prepared by dana silver, devendra gnawali, mike mcquestion · 2016-08-08 · after the opening...

Prepared by Dana Silver, Devendra Gnawali, Mike McQuestion

Sabin Vaccine Institute

Contents

Introduction .............................................................................................. 2

Proceedings ............................................................................................... 2

Day 1 ....................................................................................................... 3

Theme I: Domestic Financing Arrangements .......................................... 4

Small Groups: Theme I ........................................................................... 7

Theme II: Budget & Resource Tracking .................................................. 7

Day 2 ..................................................................................................... 10

Theme III: Legislative Analysis & Implementation .............................. 10

Small Groups: Theme III ...................................................................... 13

Theme IV: Domestic Advocacy ............................................................. 13

Role Play Exercise ................................................................................ 14

Day 3 ..................................................................................................... 15

Peer Review Exercise ........................................................................... 15

Results ................................................................................................. 15

Workshop Evaluation............................................................................ 15

Country Action Points and Closing Comments ...................................... 15

Annexes ................................................................................................... 20

Annex A: Participant List ........................................................................ 20

Annex B: Workshop Agenda ................................................................... 20

Annex C: Terms of Reference ................................................................. 23

Annex D: Small Group Results ................................................................ 27

Annex E: Peer Review Guide .................................................................. 29

Annex F: Country Action Points .............................................................. 32

Annex G: Workshop Evaluation .............................................................. 33

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Introduction

Since 2008, the Sabin Vaccine Institute’s Sustainable Immunization Financing (SIF)

Program has collaborated with 22 countries, six of which are in Asia: Nepal, Sri Lanka,

Cambodia, Vietnam, Mongolia, and Indonesia. Experience shows that sustainable

financing for national immunization programs can be secured through collective action by

key national institutions. SIF supports this kind of collective action in countries through a

range of advocacy activities. These activities include briefings on immunization financing

and legislation, peer exchanges between countries and support to the key public

institutions as they develop particular innovations that are leading to increased domestic

immunization financing and more efficient immunization programs.

Peers from seventeen Sabin/SIF countries scrutinized each other’s institutional

innovations in the Second Colloquium on Sustainable Immunization Financing in Dakar,

Senegal in August 2013. Using a standard guide, participants scored each project. Results

were analyzed and the countries were ranked in terms of perceived innovativeness.

Follow-up peer review workshops were held for six Asian SIF countries (Phnom Penh,

Cambodia, July 2014), six Francophone African countries (Kribi, Cameroon, December

2014), and five Anglophone African countries (Nairobi, Kenya, October 2015; Abuja,

Nigeria, April 2016) using the same methods. This workshop is the next in the series, and

precedes the Third Colloquium on Sustainable Immunization Financing, to take place in

July 2016.

The workshop gathered 26 participants (Annex A). This report: (a) conveys the workshop

objectives, (b) unpacks the workshop proceedings, (c) analyses institutionalized,

implemented, or aspirational key innovations, (d) determines the role of technical

partners within these processes, and (e) closes with next steps.

Proceedings

The workshop agenda can be found in Annex B and the Terms of Reference in Annex C.

Delegations presented their results in four domains, including: (a) domestic financing

arrangements, (b) budgeting and resource tracking, (c) legislation and legislative process,

and (d) advocacy strategies. These cycles were paired with two rounds of small group

work and one role-play exercise. The workshop ended with a formal peer review, in which

each delegate scored the other countries on the innovativeness of their work. Finally, the

peers produced a series of main action points which they have challenged each other to

implement.

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Day 1

After National Anthem and traditional oil lamp lighting, Sabin Senior Program Officer Dr.

