Category Archives: Asia

National immunization trust fund emerges in Nepal

As 2010 comes to a close, Nepal is eyeing the establishment of a national trust fund as a way to ensure sustainable financing for its national immunization program. The groundwork for this important step was laid over the year by a host of stakeholders. Several preparatory meetings brought together Ministry of Health and Ministry of Finance officials with parliamentarians and private sector leaders to discuss the options.

The Nepalis developed the trust fund concept in league with their Cambodian and Sri Lankan counterparts. Threes sub-regional parliamentary briefings, supported by Sabin, were held in Kathmandu (9-11 February), Colombo (15-16 July), and Phnom Penh (21-22 October). In February, the parliamentarians adopted the “Kathmandu Declaration”, in which they committed to work for sustainable immunization financing for Nepal. UNICEF/Nepal has played an important role, first by co-sponsoring some of the briefings, then by providing technical support to the Nepali parliamentary and governmental counterparts. In the July Colombo briefing the delegates exchanged more information and generated the “Kathmandu to Colombo and Beyond Declaration”, which called upon all three governments to find innovative ways to increase routine immunization budgets. The Declaration also called on national immunization program managers to begin monitoring and reporting program expenditures along with coverage and surveillance data. At the meeting in Phnom Penh, the countries elaborated lists of short-term actions they will take to move them closer to the sustainable immunization financing goal. Again the delegates produced a “Phnom Penh Declaration”, this time highlighting the urgency of achieving the Millennium Development Goals and asking for in-year reporting from the ministries to parliament on immunization program performance. With these elements in place- policy directives, better reporting, a sense of urgency- the trust fund becomes feasible.

Throughout 2010, the Rotary Clubs of Nepal also played a key role in turning the country into an SIF champion. The clubs set up and capitalized a precursor fund, assessing each member US$80 to get it started. The Rotarians had participated in national SIF briefings in June and October. Today there is consensus that achieving sustainable immunization financing will require attracting more domestic resources from national business/corporate houses. The fund will allow firms to demonstrate their corporate social responsibility while accruing tax breaks. The goal is to establish a fund independent of the current external partner pooled funding arrangements for immunization. All contributions received will be seed money. The interest income from the seed money will be provided to the government to procure vaccines. As soon as the government establishes a legal mechanism, the partners agreed, ownership of the trust fund will be shifted to the government. The growing number of new stakeholders puts pressure on the government to speed up the process of creating the national immunization trust fund. At a brainstorming meeting on 28 December, members of the Rotary Club of North Kathmandu announced they had so far contributed NRs 137350 (about US$1900) to the interim fund.

Legislative work is also required to set up a trust fund. In a series of recent meetings, senior officials from health, finance and planning ministries have taken on the task of crafting a “National Immunization Act” to support the national immunization trust fund. The Ministry of Health has inserted these two activities into its annual program. The plan now awaits the approval of the National Planning Commission. These institutional innovations demonstrate the important effects new domestic and legislative stakeholders can have on the highest policy levels of government.

Among senior officials crafting the trust fund are Hon. Dr. Chet Raj Pant of the National Planning Commission; Mr. Vidyadhar Mallik, Vice-chairman of the Nepal Poverty Alleviation Fund; and, from the Ministry of Health, Dr. YV Pradhan, Director General of Department of Health Services; Dr. RP Bichha, Director of Child Health Division; Mr. KB Chand, Chief EPI Section; and Dr. Padam Bahadur Chand, Chief of the Policy, Planning and International Cooperation Division. Also involved are officials from the Parliament Secretariat; a representative from Ministry of Finance; representatives from WHO, UNICEF, Rotary and others.

The Nepalis are currently studying immunization laws from three Latin American countries (Bolivia, Costa Rica and Paraguay). The laws have been effective. Latin American governments now finance over 95% of their national immunization budgets. Their view is that the Immunization Act and Immunization Trust Fund must be developed simultaneously. The next step is for the Ministry of Health to win approval from the Cabinet of Ministers. This will require advocacy at the highest level. The team is forming a Technical Working Group to work on this task. The group will bring together immunization experts, legal officers and others high level officials to prepare a justification for why the Act and the Fund are necessary. Assuming they succeed, another high level meeting will take place with the Secretaries of Finance, Health and Law & Justice.

