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.

Meet Senior Program Officer Diana Kizza, Representing SIF Focus Countries: Ethiopia, Kenya and Uganda

Diana Kizza, SIF Senior Program Officer for Kenya, Uganda and Ethiopia.

Diana Kizza, a Health Economist, is the Sustainable Immunization Financing Program (SIF) Senior Program Officer for the Sabin Vaccine Institute program in the Eastern African countries of Ethiopia, Kenya and Uganda. A former Overseas Development Institute (ODI) fellow in the Rwanda Ministry of Health, she holds an MSc in Health Economics from the University of York, UK and a BSc degree in Quantitative Economics from Makerere University, Kampala.

Over the past years, these three countries have experienced remarkable economic growth and improvements in both their public financial management and governance structures. These factors have encouraged their health programs to be better supported than many of their post conflict neighbors. A lot of the structural adjustments in these countries have been donor driven as opposed to country led initiatives, in effort to ensure that the countries secured much needed foreign funding.

Realizing that it is not viable to depend on external sources of funding, these three nations are slowly trying to reverse some of the current donor dependency practices to encourage greater national ownership and better practices with development partners. This, among other factors, makes the timing suitable for advocacy for sustainable health financing, particularly for immunization, which is one of the most cost effective, preventative health initiative.

The challenge with immunization financing advocacy lies in part with the success of the programs in reducing mortality due to communicable, immunization-preventable diseases (i.e. these diseases are no longer as common). Despite remarkable progress, the cost of vaccines is increasing with the introduction of new vaccines; moreover, population growth rates realize high numbers of children born each year, necessitating an increase of immunization budgets or a reduction in costs of vaccines. The concern lies in the fact that a larger proportion of the current vaccine funds is obtained from development partners.

Diana Kizza has been concerting SIF’s efforts with other stakeholders, advocating for sustainable health financing; this includes participation and involvement from members of: Parliament, Ministry of Health, Ministry of Finance, the Private Sector, Civil Society Organizations and the Media in these countries. The goal is to promote collective action to ensure sustainable immunization financing for these three nations.

SIF provides a neutral platform for these institutions to come together and through dialogue, share challenges across institutions in hopes of implementing a sustainable immunization program.

Introducing Jonas Mbwangue, Senior Program Officer for SIF countries: Cameroon, Mali and Senegal

Jonas Mbwangue, a public policy specialist, joined the Sabin Vaccine Institute’s Sustainable Immunization Financing program in  September of 08′.  Since he joined the program, Jonas Mbwangue has been working hard on sustainable immunization financing initiatives in his three program countries.

Before coming to work for Sabin, Jonas Mbwangue filled numerous roles in the national and international development arena. He worked as a consultant for the World Bank Institute, as well as for the Learning Arms of the World Bank Group, advocating for good governance of natural, resource-based revenues. Through this work, he gained experience in working with Parliamentarians in both Cameroon and Senegal.  In addition, Mr. Mbwangue held the position of Executive Director for the Cameroon National Association for Family Welfare (CAMNAFAW).  He also gained experience at the International Planned Parenthood Federation, an internationally recognized reproductive health organization operating in over 180 countries.

Jonas Mbwangue holds a Master of Public Administration (MPA) in Economic Policy Management from the School of International and Public Affairs (SIPA) from Columbia University, New York.  He was also a Fellow at  Maastricht’s School of Governance’s Policy and Governance Analysis PhD program at Maastricht University, in the Netherlands.  Currently, Mr. Mbwangue is living in Yaounde, Cameroon, the same city where he and SIF Program Director, Mike McQuestion led the SIF sponsored ‘Meeting of Mayors’ last month.  Planning, organizing and executing such events illustrates the skills needed to help an SIF country achieve a sustainable immunization plan.

