Transformational Agenda: How Cameroon is Securing Sustainable Immunization Financing
By: Jonas Mbwangue, Senior Program Officer, Sabin Vaccine Institute Sustainable Immunization Program
Recent developments in Cameroon illustrate how African countries are taking ownership of their immunization programs. Cameroon’s commitment to immunization continues to rise. On the legislative front, the Ministry of Health is developing new legislation which wills secure public financing for immunization. On the programmatic side, government and parliament have integrated the six strategic objectives of the Decade of Vaccines Global Vaccine Action Plan (GVAP) into the national immunization action plan.
From August 19th to the 23rd, I attended a national immunization planning workshop in Ebolowa, Cameroon. 40 delegates representing the government of Cameroon, the Parliament, the Association of Mayors and external immunization partners WHO, UNICEF, GAVI and AMP were in attendance. At this workshop, I saw our national institutions work together to generate a 5-year plan for the national immunization program. Sabin co-sponsored the workshop along with UNICEF, the World Health Organization (WHO) and Cameroon’s Ministry of Health.
The first order of business was to align Cameroon’s 2015-2020 Immunization Country Multi-Year Plan (cMYP) with the Global Vaccine Action Plan (GVAP), a framework adopted by the WHO in 2012 to improve health by extending the benefits of immunization to all people. The second objective was to define how Cameroon will fully finance the program in the coming years. Financing is an increasing concern as Cameroon will soon graduate from GAVI grant eligibility and will thereafter have to fully finance its new vaccines.
The workshop was the latest in a series of Sabin-supported advocacy activities in Cameroon that began in 2009. Over the years, these advocacy efforts have given voice to a cadre of immunization champions, in government, parliament and civil society. The workshop again brought them together. Dr. Marie Kobela, Cameroon’s EPI Manager, opened the workshop by explaining how Cameroon’s EPI program is working towards increasing immunization financing and vaccination coverage through new legislation and advocacy work.
Cameroon’s draft legislation for sustainable immunization financing continues to advance despite domestic political difficulties, she noted. The program’s budget has also been increasing. The progress is due to the champions, who have been working through their respective institutions, principally the Ministry of Health, Ministry of Finance, Parliament and the Association of Mayors. In essence, Dr. Kobela now works with a team of supporters who are helping advance the legislation and advocate for program budget increases.
These champions see immunization as a valuable public good which benefits all levels of society, and their advocacy has reached the highest levels of government. At their insistence, Cameroon’s Prime Minister established an inter-ministerial committee earlier this year to review the draft immunization law before it is submitted to Parliament for approval. At the workshop, the champions renewed their call for action on the bill. Once submitted, Dr. Kobela explained, the champions will do what they can to get the law approved as soon as possible.
A key immunization champion is Hon. Gaston Komba, a member of Cameroon’s Parliamentarian Financial and Budget Committee who has been involved in the country’s sustainable immunization financing advocacy efforts since 2009. Last year, Hon. Komba and Dr. Kobela led the Cameroonian delegation in a Sabin-organized legislative workshop in Kinshasa, DRC. At the Ebolowa workshop, Hon. Komba urged government policymakers to view immunization as an investment rather than an operational cost.
The proposed law will establish a fund earmarked for immunization. However, each year, Dr. Kobila and her team will still need to prepare and defend steadily increasing EPI budget requests. One part of the investment case is to show how well the previous budget was executed. The EPI program team does this by tracking, analyzing and reporting immunization program allocations and expenditures. For the past three years, Dr. Kobela and her team have used a simple budget flow sheet, provided by Sabin, to do this resource tracking. Armed with this information, Parliament monitors the government’s level of commitment to the program. Dr. Kobela refers to these MPs as her EPI “watchdogs.” Their support has proved crucial. In 2012, the government significantly cut the EPI budget. Thanks to the watchdogs, the cuts were restored and the 2013 budget was increased by US$4m.
The workshop also revealed how a new NGO-driven Immunization platform is promoting immunization throughout the country. The NGO Immunization Platform (PROVARESSC) is supported by grants from GAVI. In the workshop, a representative from this Platform shared details of their plan to bring immunization information and advocacy to all 14,000 villages of Cameroon. If this outreach activity is funded, the Platform will boost the GVAP strategy of “Reaching all households”.
The Ebolowa workshop convinced me that Cameroon is well on the way to owning its immunization program. Hearing from immunization champions within the government and NGO community, I strongly believe that long-term immunization financing will be secured through legislation. Continued monitoring and tracking of government expenditures will provide decision makers with the information they need to properly oversee the EPI program. Lastly, the NGO Immunization Platform will increase immunization demand. Together, all of these efforts will ultimately create a healthier Cameroon.