Category Archives: Reflections from the Field

Another ‘Reflections From the Field’ Entry from SIF Program Director, Mike McQuestion

Here at the WHO African Regional Conference on Immunization in Ouagadougou we heard today about new polio outbreaks in DR Congo, Uganda and Kenya. Since September, there have been around 1,000 cases in DR Congo and neighboring Republic of Congo (Brazzaville). Most of the cases have been in young adults. Case fatality rates are around 40-50%. Many adults, the data tell us, were susceptible. They were never vaccinated and never encountered the wild poliovirus as children. When high vaccine coverage is not maintained, susceptible pool in each birth cohort. The epidemic happens when there are enough susceptible to permit the poliovirus to transmit. The outbreak is a sobering reminder that once polio transmission is interrupted, countries must keep their polio vaccine coverage levels above 80%. That requires a well functioning, adequately resourced routine immunization program. Reacting to the presentation this morning, Hon. Grégoire LUSENGE KAKULE, a Member of Parliament from DRC and Sabin peer exchanger to this meeting, vowed to investigate the situation in his constituency and to report his findings to his fellow National Assembly Health Commissioners.

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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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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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Decentralization and Sustainable Immunization Financing in Liberia

In this post, we introduce the second post of ‘Reflections from the Field’ series written by our Senior Program Officers.  Writing from Monrovia, Liberia, Cliff Kamara discusses his work on strategies in securing sustainable immunization financing for this region.

Liberia 2009 Women Dancing during cultural portion of EPI Surveillance Training

I am wrapping up my week long visit to Liberia. The Ministry of Health and Social Welfare here is decentralizing, and this entails strengthening planning and budgeting in the country’s 15 counties, as well as allocation of funds to the County Health and Social Welfare Teams.  In addition, some counties have locally generated revenues which might be available for meeting recurrent health expenditures. In line with this, my ministry of health counterparts and I have been consulting with the external partners (WHO, UNICEF, USAID) to formulate a decentralized advocacy strategy for immunization and other key phc programs.  At this point, we are thinking it would be most cost effective to combine this advocacy orientation with other supervisory and training inputs. After all, everyone here has to become an advocate if we are to make the sustainable immunization financing goal! By preparing  the County Health and Social Welfare Teams to become advocates for health financing, we expect that relevant decision-makers at county level will respond positively, for example, by reporting more timely information on budget execution, preparing budgets based on actual expenditures, and exploring additional local sources of financing for immunization and other key PHC programs. We expect that this improved budget execution and oversight at county level will convince national decisionmakers to seriously consider increasing the national health budget in 2011. We have been able to get budgetary increases this year in neighboring Sierra Leone, so why not here, too?

Please visit our blog again next week for another story from ‘Reflections from the Field’.  If there is a particular SIF country you would like to learn more about, please let us know by leaving a comment on any of our stories.

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Drilling Down to Find the Best Routes to Sustainable Immunization Financing in DRC

In this post, we introduce our first piece from our new ‘Reflections from the Field’ series written by our Program Director, Mike McQuestion.  Writing from Lumbumbashi, DR Congo, he joins Senior Program Officer Helene Mambu-Ma-Disu to work on strategies in securing sustainable immunization financing for this region.

As we drill down to find the best routes to sustainable immunization financing, three seem particularly promising: budget reform, decentralization and democratization.

This week, here in Lubumbashi, capital of DR Congo’s Katanga Province, Helene Mambu-ma-Disu and I find ourselves following the decentralization route. Katanga is the first of the country’s eleven provinces to put decentralized health funds into immunization. When federal funds for the provincial immunization program were held up earlier this year (so that the federal government could be sure to pass the HIPC decision point test by showing it could restrain expenditures), the Katanga Provincial Governor kicked in about US$150,000 to keep the program running.

With about 400k infants born each year this is not much. But it’s been enough to tide them over until the federal funds again begin flowing next month.

The provincial EPI team realizes that nothing beats local support and is now preparing the investment case for a larger provincial EPI budget in 2011.

If all the provinces do this, several good things might happen. Decentralization will benefit because there will be provincial skin in the game.  Accountability and transparency will improve because Provincial Pilot Committees will want to know how and where their local revenues are being spent. The external partners can shift their support elsewhere, where it can support innovations rather than meet recurrent costs governments ought to be paying in any case. And the sum of eleven provincial budgets + the federal budget just might add up to the required $30/child fully immunized.

We will see.

Please visit our blog again next week for another story from ‘Reflections from the Field’.  If there is a particular SIF country you would like to learn more about, please let us know by leaving a comment on any of our stories.

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