Devendra Gnawali opened the meeting with a welcome address. He explained the

workshop’s objectives and the status of the present countries. The main objectives of this

workshop were the following:

1. Assess implementation of the country-specific action points developed at the

previous Sabin/SIF Asia Peer Exchange Workshop (Phnom Penh, July 2014)

2. Document and evaluate best practices in immunization financing, resource tracking,

and domestic advocacy

3. Identify strategies to use resource tracking to strengthen domestic advocacy efforts

4. Review and improve draft laws and regulations on immunization that exist or are

under preparation in the participating countries, and troubleshoot implementation

issues

5. Develop new set of country-specific short-term action points for achieving

sustainable immunization financing

Dr. Palitha Mahipala, Director General of Health Services at Sri Lanka’s Ministry of

Health, then gave his opening remarks. He noted that vaccine development has changed

the human landscape. There are currently ten vaccine antigens in Sri Lanka’s current

vaccine program, and 99% vaccine coverage. The nation’s government provides health

care free of charge.

Hon. Fizal Cassim, Deputy Director of Sri Lanka’s Ministry of Health, then gave his

support for the workshop, and invited all delegates to introduce themselves.

Dr. Jacob Kumaresan, WHO Country Representative to Sri Lanka, then gave his

remarks. He commented that we can reach good things, but if we don’t sustain them, we

do not remove the threat of a public health problem. He noted that many have begun to

wonder what the next steps are as GAVI withdraws its support, and countries need to

eventually take over their own financing. Vaccines by themselves cannot save children—

it’s the process of vaccination that is important, and Sri Lanka has integrated vaccination

into their primary health services. This is a unique feature, since they maintained high

coverage in spite of political turmoil. They also did not depend on foreign financing. This

shows a high level of commitment, and is the reason they can boast 99% vaccination

coverage. HPV vaccination will be introduced in Sri Lanka 2017, and since the

infrastructure is already in place, they do not need to be concerned with the return on

investment—instead, they know this will reach the population. It is easier to introduce

vaccines than to maintain vaccination rates, and Sri Lanka focuses on both.

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Dr. Paba Palihawadana, Chief Epidemiologist at the Central Epidemiological Unit, Sri

Lankan Ministry of Health, then voiced her support and offered a vote of thanks.

After the opening ceremony concluded, Ms. Dana Silver, Program Officer at the Sabin

Vaccine Institute, gave an introductory presentation. She explained that immunization

should be considered a public good, and highlighted the theories of institutional change

and collective action. The presentation also highlighted the main SIF domains and

presented indicators within each area used to measure a country’s progress toward the

SIF objective.

Theme I: Domestic Financing Arrangements

The domestic financing arrangements session was chaired by Dr. Paba Palihawadana.

Dr. Devendra Gnawali gave an introductory presentation about domestic financing

arrangements. After displaying recent vaccine and immunization program costs, he

explained that immunization costs are increasing as countries expand their immunization

schedules. The presentation also described major sources of domestic and external

immunization financing, and the domestic financing mechanisms considered key to

achieving SIF’s financing objectives. Mechanisms include laws regulation national

immunization financing, shared federal and subnational financing systems, and the

development of private immunization trust funds.

The floor was then opened to the delegates to present their current domestic

immunization financing arrangements.

Nepal

Mr. Jhalak Sharma Paudel, Senior Public Health Administrator at the Policy, Planning &

International Cooperation Division of Nepal’s Ministry of Health gave their presentation.

Mr. Paudel first presented the objectives of Nepal’s National Immunization Program:

Achieve and maintain at least 90% vaccination coverage for all antigens at national

and district level by 2016

Ensure access to vaccines of assured quality and with appropriate waste

management

Achieve and maintain polio free status

Maintain maternal and neonatal tetanus elimination status Achieve measles

elimination status by 2019

Accelerate control of vaccine-preventable diseases through introduction of new and

underused vaccines

Strengthen and expand VPD surveillance

Continue to expand immunization beyond infancy

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Financial Sustainability

He then explained the program’s key successes, including the increase in infant full

immunization coverage from 43% in 1996 to 87% in 2011. The under-5 mortality has

dropped in a clear inverse rate to the increase in vaccine coverage, which indicates that

the vaccinations are successfully targeting childhood killers.

The government is donating money to the fund through the tax system, they have also

proposed a tax exemption policy. The current per child cost in Nepal is approximately $43.

