Revisiting Kenya’s First Parliamentary Briefing on SIF

On September 8, 2010, Parliamentarians met with Senior Program Officer Diana Kizza to discuss Sustainable Immunization Financing. Attending, were: Hon Dr. Robert Monda (Chair Health Committee), MP; Hon Dr Eseli Simiyu, MP; Hon Dr. Bori Khalwale MP; Hon Dr. Nuh Nassir, MP; Hon Fred Orita, MP; Hon Joseph O. Magwanga, MP; Mr. Salad (Clerk Health Committee) Parliament of Kenya; Prof (Dr) Fred Were, Kenya Paediatric Association; and Dr David Githanga, from the Kenya Paediatric Association.

The purpose of the September 8 meeting was to meet directly with the health committee, to divert its focus to immunization efforts in the country. Secondly, the goal was to address making immunization programs a priority through a variety of approaches; mostly through sensitizing the public and advocating for increased budget allocations for the health sector and thus immunization. With new and underutilized vaccines rapidly being introduced onto the market, it is becoming increasingly difficult to achieve full coverage: the rapidly growing cost of immunizing the population is threatened by the increasingly limited rate of committed financial sources.

Like other countries facing a similar dilemma, GAVI is unable to patch funding in order to support the introduction of new (and expensive) Pneumococcal Vaccine and Rotavirus vaccine. This alerting fact points to the urgent action needed by Kenyan leaders for planning to ensure that its population will be adequately protected against preventable, immunizable diseases.

Recently, a new Kenyan constitution was put into place. This offers a favorable window of opportunity for the development of a proposed law on immunization in Kenya; one that would bind the Government of Kenya at central and local levels which would protect funds for immunization and ensure immunization schedules. At this meeting, MPs suggested on drafting a bill which would help secure such actions, to begin immediately, by borrowing from the successes of the PAHO countries of South America, and employing the parliamentary department specialized in drafting legislation.

The Comprehensive Multi Year Plan (CMYp) was brought to the attention of the MPs, as they requested data which described the total amount going towards vaccines in Kenya; this review also addressing the obvious gaps. The planning and advocacy tool has recently been updated by the Ministry of Health for the 2010 – 2015 period. The recommendation of a policy brief, designed to address and illustrate funding challenges, as well as the total costs and gaps for procurement for new and underutilized vaccines be drawb. With new information on the availability of a CMYp, the parliamentarians (MPs) proposed a meeting with members of the Ministry of Health for elucidation on the Comprehensive Multi Year Plan, as well as a proposed immunization financing plan post 2015.

It was further proposed that the committee organize a core team which would include dedicated MPs which would demonstrate their commitment to immunization financing advocacy, thereby ensuring a high level advocacy campaign. The Health Committee was updated on the proposed March SIF colloquium where 12 African and 3 Asian countries will meet in Addis Ababa to share experiences on best practices on immunization financing.

The meeting was adjourned at 1220H with closing remarks from the Chair.

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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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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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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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Second Day of Activities from the Third Parliamentary Symposium on SIF

Today marks the second day of the Third Parliamentary Symposium on Sustainable Immunization Financing (SIF) in Phnom Penh. Delegates from SIF pilot countries Sri Lanka, Nepal, and Cambodia will be discussing: Budget Preparation and Oversight; Legislating for Immunization and Health; and National Delegations’ Action Plans. All three countries will present their Action Plans and collectively discuss the adoption of a new Cambodia Declaration. To learn more about these two-day proceedings, please return to our blog next week for a field report from our Sabin SIF Program Director, Mike McQuestion.

Cambodian delegation prepares its action plan.

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Third Parliamentary Symposium on Sustainable Immunization Financing Begins Today in Phnom Penh, Cambodia.

The Third Parliamentary Symposium on Sustainable Immunization Financing (SIF) begins today in Phnom Penh, Cambodia, lasting from October 21-22, 2010. Sponsored by the Sabin Vaccine Institute and hosted by the Government and Parliament of Cambodia, government representatives from Sri Lanka, Cambodia, Nepal, as well as representatives from the WHO, UNDP, UNICEF, and World Bank will be joining Director Mike McQuestion and Senior Program Officer Devendra Gnawali today to discuss these countries’ statuses in reaching sustainable immunization financing. Government representatives from each pilot country will summarize their achievements to date in reaching this initiative. Topics to be broached, will be: best practices in budgeting and legislation; best practices in advocacy; problem areas; goals; as well as varied and practiced approaches to sustainable immunization financing.

In both February and July of 2010, SIF Sabin sponsored two briefings in Asia. In February 2010, the First Asian Sub-regional parliamentary colloquium in Kathmandu, Nepal, produced the Kathmandu Declaration, which called for bigger national immunization budgets in SIF Sabin’s three Asian focus countries: Nepal, Cambodia, and Sri Lanka. In July 2010, a similar colloquium was held in Colombo, Sri Lanka; the output of this convening of nations was the Kathmandu to Colombo and Beyond Declaration, which called upon governments to find innovative ways in which to increase routine immunization budgets, also calling upon nations EPI managers to begin monitoring with fiscal findings and follow up reporting.

Nepal's RP Biccha calls for less donor dependence during panel discussion.

Today’s Third Parliamentary Symposium on Sustainable Immunization Financing will follow up on these prior achievements and explore viable initiatives in achieving sustainable immunization financing. A series of presentations will inform the next two days planned side meetings and scheduled workshops. These activities will offer Parliamentarians, as well as members from Ministries of Health and Finance from all three countries an opportunity to discuss varied proposed strategies, all of which will be analyzed in a peer review. Anticipated outputs will be work plans and refined approaches to progress monitoring. Collectively, participants will agree on a list of follow-up action items and activities which will help each focus country move closer to sustainable immunization financing.

All three SIF Asian pilot countries recognize that immunization is an effective and powerful public health tool; governments from Cambodia, Nepal, and Sri Lanka are working to reach Millennium Development’s Goal 4, Reducing Child Mortality, by 2015. The introduction and incorporation of new vaccines have greatly added to the cost of current immunization program needs; all three countries recognize that external donors such as GAVI, WHO, and UNICEF are increasingly unable to fill the the fiscal gap needed to ensure continued execution of national immunization program schedules. These are vital to maintaining herd immunity and protecting the public’s health from life-threatening and debilitating diseases. With Declarations such as the Kathmandu Declaration and Kathmandu to Colombo and Beyond Declaration, these three countries are collectively moving forward towards reaching their respective goals in independently achieving sustainable immunization financing via internally conceived strategies and programs. Sabin SIF is proud to be a part of this collective process and effort; by providing the context, agenda and platform for these dialogs to take place, each of these three countries is making undeniable advances towards sustainable immunization financing.

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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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