Category Archives: National Immunization Trust Fund (NITF)

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)

DR Congo and Cameroon delegations present SIF work at the WHO/AFRO Annual Regional Conference on Immunization

Here in the second day of the WHO/AFRO Annual Regional Conference on Immunization in Ouagadougou, Burkina Faso, participants heard how the Democratic Republic of Congo and Cameroon are working together to develop sustainable immunization financing plans. Representing the DRC delegation were Hon. Gregoire LUSENGE KAKULE, Member of Parliament, and Mr. Andre BONA KABAMBA, Chef de Division Unique in the Ministry of Finance. Representing Cameroon were parliamentarian Hon. Gaston KOMBA and EPI finance officer Sylvain BRICE BANELA. Also attending were Sabin’s Senior Program Officers, Dr. Helene MAMBU-MA-DISU, who is based in DRC, and Jonas MBWANGUE, who is based in Cameroon.

In his presentation, Hon. LUSENGE described how a team from WHO, UNICEF and GAVI came to Kinshasa in April 2009 to assess the country’s immunization financing situation. That year DRC’s immunization program was almost entirely donor-dependent. The government had allocated just US$777,609 for the approximately $90m program. In September 2009, Sabin organized the first in a series of parliamentary briefings in Kinshasa. For the first time, said Hon. LUSENGE, the parliamentarians saw how immunizations are given in this vast country of 445 ethnic groups. What alarmed them most was the program’s high donor dependency.

The members of the National Assembly’s Health Commission immediately became immunization advocates.

During the 2010 budget hearings they demanded and got specific immunization line items added to the budget, allowing them to track budget execution. And they convinced the government to push its EPI investment up to $6.4m. But progress eluded them. Most of the 2010 government funds were never disbursed. Worse, vaccine coverage fell from 83% to 69% due to staff turnovers and lackluster performance.

The solution that occurred to the MoF’s BONA KABAMBA was to develop a national immunization trust fund. To be financed by a new tax on cell phone calls, private sector donations and external immunization partner contributions, the fund would be governed by a quasi-public board. Bypassing the Treasury would eliminate the cash rationing problem. The EPI would have to demonstrate its performance to the fund directors in order to qualify for each budgetary tranche.

As BONA KABAMBA puts the finishing touches on the proposal, the MPs on the Health Commission are rallying their fellow parliamentarians, five key ministries and the country’s eleven provincial governors and provincial assemblies to support the proposed fund.

Meanwhile, a similar advocacy process is underway in nearby Cameroon. Both countries are developing national immunization trust funds. In his presentation, Hon. KOMBA described a Sabin-sponsored visit by the DRC delegation to Yaounde last September. The peer exchange allowed LUSENGE, KABAMBA and DRC EPI Manager Raymond CAMBELE to compare notes with their Cameroonian peers. The teams continue to collaborate as they advance their innovative financing projects.

The funds will be broadly similar, however, Cameroon’s will take advantage of the country’s fast-moving decentralization program by ensuring that municipalities (mairies) also contribute to the fund. An expert committee, added Hon. KOMBA, will oversee technical aspects of the program. A permanent secretariat will ensure the new funding streams are used as efficiently as possible.

Much work remains to be done before the funds are operational. Feasibility studies must be completed and both packages must ultimately be passed into law. Afterwards several participants congratulated the delegations for their pathbreaking work. It was the first time parliamentarians had ever attended an ARCI meeting.

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Filed under Advocacy Activities, Africa, National Immunization Trust Fund (NITF), Peer Exchange, Uncategorized

Nigeria holds its First Briefing on Sustainable Immunization Financing

Some of the participants in Nigeria's first SIF parliamentary briefing, 29 Oct 2010, Abuja.

Sponsored by SIF Sabin, Nigeria held its first parliamentary briefing in Abuja, Nigeria today. It was chaired by the Executive Director of the National Primary Health Care Development Agency (NPHCDA) Dr. Muhammad Pate. The 32 participants included the Chairlady of the Senate Health Committee, Hon. Mrs. Dr. Iyabo Obasanjo-Bello, colleagues from the NPHCDA, WHO (including the Representative, Dr. Peter Eriki), UNICEF, USAID and Rotary International. The Chairman of the Board of the NPHCDA, His Royal Highness, Dr. Yahyah, was also in attendance, and the event was fully covered by the print and electronic media.

In his remarks, Dr. Michael McQuestion, the Director of the Sustainable Immunization Financing Program of the Sabin Vaccine Institute opined that although Nigeria is the thirteenth of the fifteen program countries, it has the potential to become the first to achieve Sustainable Immunization Financing. The country already funds over 70% of the routine vaccine costs, higher than any other country in sub-Saharan Africa. He emphasized the commitment of the SIF program to work closely with the NPHCDA and other stakeholders to achieve this in the near future.

In her remarks, the Chairlady of the Senate Health Committee, Hon. Mrs. Dr. Iyabo Obasanjo-Bello, apologized on behalf of her Senate colleagues, who could not attend because they had to travel outside Abuja to attend urgent political events. She emphasized that this is not a manifestation of lack of interest on their part, and assured all that the attendance will definitely be much better if the next event is organized at a more appropriate time.

Discussions after the presentations focused on the need to strengthen routine immunization activities; need for health systems strengthening, especially in the light of the introduction of additional, more expensive vaccines; need to introduce strategies and possibly legislation to “ring-fence” adequate funding for immunizations; and the significant contribution immunizations can make towards achieving the MDGs in Nigeria.

