I am Clifford Kamara, Senior Program Officer in the Sabin Vaccine Institute’s Advocacy Program for Sustainable Immunization Financing, responsible for program activities in Liberia, Nigeria and my native Sierra Leone. Two of these countries, Liberia and Sierra Leone, are post-conflict countries struggling to get to their feet after years of devastating wars that resulted in the virtual collapse of both governments. Although the worst appears to be over after the cessation of hostilities in the early 2000s, these countries are still fragile, with weak economies, and donor-dependent.

Enter the Advocacy Program for Sustainable Immunization Financing in late 2008. With a focus on the Ministries of Health, of Finance and Parliaments, an investment case was made for immunizations to receive priority funding. One of the main problems noted was that key decision-makers in the planning and budgeting process in the above-mentioned institutions and amongst partners were not fully informed of the benefits of immunizations; no justification was provided as to why immunizations should receive priority funding, even with the limited resources available in these countries.

Successes to date include the fact that key decision-makers in both countries are now better informed of the cost-effectiveness of immunizations and their tremendous potential contribution to the achievement of the MDGs; a budget line for immunizations was introduced in Sierra Leone, with increased budgetary allocations to the National Immunization Program. Challenges still remain, and these include synchronizing activities with the decentralization process underway in both countries, especially in view of the weak institutional capacity. Numerous questions come up that include “why the focus on immunizations?”, “The focus on immunizations must be at the expense of other health services within the “Basic Health package””. The introduction of newer and more expensive vaccines adds an urgency that must be addressed, especially since the cost of fully immunizing one child now exceeds the total per capita health budget of most of the AP countries. This clearly suggests the need to intensify advocacy for SIF, not only with the above-mentioned institutions, but also with a wider range of stakeholders that should include the Counties/ Districts, donors, the private sector, and Civil Society Organizations.

The socio-economic development of both countries is expected to improve, especially in the light of strengthening of democracy and governance. However, whilst there is room for optimism, it is probably prudent to prepare for the worst-case scenario, which will necessitate a more vigorous advocacy amongst the major stakeholders if SIF is to be achieved. In the future, we envisage a situation whereby those that are now being targeted for advocacy will themselves become advocates for SIF. Legislation should be enacted to contribute towards ensuring SIF, and the necessary funds will be “ring fenced” to ensure that adequate resources are always available for immunizations.