institute’s head office.

·This summer, the SIF Sabin DC office welcomes Emilie Koum Besson as its new intern. Originally from Cameroon, Emilie is a 23- year-old student at the University of Lyon. Emilie is updating the Program’s websites, doing research on financing mechanisms and transcribing proceedings from SIF’s recent colloquium in Addis Ababa.

·On 2-4 May 2011, SIF Director Mike McQuestion attended the “Global Vaccines 202X: Access, Equity, Ethics” Conference, at The Franklin Institute Science Museum in Philadelphia, PA, USA. His two -part presentation can be accessed here and here.

·In January 2010, the Bill & Melinda Gates Foundation announced it would allocate an additional US$10b to launch the Decade of Vaccines (DoV). Led by WHO, UNICEF, the Bill & Melinda Gates Foundation and the US National Institute of Allergy and Infectious Diseases, the aim of the DoV Collaboration is to foster innovation for this priority health intervention. Working groups are developing strategies in four key areas: Delivery, Global Access, Public & Political Support and Research & Development. Sabin Executive Vice President Ciro de Quadros serves on the DoV Steering Committee. SIF Senior Program Officer Clifford Kamara and SIF Director Mike McQuestion are members of the Delivery Working Group. Click here for more on the DoV Collaboration.

SIF Immunization Champion

Honorable RAJOELINA Aro Tafohasina Herinalinjaka is a medical doctor and a member of the transitional parliament in Madagascar. He attended the Sustainable Immunization Financing (SIF) Colloquium in Addis Ababa, Ethiopia, in March. Since then he has become a key link in the country’s SIF project. Hon. Dr Aro stated “Immunization has proved to be an effective method to protect the vulnerable groups against the most feared diseases."

In 2010, Madagascar’s Expanded Program on Immunization reached about 80% of all children under the age of one. To improve and reinforce this program, legislation on immunization must be adopted, recognize Hon. Dr. Aro. He went on to say, that the Malagasy national immunization program should be supported by its government, so that it may contribute to its sustainability. “The sustainable implementation of the immunization program will increase the already felt benefits provided by vaccines,” he added. It is because of his vision, and his dedication to sustainable immunization financing in Madagascar that we have chosen Hon. RAJOELINA Tafohasina Herinalinjaka Aro as this issue’s recognized Immunization Champion.

 

Immunization Financing News

Volume 3.1, March 2011

View in PDF: English, Français

Sabin Vaccine Institute's First Colloquium on Sustainable Immunization Financing Convenes in Addis Ababa, Ethiopia

Latin American Parliamentarians Share Experiences in Passing Immunization Legislation

Sabin Participating in CMYP Updates

Sabin Sustainable Immunization Financing Program Partners Group Meeting Marks Midpoint

SIF Sabin News Highlights

SIF Immunization Champion

Sabin Vaccine Institute’s First Colloquium on Sustainable Immunization Financing Convenes in Addis Ababa, Ethiopia

From 28-29 March, 2011, more than 100 delegates and external partner counterparts gathered in Addis Ababa, Ethiopia for Sabin’s first Colloquium on Sustainable Immunization Financing. The event gave participants the opportunity to network and showcase best practices. In his opening remarks, World Health Organization Regional Director for Africa Dr. Luis Gomes Sambo described how African immunization programs have cut into child mortality levels by offering pneumococcal, meningococcal and other life-saving vaccines.

“All of this must be properly financed,” he stated. “African countries are already doing their part by increasing their immunization program budgets. But more must be done.” The new Chairman of GAVI’s Board of Directors, Mr. Dagfinn Høybråten, urged the delegates to make the most of the opportunity to collect best practices from 15 African, Asian and Latin American nations. A former minister of health and parliamentarian himself, Mr. Høybråten stressed the need for parliamentarians and government ministries to pull together and find innovative solutions to the financing problem.

