overview of the cmyp process gavi irc training, geneva, 5 october 2012 ahmadu yakubu claudio politi

Overview of the cMYP ProcessOverview of the cMYP Process

GAVI IRC Training, Geneva, 5 October 2012Ahmadu Yakubu

Claudio Politi

Overview of cMYP process | 24 July 20122

Planning cyclePlanning cycle

Set goals and standards

Make policies and decisions

Plan and budgetImplement

Review and assess


Three types of EPI planningThree types of EPI planning

Multiyear strategic planning

Annual planning

Project planning

cMYPs

aPOAVacc forecastDistrib.system

Vacc. IntroductionSIAsCoverage Improvement Plans


cMYP – backgroundcMYP – background

Multi-year plans, strategic plans have been in existence for a long time, before cMYP, before GAVI, but frequently…

– …not comprehensive (separate plans for separate components of EPI)– … not strategic (more reactive to govt or donor direction)– … uncosted

cMYP was designed to change all this, replacing the GAVI Financial Sustainability Plan (FSP)

Common criticism of MYPs in the past:– Rapidly becomes irrelevant to the programme– Becomes a shelf document without consequence– Out of step with internal MoH or governmental planning– “Wish list” without financial or political backing– Inflexible, unable to address new situations, especially in later years– Perception that the primary incentive to develop a cMYP is to apply or extend support

from GAVI


What is a comprehensive Multi-Year Plan (cMYP)?

What is a comprehensive Multi-Year Plan (cMYP)?

A long term strategic and operational plan (3 - 5 years)

Comprehensive, consolidated, costed plan (including funding analysis and gap analysis), ideally aligned to the health sector planning cycle

Should be guided by GVAP in translating global and/or regional goals into national programme priorities, includes activities to solve identified problems and to reach national and global goals

Aims to improve the programme performance

Based on situational analysis (review or desk) and recent reviews and assessments

Comprehensive and integrating:– Addresses all components of the immunization system: management, logistics, social mobilization,…– Focus on immunization system, rather than on disease specific initiatives (e.g. Polio, MNT).– Integrates activities: solve shared problems, avoid duplication.– Links closely to the National Health Plan in terms of priorities, budgets and timing

Considers contextual issues and different scenarios

Articulates how annual Plans of Action (aPoA) would be monitored


Multi-year Planfor EPI

MTEF

Global EPIPriorities

FSP

National HealthSector Plan

SituationalAnalysis/

EPI ReviewDonor

projects/ requirement

Other

Proposalsto donor / funders

AnnualPlans of Action

Budgets

ICCDocuments

&Activities


When should a MYP be developed?When should a MYP be developed?

Country decision, but ideally in synchronization with the national health sector planning cycle

Ideally 1 year before the expiry of the current plan, or earlier if current plan is out of date.

Will require annual review and updating

In initiating the development or revision of a cMYP, take a team approach:

– call a meeting with all sections of the immunization system, – Provide and use as much recent data as possible – Joint analysis and identification of problems and solutions. – Obtain consensus about objectives, strategies, directions.


Conducting situation analysis

Steps for creating a cMYPSteps for creating a cMYP

Setting national objectives and priorities

Planning strategies and key activities by system

components

Analyzing the costs, financing, and financial gaps

Putting the cMYP into action: approval, dissemination,

implementation, monitoring

Using GVAP framework as a guide and checklist

Making an activity timeline

1. Establish national database of district indicators 2. Microplanning workshops 3. Supervisory follow up priority districts 4. Monitor use of VitA for infants with routine measles dose 5. Pilot distribution of bednets with measles vacc. and routine TT 6. Joint planning with malaria dept. 7. Training needs assessment


Steps for creating an Annual Plan of Action (aPOA)Steps for creating an Annual Plan of Action (aPOA)

Developing annual plan for relevant year from MYP

Integrating and consolidating activities for implementation

Prioritizing activities using district data analysis

Costing and completing the annual plan


Development of an aPOADevelopment of an aPOA

Ideally to be undertaken in Oct/Nov for the coming year, and should have elaboration of all the activities planned for the year

cMYP should have been updated if required

Key components– Description of all the planned activities for identified strategies in cMYP– Consolidation of the activities– Prioritization of activities– Dates and time frames for implementation – considering other planned

activities– Resources required and source of financing– Responsible person/entity– Monitoring mechanism (including indicators)


Benefits of aPOA Benefits of aPOA Clear deliverables at all levels

Understandable and realistic targets

Opportunity to amend if required

Building team work and cooperation

Facilitating monitoring

Sense of accomplishment for staff based on step by step implementation approach.