Mr. Paudel then explained that in FY 2010/2011, Nepal’s NIP was 60% financed by Gavi,

34% the Nepalese government, 5% WHO, and 1% UNICEF. Today, the Nepalese

government’s share has increased to 43%, with Gavi providing 42%, WHO 8%, and

UNICEF 7%. This shows an increase in government ownership of the immunization

program.

Nepal established a national immunization fund in July 2014, and at the time of the

presentation, had deposited 60 million Nepalese Rupees into it. The government is also

collaborating with local governments and domestic private partners, such as the local

Rotary club, which has established a sustainable immunization support fund. Nepal’s

fundraising model for the immunization fund is displayed below:

Vietnam

Ms. Nguyen Mai Khanh of Vietnam’s National Expanded Programme on Immunization

then presented on her nation’s financing situation. The EPI is separated for the four main

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regions of the country. Vietnam currently has 13 vaccines included in its immunization

schedule, with IPV added and the polio switchover done this year. Overall immunization

coverage rates hover above 90%, though there is some variation in specific vaccines and

across provinces. The EPI prides itself on its efforts in control of polio, measles, Hepatitis

B, and other antigens, and plans to introduce the Japanese Encephalitic vaccine into the

immunization schedule in 2018. Vietnam also plans to begin local vaccine production on

the rotavirus vaccine in 2017.

The EPI is funded by the central government, local governments (provinces, districts, and

communes), Gavi, UNICEF, WHO, and others. The central government contributed 335

billion Vietnamese Dong (VND) in 2015 (approximately 15,000,000 USD), a large increase

from previous years. The central government’s funding covered 50% of EPI activities, and

more than 70% of that money goes to vaccine procurement and logistics. There is a lack

of funds for other activities, including cold chain equipment procurement, research,

disease surveillance, supportive supervision. The government needs to increase its

contributions as donor funds are reduced in order to cover the expanding program needs.

There is an annual report about EPI activities, but in the past they never asked about

reporting from province to central level, which is a needed change. The government does

not currently plan to add private sector investment into its immunization fund.

Ms. Khanh then showed a breakdown of local government EPI contributions. These

increased from a total of 12,459 million VND in 2012 to 62,739 million VND in 2015, with

some provinces not reporting. She emphasized that the local governments need to

increase their EPI contributions each year in tandem with the central government to

ensure the continuation of full EPI implementation.

Mongolia

Ms. Baasandorj Dambasuren, EPI Manager of Khentii Aimag [province] Mongolia, then

presented on her nation’s financing arrangements. The Mongolian government increased

its financial support for immunization each year from 2007 through 2011. In Khentii

Aimag, routine immunization coverage is over 98%. In 2015, 4.8% of children were

vaccinated through mobile teams, since the province encompasses rural areas and herd

families. Around 2.5% of target children are considered hard-to-reach. The operational

costs for immunization went in large part to petroleum, given these mobile needs, with

staff trainings, disposable gloves, and syringes taking the next largest shares of costs.

Ms. Dambasuren then explained that like petroleum costs, syringe expenses vary by

province according to the population size and characteristics. Disinfectants are also a large

immunization cost, with safety policies focusing on the avoidance of adverse events

following immunization (AEFI). In hospitals, one or two nurses are designated to

specialize as vaccinators in order to reduce human resource costs.

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There is currently no operational budget for immunization. Instead, most support for

trainings and materials are donor supported. There is lack of funding for surveillance

system and supportive supervision for immunization units. Vaccinators were recently

trained to calculate the cost of immunization per child, and the EPI is cooperating with

local governments and NGOs to increase inter-sectoral immunization achievements.

Future goals include developing a designated budget for operational costs, establishing an

incentives system for staff, improving public knowledge about the immunization program,

and increasing public participation in the program.

Small Groups: Theme I

After the plenary session, delegates were randomly assigned to three small groups of 5-8

people. The theme for this first round of group work was domestic immunization financing

arrangements. The small group findings were reported in plenary, with one spokesperson

representing each group. The presentations were followed by a question and answer

session. Small group results are shown in Annex D.

Theme II: Budget & Resource Tracking

The session was chaired by Sri Lanka’s Hon. Sudarshani Fernandopulle, State Minister

of City Planning and Water Supply.