One by one the delegates spoke about their immunization financing strategies. Vidyadhar Mallik, a former finance secretary from Nepal, described how a properly financed EPI program would look from the ministry of finance viewpoint. Speaking for Uganda’s Ministry of Health, health economist Rogers Enyaku gave the group a glimpse of Uganda’s new output-based budget system and explained how it is improving immunization program performance. Parliamentarian Hon. Hubert-Alphonse Masala Loka Mutombo, Chair of the Budget Commission in Democratic Republic of Congo, told of his Commission’s ultimately successful efforts to win a bigger 2010 immunization program budget. In all, twelve delegates from the SIF pilot countries presented experiences and lessons learned.

Delegates also learned about the evolution of immunization financing in the Americas region. The Americas panel was moderated by Dr. Jon Andrus, Deputy Director of the Pan American Health Organization (PAHO). Pierce Trumbo, Finance Officer for PAHO’s Immunization Project, explained the historical evolution of immunization laws in the Americas region and presented a comparative analysis of recent legislation in Latin America and the Caribbean. Two parliamentarians, Hon. Alejandro Northon Zapata Avendaño from Bolivia and Hon. Zoila Beatriz Quijada Solís from El Salvador, shared their experiences in immunization advocacy and in passing immunization legislation.

Much of the strategizing was done in two rounds of small groups. Delegates first brainstormed about their constraints and best practices in the areas of advocacy, budget and financial management and legislation. Reporting for one of the legislation groups, Cameroonian delegate Hon. Gaston KOMBA outlined procedures both parliaments and governments can take to pass new immunization financing legislation. The group also described the hurdles they have faced in moving their projets de loi. Dr. Nadine RAKOTOVAO, Health Adviser to Madagascar’s Ministry of Finance, summarized her group’s analysis of the budgeting and financing problems the countries face. Governments and parliaments alike, the group felt, need to much more actively monitor budget preparation and execution. Speaking for one of the advocacy groups, Sri Lanka parliamentarian Hon. Thalatha Atukorale urged delegates to engage private firms. Their desire to project a socially responsible image makes them likely immunization contributors. The nine small group reports can be found here.

In the second round of small group work, national delegations identified the shortterm action points they will follow in the coming months to move their countries closer to the sustainable immunization financing goal. Among their action points, delegates from Cambodia identified greater engagement with provincial authorities in immunization financing. Delegates from Kenya listed the need to pass legislation guaranteeing a routine immunization budget pegged to the annual number of newborns. In Liberia, delegates will insert immunization financing into a pending health insurance bill. Sierra Leone’s delegates will submit a white paper to the cabinet addressing advocacy, legislation and financing needs for immunization. The full set of action points can be found here.

The Addis Colloquium was the first ever international meeting to address immunization financing. It was also the first occasion for delegates from the SIF Program countries to come together. Most had participated in earlier Sabin-organized national and subregional meetings. “They knew the issues well,” observed SIF Program Director Mike McQuestion. To Sabin Executive Vice President Ciro de Quadros, the Colloquium showed the power of collective action for sustainable immunization financing. “This is the beginning of a paradigm shift- from paternalism to country ownership.”

Latin American Parliamentarians Share Experiences in Passing Immunization Legislation

On 1 March 2011, three Latin American parliamentarians met with Sabin and Pan American Health Organization counterparts at Sabin Headquarters in Washington, DC to analyze their legislative efforts for sustainable immunization financing. Represented were Bolivia, Colombia and El Salvador. The meeting generated material the legislators later presented at the Sabin Colloquium on Sustainable Immunization Financing, which took place on 28-29 March, in Addis Ababa, Ethiopia.

African and Asian countries have much to learn from the evolution and success of Latin American immunization programs. In 1992, Latin America became the first WHO region to eradicate polio. In all, over $120m was invested over the period 1985-1991 to knock out the virus. The effort forced national EPI programs to become efficient and effective but left governments highly donor-dependent. In the succeeding decade, countries progressively assumed greater shares of their routine immunization budgets. Today, countries in the Americas Region support 99% of the cost of national programs, an achievement that has allowed for maintained polio eradication, the elimination of measles and rubella, and the introduction of new vaccines. It was the adroit crafting and passage of national immunization laws that made this transition possible.