The symposium ended with a clear agreement by all that the good working relationship established between the various partners for immunization must continue and be strengthened. The process of information sharing, consultation, collaboration, and advocacy will definitely lead towards sustained immunization financing, thereby putting the country on the firm path towards achieving the MDGs.

For photos of this event, please visit our Flickr site here.

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Cameroon Approves the Creation of a National Immunization Trust Fund (NITF)

On October 7, 2010, Dr. Mama Fouda of the Cameroonian Ministry of Public Health, approved the creation of the National Immunization Trust Fund (NITF) as an alternative for sustainable immunization financing in Cameroon. This political commitment is the result of a comprehensive change on long term immunization financing, facilitated by the Sustainable Immunization Financing program at the Sabin Vaccine Institute and done with the helpful support of both the WHO, and UNICEF Cameroon.

The inception of this change began with the assessment of the main challenges of immunization financing in a December 2009 sub-regional meeting in in Dakar, Senegal. Resulting from the assessment, were the drafting of finding alternative solutions for immunization financing for participating countries: Cameroon, Mali, and Senegal. In a May 2010 following sub-regional meeting in Yaounde was opened by Dr. Mama Fouda, Parliamentarians, maires, and technical staff from the Ministries of Economic and Planning, Finance, and Decentralization, all worked together to formulate a recommendation to establish a National Immunization Trust Fund for each of the three countries.

A similar process started in the Democratic Republic of Congo (DRC); Parliamentarians and technical advisers from both Cameroon and the DRC agreed to engage in a Sabin SIF sponsored peer exchange. From September 11-15, Delegations from both countries met in Yaounde, Cameroon, to share their experiences. Despite GAVI’s fiscal support for immunization funds, the present government budget stands at less than 20% for these funds. Convinced that immunization is the best investment to achieve Millennium Development Goal 4 (reducing by 2/3 the rate of child mortality), all agreed to draft a “Call for Action” asking their government to address the problem of immunization financing, and to treat it as a development priority.

The Yaounde Call for Action was conceived and signed by the Honorable Gaston Komba, President of the Finance and Budget Committee of Parliament, as well as by Professor Lazard Kaptue, the General Secretary of the Association des Villes et Communes Unies du Cameroun, (who served as both the chairman of the May Sub-Regional meeting as well as for the Sabin sponsored Peer Exchange.) After discussions at October 1st’s ICCA Meeting, this document was then sent to the Ministry of Health for review.

Briefed by both the Honorable Gaston Komba and Honorable Amougou Mezang, the Minister of Health gave his final approval for the creation of the National Immunization Trust Fund on October 7, 2010. The Minister of Health asked that the EPI Team to work closely with the SIF program at the Sabin Vaccine Institute, as well as with the Legal Services department of the Ministry of Health to assist in the beginnings of drafting a law which would secure the establishment of a National Immunization Trust Fund in Cameroon.

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Mali forms Innovative ‘Plateforme’ for Sustainable Immunization Financing

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.

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Working on a National Immunization Trust Fund in Senegal

SIF Program Director Mike McQuestion and SIF Senior Program Officer Jonas Mbwangue are in Dakar, Senegal today to meet with members of the Ministry of Health, the Ministry of Financing and Parliament to work on recommendations for a national immunization fund.  Their meeting is subsequent to Senegal’s second Sabin-sponsored parliamentary briefing which took place in December of last year.  It was at this time that parliamentarians convinced Dr. Lamine Sall, the Chief of Cabinet, to increase the budget for their national immunization program.  This year, the Senegalese Government was able to allocate 2.2 million USD for this program – a marked 10 percent increase from 2009.

Depicted in the photo are Dr. Aboubacry Fall, Director of Division of Preventive Medicine, and Mamadou Ndiaye whom were at Senegal’s Ministry of Health discussing financing strategies with counterparts in Dakar.

To follow ‘tweets’ and real time updates of SIF Sabin’s activities in the field, please visit our Twitter site at https://twitter.com/SIF_Sabin

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Elected Officials Contemplate a National Immunization Fund For Cameroon

By Mike McQuestion

On 29-30 April 2010, a group of parliamentarians and elected mayors (maires) met to discuss immunization financing in Cameroon.  Ministry of Health, Finance and Decentralization officials and a visiting delegation from Mali also attended the Sabin-sponsored workshop, which took place in Yaounde.  Motivating the meeting was a recent executive order from His Excellency President Paul Biya to implement the country’s decentralization program. The order took effect on 1 January 2010. Each of the country’s ten districts must henceforth form its own budget.  The maires have agreed to use immunization as a vehicle for developing this new capacity for the health sector.

L to R: SIF Senior Program Officer, Jonas Mbwangue and SIF Program Director, Mike McQuestion join Cameroonian district representatives for SIF's First Meeting of Mayors in Yaoundé‎, Cameroon.

Cameroon is well on its way to sustainably financing its EPI Program. GAVI is its only remaining external EPI partner. Following briefings from national EPI Manager Dr. KOBELA Marie and WHO Immunization Focal Point Dr. ANYA Blanche, the MPs and maires decided to include immunization line items in their regional budgets.  Concerned with donor dependency, they further recommended forming a national immunization fund, to be financed jointly by the federal government and the ten regional governments.  The Ministry of Health will relay this recommendation to the Prime Minister. A task force will prepare a draft law instituting the fund. If the Council of Ministers agrees, the proposed law will be submitted later this year to parliament for its approval.

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Filed under Advocacy Activities, Africa, National Immunization Trust Fund (NITF)