The Nepali delegation is expected to present their immunization trust fund case study at a Parliamentary Colloquium on Sustainable Immunization Financing, which SIF is organizing in Addis Ababa the last week of March 2011. Similar immunization trust funds are being organized by parliamentary and government counterparts in DR Congo and Cameroon. Mali, Senegal and Sri Lanka are also studying the idea. The Nepali case will be the first to demonstrate how a poor country can nevertheless make headway on the path to sustainable immunization financing.


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Filed under Asia, Legislation for Health Financing, National Immunization Trust Fund (NITF)

SIF’s Program Director Reflects on Public Health Initiatives in Asia

In our fifth post from our ‘Reflections from the Field’ series, our Program Director, Mike McQuestion, writes about his recent time spent in Asia as well as his thoughts on sustainable immunization financing initiatives in SIF’s three Asian pilot countries.

The three Asian SIF pilot countries could not be more distinct. In Cambodia, a rice growing culture has flourished for 2000 years in the Mekong River delta. Public health programs are just now starting to cut maternal and child mortality. Nepal is a polyglot of mountain and plain dwellers unexposed to the modern world until the late 1940s. Its health programs are also rapidly driving down mortality. Both countries are on track to make their MDG4 targets. Sri Lanka, in contrast, is a prosperous island with a diverse economy, high educational levels and a sophistocated public sector. Mortality has been low for decades. These contrasts aside, the three countries are pulling together to reach the sustainable financing goal. This was the theme of last week’s Third Sabin Asian Subregional Symposium on SIF.

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Sabin’s Communication Officer Writes About Recent SIF Phnom Penh Meeting

Our fourth post from our ‘Reflections from the Field’ series is written by Eteena Tadjiogueu, a Communications Associate here at the Sabin Vaccine Institute. While on her travels in South East Asia, she participated in SIF Sabin’s sponsored meeting in Phnom Penh dedicated to SIF and child initiatives. Here, she writes about her experience.

Last week I had the opportunity to participate in the two day “Third Sub-Regional Symposium for Parliamentarians on Child Health and Sustainable Immunization Financing” in Phnom Penh, Cambodia. It was my first time visiting South East Asia and my first opportunity to witness the work of the SIF program first hand.

Day one of the symposium was filled with highly informative presentations from parliamentarians from Cambodia, Sri Lanka and Nepal as well as representatives from UNICEF, World Bank and UNDP. The agenda really got interesting on the afternoon of day one when the delegates and I were placed into small working groups, comprised of representatives from each of the three countries, and asked to discuss challenges to budget preparation oversight or legislating for immunization and health.

Eteena Tadjiogueu, Sabin Communications Associate; Dr. Mike McQuestion, SIF Program Director; Dr. Devedra Gnawali, SIF Senior Program Officer; and Mr. Visal Uy, Cambodian Director of International Relations Division of the National Assembly (left to right); pose with the symposium organizers at the conclusion of the two-day meeting

My group discussed the budget preparation oversight process and came up with eight challenges that hindered the process. From the list of eight we drilled down to three main challenges, first and foremost being a limited budget to support health activities. Next we discussed several options to remedy our main challenge including the potential to develop a national immunization fund, increasing the amount of money allocated to the health budget by the national government, improving the economy through boosting agriculture exports, and financing health projects through taxes.The results of each working group were shared the following morning and then delegates were placed into three country-specific working groups to develop action plans that devised components of the “Phnom Penh Declaration.”

Similar to the Kathmandu Declaration, the Phnom Penh Declaration lists out specific actions that should be taken by parliamentarians, ministers of health and finance, and government officials to ensure immunization programs are sustainably funded. For instance, bullet point number one directly alludes to what my group discussed in calling for the ministers of finance and health to increase the national immunization budget. Other points, like requesting governments to create National Immunization Acts, were developed from the results of the working groups who discussed legislating for immunization and health.