Introducing SIF’s Asian countries representative: Devendra Prasad Gnawali

Devendra Prasad Gnawali is Sabin Vaccine Institute’s Sustainable Immunization Financing program’s Senior Program Officer representing Asian countries: Nepal, Sri Lanaka and Cambodia. With a PhD in health economics from Heidelberg University, Germany; an M.Sc. in health economics from Chulalongkorn University, Thailand; and an M.Sc. in Statistics from Tribhuvan University, Nepal; Dr. Gnawali’s main focus of work has been on health care financing. Inclusive of this, has been his work on collective action initiatives among key stakeholders in immunization financing within this region.

Devendra Gnawali has been working with members of parliament, Ministries of Health, Ministries of Finance and civil society organizations in these countries, working on fostering collective action which will help secure sustainable immunization financing for these countries. Recently, he worked with UNICEF Nepal and with The Women, Children and Social Welfare Committee of Legislature Parliament of Nepal to host Sabin Vaccine Institute’s Sustainable Immunization Program’s 9-11 February, 2010 sub-regional level meeting entitled “Symposium for Parliamentarians on Child Health and Sustainable Immunization Financing” in Kathmandu, Nepal. Parliamentarians, officials from the Ministry of Health, and Ministry of Finance from Cambodia, Nepal, and Sri Lanka, all participated in this momentous symposium. Development partners working in the health sector were also among its participants.

Realizing the importance of immunization programs to lessen infant mortality rates (MDG#4), parliamentarians announced their commitment through what is now known as “The Kathmandu Declaration”. Endorsed by the full house of the Legislature Parliament of Nepal, the declaration’s focus is on advocacy which will help ensure sustainable immunization financing in Nepal: to increase, and sustain existing performance as well as speedy introduction of new and under-utilized vaccines through various innovative ways.

The Declaration stresses the development of legislation for immunization, to assure adequate funds for immunization programs through specific taxes. Through this Declaration, parliamentarians will explore domestic resources for sustainable immunization financing by developing legislation for tax-credit and will also reach out to corporate houses who have pledged to donate funds for immunization programs. The parliamentarians have also recommended legislation which will increase tax on tobacco and alcohol; these funds would become ear-marked funds for immunization programs. For more details, please read the “Kathmandu Declaration”

Helene Mambu-Ma-Disu is the SIF Senior Program Officer for Madagascar, Rwanda and DR-Congo

Helene Mambu-Ma-Disu is the SIF Senior Program Officer  for Madagascar, Rwanda and her home country, DR-Congo. All three countries are either post conflict or still in conflict, some are doing much better than the others but all three remain donor dependent.

All three countries joined SIF in 2009 but more work has been done with DR-Congo in sensitizing national stakeholders and major partners on the importance of immunizations and the need for the national government to take ownership of the program by allocating sufficient resources for its activities – including the purchasing of routine vaccines.

Targeted stakeholders have been government institutions: The Ministries of Health, Budget, Finance and Planning and Parliament.  This also includes: civil society groups, media and external partners. Information about immunization program performance and challenges has been shared. This has been somewhat hampered by the relative instability of the leaders of the government institutions.

The current economic health of the country does not allow the allocation of sufficient resources for the immunization program, but the 2010 national budget does show that a relative priority has been given to the immunization program within the Ministry of Health. Continuous advocacy is needed so that the allocated resources can be disbursed, and efficiently used in order to improve the program performance to attract more resources.

The law on decentralization was voted and promulgated in 2008. Given the low level of development of the country, this is certainly the way to go. Work is under way so that decentralized entities will include immunization needs in their respective budgets.

The other medium term hope is that that country is scheduled to reach the HIPC completion point in 2010; and health is one of the priority sectors to benefits from the debt relief. Once again, more active advocacy will be needed to make sure that immunization programs receive the needed resources for its activities.

So far Rwanda seems to be doing quite well even though a non negligible portion of the government budget is from a budget support scheme from external donors. Although the program is performing well, SIF advocacy is needed to hopefully help diversify financing sources from within the country. It could provide an example for other countries to learn from the Rwanda’s experience.  As for Madagascar, there is hope that this country will make a big jump once their political turmoil is under control.

Introducing Clifford Kamara, Senior Program Officer for countries: Nigeria, Sierra Leone and Liberia

Clifford Kamara, SIF Senior Program Officer

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.