“Immunization in my country is considered a right”, remarked Hon. Zoila Beatriz Quijada Solís, who chairs the Health Commission in El Salvador’s National Assembly. Representative Quijada Solis is now spearheading the effort to pass El Salvador’s first immunization legislation The proposed vaccine law has three objectives: 1) to guarantee sufficient public resources to meet the country’s annual vaccine bill (US$20.5m in 2010); 2) to oblige the state to make vaccination accessible to every Salvadorean citizen; and 3) to establish sanctions for parents who do not get their children vaccinated (fines, no school entry).

Immunization is not always perceived as a priority, particularly in countries where larger political issues are being contested. Hon. Alejandro Northon Zapata Avendaño, who represented Bolivia in the Addis Colloquium, described his efforts to recruit supporters for Bolivia’s Ley 3300, which guarantees the right of every Bolivian citizen to be immunized. “In the end, we were but ten diputados, remarked Zapata Avendaño, “and that was enough to get the law passed.”

Colombia, the third Latin American case, has a high-performing immunization program with an interesting history. In 1993- a year after polio was eradicated- the country experimented with privatizing immunization services as part of a larger health sector reform. Vaccine coverage levels soon dropped. In 2001, Ley 100 was superseded by Ley 715, which returned immunizations to the public domain. This year, Colombia will spend $ 96.8m to fully immunize approximately 900,000 infants at a cost of US$100 per child. That relatively high figure reflects in part the efforts of Rep. Luis Salas, who represents a coastal area around Santa Marta. Hon. Salas told the group: “We learned about the new vaccines against pneumococcal and rotavirus, and how many more lives could be saved. So we went to work. It took us two years but we got la Ley 1373 passed. It guarantees the funding to immunize all children under five with these newest vaccines.”

Sabin Participating in CMYP Updates

In 2005, WHO and UNICEF unveiled a new tool to help countries plan their immunization programs. The comprehensive Multi-Year Plan (cMYP) analyzes program expenditures for a given baseline year, then uses these baseline data to project financing needs for the coming five years in light of a particular program’s unit costs, strategies and objectives. Comparing projected costs to sources of finance- government and external- gives an idea of how sustainably a program is financed. Since 2006, cMYP plans have been prepared for 77 WHO Member Countries, including all 15 SIF Program pilot countries. These first wave cMYPs are now being updated with new information. SIF Senior Program Officers are participating, ensuring that the latest advocacy strategies, activities and objectives are inserted into the revised plans. Here are some examples:

In DR Congo last August, Helene Mambu-MaDisu joined her ICC counterparts to produce a 2011-2015 cMYP update which includes the creation of a national immunization trust fund. For the first time, members of parliament (Budget Committee) actively participated in the exercise. A second new activity is to carry out a systematic national and subnational advocacy effort aimed at enlisting financial support for EPI from private firms and mobilizing other new stakeholders.

This past March, Devendra Gnawali and his Inter-Agency Coordinating Committee counterparts (Ministry of Health and Population, of Nepal, WHO, UNICEF, other external partners) inserted two new advocacy activities into draft Nepal’s 2012-2016 cMYP: passage of a National immunization Act and the writing of new legislation to create a national immunization trust fund. The draft cMYP is in finalization process.

Sabin and WHO co-funded the cMYP update for Cameroon last March. The Sabin funding allowed representatives from the country’s ten provinces (mairies) to participate. SIF Program Officer Jonas Mbwangue has been working with these officials to design a revenue-sharing national immunization fund. In Cameroon, decentralization provides the strategic framework for developing subnational immunization budgets. The updated 2012-2015 cMYP now emphasizes this new financing strategy.

