By Mike McQuestion
As we drill down to find the best routes to sustainable immunization financing, three seem particularly promising: budget reform, decentralization and democratization.
This week, here in Lubumbashi, capital of DR Congo’s Katanga Province, Helene Mambu-ma-Disu and I find ourselves following the decentralization route. Katanga is the first of the country’s eleven provinces to put decentralized health funds into immunization. When federal funds for the provincial immunization program were held up earlier this year (so that the federal government could be sure to pass the HIPC decision point test by showing it could restrain expenditures), the Katanga Provincial Governor kicked in about US$150,000 to keep the program running.
With about 400k infants born each year this is not much. But it’s been enough to tide them over until the federal funds again begin flowing next month.
The provincial EPI team realizes that nothing beats local support and is now preparing the investment case for a larger provincial EPI budget in 2011.
If all the provinces do this, several good things might happen. Decentralization will benefit because there will be provincial skin in the game. Accountability and transparency will improve because Provincial Pilot Committees will want to know how and where their local revenues are being spent. The external partners can shift their support elsewhere, where it can support innovations rather than meet recurrent costs governments ought to be paying in any case. And the sum of eleven provincial budgets + the federal budget just might add up to the required $30/child fully immunized.
We will see.
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