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Sierra Leone Adopts “Reach Every District” Strategy to Increase Immunization Coverage

Sierra Leone moved closer to achievement of both the Global Immunization Vision and Strategy and Millennium Development Goals related to poverty-reduction and improved health outcomes when the nation adopted the “Reach Every Child (RED)” approach to healthcare last fall.

In 2002, the World Health Organization (WHO) developed RED in response to stagnating immunization coverage throughout the African continent. The RED approach focuses on improving immunization coverage by concentrating attention on district level healthcare facilities, and stressing the importance of collecting data and monitoring progress.
Sabin Senior Program Officer Dr. Clifford Kamara facilitated a lecture on ToT for 22 health personnel during a RED training workshop sponsored by Sabin, WHO, and UNICEF. The workshop provided attendees with insights on how to utilize effective planning and monitoring and evaluation techniques for immunization and maternal and child health interventions. The 22 health personnel, who represented each of Sierra Leone’s 13 districts, will in-turn train other health workers and ensure that the RED approach is widely implemented.

Participants in the RED training developed five key recommendations at the conclusion of the meeting, including a focus on training health workers whose primary focus is maternal and child health, mobilizing resources to ensure that the RED approach is effectively implemented, and empowering “district health sisters” to be responsible for training health workers and monitoring the implementation of RED.

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Progress in the review of Uganda’s health legislation

One of the achievements of the discussions with medicines taskforce of the Ministry of Health and Civil Society Organizations, which are strongly involved in advocacy for Medicines, is a current effort by SIF to perform a legal audit and analysis of the current legal framework on immunization. This effort, which was initiated in September 2010, will provide a legal opinion on the existing options for adopting a legislation of regulation pertaining to immunization in Uganda. The product of the assignment should be able to guide an advocacy plan to use the public health legal regime and human rights based approach to influence funding for immunization and national action on the current challenges of the immunization programs in Uganda.

So far, a national survey at different levels of the implementation process of immunization, beginning at the national level, distribution, district, and ending at the local government level, was conducted. Findings of the survey have been presented at the National Health Review Meeting in November and new strategies for the next phase of the planning cycle HSSP III (2011 – 2014) have been discussed and formulated.

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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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“Reaching Every Child in the African Region with Immunization” – ARCI/ARICC meeting in Ouagadougou, December 6-9, 2010

On December 6-9, 2010, the WHO will host ARCI/ARICC meetings in Ouagadougou, Burkina Faso. The Sustainable Immunization Financing (SIF) Program at Sabin will host and oversee a Parallel 3 Session dedicated to Immunization Financing. Representatives from five of SIF Sabin’s pilot countries will be presenting and reporting on a variety of aspects relating to sustainable immunization financing.

Results that have been achieved to date in Africa to improve routine immunization coverage, eradicate polio as well as reduce measles morbidity and mortality, are impressive. A lot of goals remain to be achieved; among them, is the increase in national resources, the introduction of new evidence-based vaccines, as well as the creation and improvement of national legislation for national immunization efforts. With these goals in mind, the parallel 3 Session will address such issues as the dissemination of performance-based budgeting practices and the establishment of emergent National Immunization Trust Funds. These presentations will inform the attendees on the various facets of these initiatives, promoting collective dialog on how to address the challenges unique to developing nations, and helping countries reach sustainable immunization financing for vital-to-public-health immunization programs.

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