On 28 September, seventeen parliamentarians and government officials came together in Bamako to discuss ways to sustainably finance Mali’s immunization program. It was the latest in a series of Sabin-organized briefings that began in Bamako in October 2009. Malian delegations subsequently attended a December 2009 briefing in Dakar, Senegal and a meeting of mayors last May in Yaounde, Cameroon. Now well aware of what is at stake, the Malians have rolled up their sleeves and begun working on a proposed national immunization trust fund.
“Comment perenniser le budget du Programme National de Vaccination?”, asked Dr. Zankoma, Assistant Director of EPI, in opening remarks. It is a problem most low income countries face. The workshop began with a penetrating presentation by newly named EPI Manager Dr. Toure Albouhary. Using the Program’s time series data, Dr. Toure showed that over 80% of Malian children have been fully immunized in recent years. The country was one of the first in Africa to vanquish polio. Measles is next on the list. Mali is on track to achieve MDG4. EPI can claim credit for 25-40% of the child deaths averted. But these gains are fragile. Like other African countries, Mali finances just 20% of its EPI Program and depends on GAVI, UNICEF, WHO and other donors for the rest. Accessing the government funds in timely fashion is a chronic problem. In 2010, the Government approved an EPI budget of CFA2.5b (about US$6.2m) but only CFA360m of that (US$900,000) has been disbursed by the Treasury to date. The Program uses all the funds it receives. In technical terms, the Program has 100% absorptive capacity. Cash rationing is the problem.
Even if the approved budget is entirely disbursed, Mali’s EPI investment this year will only be far below the actual cost of about US$20. With new rotavirus and pneumococcal vaccines in the pipeline, that figure will soon reach US$30 or more. New funding sources are needed. The creation of a national immunization trust fund was proposed earlier this year in DR Congo. The idea is catching on. In his presentation, Dr. Toure identified some of Mali’s potential fund contributors: various federal ministries and local governments (communes); foundations; Orange, Malitel and other leading firms; Rotary and Lions clubs and other interested donors.
Sensing the need to act, the group agreed to act as a plateforme that ties together the three key national institutions concerned with the fund- parliament, Ministry of Health and Ministry of Finance. The plateforme resolved to launch new legislation (projet de loi) and to carry out a feasibility study for a new national immunization trust fund. Decentralization will be part of the strategy. “We have lots of duties assigned to us”, commented Bamako’s Commune III maire, Mr. Mamadou Sacko, “but not the resources we need to carry them out”. The plateforme will address these sorts of administrative bottlenecks. The trust fund will thus act as an incubator for best practices within the country’s public finance systems.
Similar efforts are now underway in DR Congo, Cameroon, Senegal and Nepal. SIF Senior Program Officer Jonas Mbwange has been working with the African plateformes and follows their development closely. “The technical capacity for the funds is in place. The political will is coming together, too. The funds will give the actors a new space to develop new ideas, to work together”, said Mbwangue.
Representatives of the African plateformes will have a chance to present their work to their peers at Sabin’s first Parliamentary Colloquium on Sustainable Immunization Financing, which will take place in Addis, Ababa, Ethiopia on 15-16 November 2010. Delegations from all fifteen SIF Program countries will attend.