Category Archives: Peer Exchange

Lessons Learnt Through Peer Exchange on Performance Based Budgeting Practices: Case Study from Liberia, Sierra Leone and Uganda

by SIF Senior Program Officer, Cliff Kamara
The Sustainable Immunization Financing Program of the Sabin Vaccine Institute had another opportunity to share experiences during the WHO/ AFRO Annual Regional Conference on Immunization in Ouagadougou 6th – 8th December, 2010. Peter Sam-Kpakra, Senior Assistant Secretary for Donor-funded Projects in Sierra Leone’s Ministry of Finance and Economic Development, presented a paper outlining the lessons learnt when he and Bernard Jappah of Liberia’s Ministry of Finance conducted a Peer Exchange visit to Uganda, another SIF program country. Uganda is recognized as a country with best practices as far as budget reforms are concerned; these include performance based monitoring of immunization and other health programs.

Hosted by the government of Uganda, Peter and Bernard familiarized themselves with innovative financial management practices during a two day visit to the Ministry of Finance and the Ministry of Health of Uganda. Lessons learnt include the benefits of signing performance-based contracts, with the disbursement of subsequent allocations based on satisfactory program execution/ performance. The government of Uganda also front loads program in the event of delayed donor funding, thereby averting the delays in the implementation of planned activities. As opposed to Liberia and Sierra Leone, the budget monitoring process is formalized, and is the responsibility of a well established unit staffed by relevant specialists.

Peter described how on return to Liberia and Sierra Leone, he and Bernard are currently applying the lessons learnt in their respective Ministries of Finance. In Liberia, Bernard is introducing health sector budgeting, as compared to ministerial budgeting; in Sierra Leone, Peter is strengthening the recently introduced performance-based financing in the Reproductive and Child Health Program, where immunization coverage is the main indicator for monitoring performance.

Clearly, it was agreed that Peer Exchanges on topical issues can play a vital role in sharing experiences and learning between SIF program countries. Whilst monitoring the introduction and implementation of the best practices seen in Uganda by Peter and Bernard, the SIF will continue to organize other Peer Exchange visits between program countries, with the firm belief that this is a fast method of introducing innovative practices that can contribute meaningfully towards achieving the overall goal of sustainable immunization financing.

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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

DRC and Cameroon Engage in an SIF Sponsored Peer Exchange

In our third post from our ‘Reflections from the Field’ series, Senior Program Officer Helene Mambu-ma-Disu writes about the recent Sabin-sponsored peer exchange between SIF pilot countries, DR Congo and Cameroon. Senior Program Officer, Jonas Mbwangue, also co-hosted and arranged for key meetings with members of Cameroon’s government; discussions were largely focused on the establishment of a National Immunization Fund for both countries.

Things seem to be moving in the right direction for immunization financing in the DRC. After sponsoring and actively participating in a very successful parliamentary briefing a few months ago, we have recently organized the first SIF Sabin sponsored peer exchange for the DRC. We had the opportunity to bring five DRC immunization stakeholders to Cameroon, to allow for an exchange of experiences with their Cameroonian counter-parts, and most importantly, to discuss the necessity to establish a fund dedicated to the financing of immunization in each country, and discuss the legal, political and practical issues surrounding that endeavor.

On the Congolese delegation, we had the vice-chair of the Economic and Finance committee of the National Assembly, a member of the socio-cultural committee at the National assembly, the director of the national EPI program, a civil servant from the ministry of budget and another one from the ministry of Finance, both intimately implicated in the push for more sustainable financing for immunization.

The exchange was very successful, as it truly allowed the peers to learn from each other, and to formulate a common declaration named “Appel de Yaounde” ( Yaounde Call for Action) aimed to accelerate the establishment of a National fund for immunization in each of the countries. Watch out for next steps…

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SIF Sponsored Peer Exchange between DRC and Cameroon taking place in Yaounde this week

SIF Sabin is currently hosting a peer exchange between Cameroon and DRC  in Yaounde this week.  SIF SPOs Helene Mambu-ma-Disu and Jonas Mbwangue are working together to host MPs through a planned series of activities intended to inform policymakers from both countries on various recommendations and best practices for establishing sustainable mechanisms for immunization financing.  This time together will also give the opportunity for Cameroon MPs to share their progress in establishing their National Immunization Fund in Cameroon.  DRC officials will use this knowledge to inform and identify the necessary actions needed to initiate the  establishment of a National Immunization Fund of their own in their native DRC.  This exchange will likely result with the development of an action plan for implementing the key recommendations so that this Fund may be realized.

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Filed under Advocacy Activities, Africa, Peer Exchange