The most exciting part of the symposium came on the last day and it certainly wasn’t because the event was drawing to a close! Instead, when I saw each of the participants armed with a copy of the Phnom Penh Declaration and fully aware of the upcoming SIF colloquium where they will have to report on their progress in front of the other 14 pilot countries, I was excited about the immense amount of opportunity for change that lays ahead.

SIF Program Director Dr. Mike McQuestion told participants during the closing session that he hoped in the coming months each of the delegates would continue to work as innovative groups. Based on my conversations with several delegates in my working group, and during coffee breaks, I have no doubt that they will and I believe that the conversations and presentations on sustainable immunization financing will be even more fascinating at the SIF colloquium.

Please join us for our next entry from this series when Director Mike McQuestion writes about his experience at this Sabin-sponsored symposium in Phnom Penh event. For additional photos, please visit the event album on Flickr

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Second Day of Activities from the Third Parliamentary Symposium on SIF

Today marks the second day of the Third Parliamentary Symposium on Sustainable Immunization Financing (SIF) in Phnom Penh. Delegates from SIF pilot countries Sri Lanka, Nepal, and Cambodia will be discussing: Budget Preparation and Oversight; Legislating for Immunization and Health; and National Delegations’ Action Plans. All three countries will present their Action Plans and collectively discuss the adoption of a new Cambodia Declaration. To learn more about these two-day proceedings, please return to our blog next week for a field report from our Sabin SIF Program Director, Mike McQuestion.

Cambodian delegation prepares its action plan.

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Third Parliamentary Symposium on Sustainable Immunization Financing Begins Today in Phnom Penh, Cambodia.

The Third Parliamentary Symposium on Sustainable Immunization Financing (SIF) begins today in Phnom Penh, Cambodia, lasting from October 21-22, 2010. Sponsored by the Sabin Vaccine Institute and hosted by the Government and Parliament of Cambodia, government representatives from Sri Lanka, Cambodia, Nepal, as well as representatives from the WHO, UNDP, UNICEF, and World Bank will be joining Director Mike McQuestion and Senior Program Officer Devendra Gnawali today to discuss these countries’ statuses in reaching sustainable immunization financing. Government representatives from each pilot country will summarize their achievements to date in reaching this initiative. Topics to be broached, will be: best practices in budgeting and legislation; best practices in advocacy; problem areas; goals; as well as varied and practiced approaches to sustainable immunization financing.

In both February and July of 2010, SIF Sabin sponsored two briefings in Asia. In February 2010, the First Asian Sub-regional parliamentary colloquium in Kathmandu, Nepal, produced the Kathmandu Declaration, which called for bigger national immunization budgets in SIF Sabin’s three Asian focus countries: Nepal, Cambodia, and Sri Lanka. In July 2010, a similar colloquium was held in Colombo, Sri Lanka; the output of this convening of nations was the Kathmandu to Colombo and Beyond Declaration, which called upon governments to find innovative ways in which to increase routine immunization budgets, also calling upon nations EPI managers to begin monitoring with fiscal findings and follow up reporting.

Nepal's RP Biccha calls for less donor dependence during panel discussion.

Today’s Third Parliamentary Symposium on Sustainable Immunization Financing will follow up on these prior achievements and explore viable initiatives in achieving sustainable immunization financing. A series of presentations will inform the next two days planned side meetings and scheduled workshops. These activities will offer Parliamentarians, as well as members from Ministries of Health and Finance from all three countries an opportunity to discuss varied proposed strategies, all of which will be analyzed in a peer review. Anticipated outputs will be work plans and refined approaches to progress monitoring. Collectively, participants will agree on a list of follow-up action items and activities which will help each focus country move closer to sustainable immunization financing.

