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.