Systematic process towards achieving the objectives of the Immunization programme.


Benefits of aPOA Benefits of aPOA

aPOA - from development to evaluation– Developed with consensus– Approved by competent authority– Copy provided to all concerned– Consulted frequently– Monitoring implementation– Evaluation– Provide basis for next POA.


Key reasons for unmet targetsKey reasons for unmet targetsOverly-ambitious planning (time constraint!)

Unrealistic workload on existing staff

Delay in initiating the process

Weak regular monitoring

Lack of funds– Weak advocacy (for Govt. / Partners funds)– Financial constraints of Govt. /partners.

Geographic areas that become inaccessible to the programme due to security issues


Costing & financing analysis in cMYPsCosting & financing analysis in cMYPs

Quite complex step requiring detailed cost information, understanding of the economic and health system financing context in order to:

– Costing the cMYP objectives– Projecting sources of financing and gap analysis– Developing alternative costing and financing scenarios– Quantifying GAVI co-financing requirements

Detailed cMYP Costing – Vaccines & Injection Supplies (Routine and campaigns)– Personnel Costs– Vehicles & Transport Costs– Cold Chain Equipment, Maintenance & Overheads – Operational Cost of Campaigns– Program Activities and Other Recurrent Costs– Other Equipment Needs and Capital Costs– Building & Building Overheads


The toolThe tool

Excel File

3 worksheets for data entry

4 worksheets for results (tables and graphs)

1 big worksheet for calculations (approx 6,000 rows)

Password protected

3.4 MB file


A balanced toolA balanced tool

Standardization:– It requires to enter standardized information, for example:

• According to standard cost categories• Gross monthly salary per each category of staff• Sources of financing as 1) secured or 2) probable

Flexibility:– It allows to introduce country specific features, for example:

• Administrative structures• Typology of staff • Different programme activities


Financing and gap analysis in cMYPs


LimitationsLimitations

It is a sensitive tool:– Data cannot be copied & pasted– A "," instead of "." can results in #VALUE

Data entry process is data intensive - in countries that often lack of reliable data - and relatively time consuming.

Frequently data entry and data analysis need assistance by consultants, RO focal points and EPI/HQ "Hotline"

Methods for calculating shared costs are quite subjective (based on % of staff time, % car sharing, % building space)

High risks of poor quality data entry and mistakes


cMYP integration in National Health PlanscMYP integration in

National Health PlansRecent analysis in GAVI eligible countries to document the extent of cMYP integration in NHP, based on the following criteria:i) cMYP and NHP planning cycles cover the same time period;

ii) cMYP situation analysis provides same information with regards to vaccine-preventable disease as the NHP situation analysis;

iii) Key immunization goals and objectives are included in the NHP;

iv) Key immunization specific milestones are reflected in the NHP;

v) cMYP immunization M&E activities/indicators are incorporated into national M&E process/indicators.


cMYP integration in National Health PlanscMYP integration in

National Health PlansPreliminary findings on 43 countries analysed:

18 countries (42%) have cMYP fully integrated in NHP

23 countries (53%) have cMYP partially integrated in NHP

2 countries (5%) Not integrated / NA


Vaccine Requirements reflected in National Budgets

Vaccine Requirements reflected in National Budgets

Preliminary findings from 49 countries analysed:

24 countries (49%) have vaccine requirements -estimated in cMYP- reflected in National Budgets

25 countries (51%) have vaccine requirements –estimated in cMYP- reflected in National Budgets


Thank you

overview of the cmyp process gavi irc training, geneva, 5 october 2012 ahmadu yakubu claudio politi

Documents

gavi overview of cmyp

national health plan

current plan

costed plan

operational plan

cmyp processgavi irc

strategic plans

national objectives