All three SIF Asian pilot countries recognize that immunization is an effective and powerful public health tool; governments from Cambodia, Nepal, and Sri Lanka are working to reach Millennium Development’s Goal 4, Reducing Child Mortality, by 2015. The introduction and incorporation of new vaccines have greatly added to the cost of current immunization program needs; all three countries recognize that external donors such as GAVI, WHO, and UNICEF are increasingly unable to fill the the fiscal gap needed to ensure continued execution of national immunization program schedules. These are vital to maintaining herd immunity and protecting the public’s health from life-threatening and debilitating diseases. With Declarations such as the Kathmandu Declaration and Kathmandu to Colombo and Beyond Declaration, these three countries are collectively moving forward towards reaching their respective goals in independently achieving sustainable immunization financing via internally conceived strategies and programs. Sabin SIF is proud to be a part of this collective process and effort; by providing the context, agenda and platform for these dialogs to take place, each of these three countries is making undeniable advances towards sustainable immunization financing.

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SIF Team Meets in Johannesburg, SA for SIF Sabin Meeting and the 9th International Rotavirus Symposium

The Sabin SIF team- Devendra Gnawali, Clifford Kamara, Diana Kizza, Jonas Mbwangue, Helene Mambu-Ma-Disu, Mike McQuestion, Sandra Keller and Sabin Executive Vice-President Ciro de Quadros- met in Johannesburg from 31 July to 4 Aug for a SIF Sabin Meeting and the 9th International Rotavirus Symposium.  At the SIF meeting on 1 Aug, the team assessed progress to date in the fifteen pilot countries. Best practices were identified, including incorporating immunization financing into ongoing decentralization programs.  Six countries increased their immunization budgets this year and five countries are currently drafting immunization legislation, reported the five Senior Program Officers.”This Program is breaking new ground”, commented Ciro de Quadros. “We are getting everyone to re-think how we work. Keep going!”  Looking ahead, the SIF Program will look for ways to synergize with other BMGF-funded programs.  “Our combined effect will help countries increase their investments so that, ultimately, they fully own their programs”, said SIF Director Mike McQuestion.  The team also reviewed administrative issues including the recently overhauled SIF Groove workspace.  Program Officer Sandra Keller brought the team up to speed on the social media front: SIF news can now be gleaned from Facebook, Twitter, Flickr and YouTube.

Mike McQuestion speaking at the 9th International Rotavirus Symposium

The 2-3 August International Rotavirus Symposium drew 365 participants from 65 countries. In opening the meeting, Sabin’s Executive Vice President, Ciro de Quadros, remarked:  “There is a serious and growing need to increase access to affordable rotavirus vaccine in the developing world, where 85 percent of rotavirus deaths occur. This need is most severe in impoverished communities where access to medical care for rotavirus is often out of reach.  The symposium conveners, as well as the hundreds of attendees, are committed to ensuring that universal access to rotavirus vaccine becomes a reality.”

In the various sessions, conference participants were updated on  rotavirus and rotavirus vaccines. Latin American, Asian and African researchers presented the results of their vaccine studies. In the past decade an estimated 5m children died of diarrhea due to rotavirus.  Merck and GSK are now producing two rotavirus vaccines.  Both have been shown to reduce rotavirus severity and mortality. At least 1.6m future deaths will be prevented between now and 2020 as the two vaccines come into routine use. To accomplish this, countries and donors will have to increase their financial support. The conference closed with a Call to Action in which participants pledged to advocate for introducing the vaccines in their respective countries.

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Filed under Advocacy Activities, Africa, Asia, Meet the SIF Team

SIF-Sponsored Event Gains National News Coverage in Sri Lanka

A second news article covering the two-day SIF-sponsored July 15-16 event, the “Second Sub-regional Symposium for Parliamentarians on Sustainable Immunization Financing” from Sri Lanka’s ‘Daily News’ was published today, giving highlights of the event:

“…Health Minister Maithripala Sirisena said he is willing to make any sacrifice to obtain required funds for the health sector and to explain requirements to international organizations such as the WHO, UNICEF and SABIN to obtain the funds. According to Minister Sirisena Sri Lanka’s National Immunization Program is very effective and paid off well by recording the lowest infant and maternal mortality rates in the region.

Sri Lanka’s health indicators improved due to the success of the immunization program. Earlier there was only one Medical College in Sri Lanka and now there are seven.”

To learn more about the symposium and the initiatives Sri Lanka is taking to improve its public health program, please read the entire ‘Join Hands to Fight Dengue’ article by visiting the ‘Daily News’ online.

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