Commenting on her experience, Dr. Mambu-MaDisu said: “Before the cMYP was not really being used. Now I think we will all be using it. People here see now that they have to be their own advocates.”

Sabin Sustainable Immunization Financing Program Partners Group Meeting Marks Midpoint

The third meeting of Sabin’s SIF Program Partners Group took place on 29 March 2011 in Addis Ababa, Ethiopia. Representing the partners were Violaine Mitchell (Bill & Melinda Gates Foundation), Miloud Kaddar (WHO), Santiago Cornejo (GAVI) and Chris Lovelace (World Bank). Sabin Executive VicePresident Ciro de Quadros welcomed the participants and gave an overview of SIF Program activities over the past year. Each of the five SIF Senior Program Officers in turn briefed the partners on their work in the fifteen SIF pilot countries. Now at its halfway point, the Program has engaged networks of parliamentarians and government officials, all working toward sustainable immunization financing solutions for their countries. This collective action was evident during the just concluded Sabin Colloquium on Sustainable Immunization Financing (see related story). “These networks are a powerful new tool for immunization financing”, commented Santiago Cornejo. The partners agreed to develop more collaborative activities at country level. Summarizing, de Quadros said “In the next three years the SIF Program will maintain its vision of coaching countries from dependency to self-reliance and self-sufficiency.” For the full report of the meeting, click here.

SIF Sabin News Highlights

  • Sabin held a press conference during Day 1 of its first Colloquium on Sustainable Immunization Financing . Members from both the local and international press were invited, with twenty-two journalists attending. Reporters from WARI/TV5 (West Africa), Madagascar Matin, The Daily Monitor (Ethiopia), Ethiopian Radio and Television Agency, and The Point Newspaper (Gambia) gave their reports, some of which can be found on our event site. Please visit this site for a list of press clippings and links relating to our event. To view a compilation of our updated country fact sheets, please click here.
  • · Sabin has hired the Boston Consulting Group (BCG) to review and evaluate its Sustainable Immunization Program. The midterm evaluation began in March and will conclude in May. The purpose of the evaluation is to assess Program operations and processes, both at headquarters and in the field. The BCG team visited Uganda, Cameroon and Liberia and conducted detailed reviews of SIF projects in DR Congo and Cambodia. Two BCG evaluators also attended the recent Sabin Colloquium in Addis where they interviewed members of parliament, delegates from ministries of health and ministries of finance and external partner representatives. In all, 81 informants were interviewed in the course of the evaluation. Results will be presented in early May.

SIF Immunization Champion

For this Summary Digest, we would like to highlight Dr. Sudhir Khanal as our immunization champion. A graduate of Medicine and holder of a Masters in Public Health from Bangladesh, he received the Hubert Humphrey fellowship to pursue his Masters at the Johns Hopkins Bloomberg School of Public Health in the United States.

Dr. Khanal currently works as a Child Health and Survival Program Specialist at UNICEF Nepal’s country office where he has been collaborating with Nepal’s Ministry of Health and other partners to achieve MDG 4. He has been playing an instrumental role in fostering collective action among parliament, civil society, government agencies and partners to reach sustainable immunization financing in Nepal. Sabin’s Kathmandu’s 9-11 February 2010 parliamentarian symposium produced the “Kathmandu Declaration.” The success of this meeting was largely due to Dr. Khanal’s help in planning this event.

Dr. Khanal also helped organize the first ever meeting of civil society (Rotary Clubs), parliament , government institutions (Ministry of Health, Ministry of Finance) and partners to advocate for sustainable immunization financing. The meeting jointly sponsored by Sabin and UNICEF (“Countdown to 2015 and Sustainable Immunization Financing: Role of Civil Society”) highlighted the important role both private sector and civil society can play in mobilizing domestic resources for immunization. Dedicated individuals such as Dr. Khanal are helping to bring countries closer to their sustainable immunization financing goals.