The budget and resource tracking theme was introduced in plenary with a presentation by

Sabin/SIF Senior Program Officer Dr. Devendra Gnawali. Many countries, stated

Gnawali, are paying more of their immunization program costs than their reported

numbers show, since they are not properly capturing and reporting expenditures. The

presentation showed that Mongolia and Sri Lanka are increasing their government

financing in preparation for Gavi withdrawing support, with Cambodia also largely

increasing its routine immunization expenditures in recent years.

Dr. Gnawali outlined the concepts of transparency and accountability, and explained the

importance of financial data collection, focusing on how a budget is implemented and

accounted for once it has been approved. He described the importance of good financial

data and indicators to monitor progress towards country ownership. He emphasized that

transparency is linked to adequate funding from government budgets, and spoke of the

importance of oversight, especially by Parliaments.

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Six World Bank Public Expenditure and Financial Accountability (PEFA) standards offer a

systematic, comprehensive approach to chart budget performance. He then discussed the

SIF budget flow analysis tool, which a little more than half of SIF countries have used to

date. It incorporates the above-mentioned PEFA indicators. A recent successful example

comes from DRC, where Ministry of Health counterparts have tracked central level

immunization budget performance for four consecutive years.

Following this presentation, the delegates presented their national budget and resource

tracking systems, highlighting associated institutional innovations.

Cambodia

Ms. Bola Kan, Deputy Office Chief of General Department of Budget at Cambodia’s

Ministry of Economy & Finance, presented on Cambodia’s budgeting and resource tracking

practices. She discussed Cambodia’s five-step budget cycle and the audits that are

included in the budget execution phase. While budget allocation for medical expenses

increased each year from 2013-2015, it decreased for 2016. This was because the

government decided to instead allocate money to pensions and funds for medical

equipment. Priorities changed and the budget focus shifted to health system maintenance

at subnational levels.

The Cambodian government currently spends less on health and vaccines than Gavi does

(1.71 million USD to 4.10 USD in 2015, respectively). Vaccines make up a very small

percentage, approximately 0.68%, of the government’s total health budget. Cambodia’s

National Immunization Programme (NIP) is supported by Unicef, WHO, Path, and Gavi in

addition to the national government.

Some issues related to resource tracking and monitoring include a lack of human

resources, a lack of economic analyses and related data, and a weak reporting system.

The data source for expenditure-tracking exercises suffer from issues with timeliness,

comprehensiveness, and accuracy. Data is reported manually through excel spreadsheet,

and many reports include only a lump sum amount.

Recommendations include timely reporting of expenditures and other performance

measures (such as wastage, number of children vaccinated) to the Ministry of Economy &

Finance, improving public financial information systems, and improving human resources

capacity. There isn’t must costing information on human resources, which makes it

difficult for budgets to be submitted for this cause.

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Nepal

Mr. Jhalak Sharma Paudel presented on Nepal’s resource tracking systems and

innovations. The budget reporting accuracy decreases with each step of the process. The

steps include proposed budget, allocated amount, disbursed amount, and spent amount.

The government doesn’t always know actual costs and program needs, and therefore,

estimated costs and actual expenditures are not necessarily consistent. The government

needs to increase its understanding of program efficiency and absorptive capacity, and

explore local resources for immunization.

Nepal started resource tracking exercises in eight districts. The data has been collected,

but the analysis not yet done. The exercise explored new sources of immunization

financing not reflected in central and district level budget allocation. Examples included

local village development committees, local philanthropists, Lions and Rotary clubs, and

others.

A new system is emerging for central and district level resource tracking. The Transaction

Accounting and Budget Control System (TABUCS) software system is functional in Nepal,

and provides data based on recorded expenditures. Trainings were done at the district

level, and the districts have subsequently increased their reporting. The system aims to

improve processing of expenditures and payments, processing of cash and bank receipts

and revenues, will create financial monitoring reports, and will handle automatic posting

of receipts and payments to ledger and summary accounts.

Sri Lanka

Dr. Paba Palihawadana then presented Sri Lanka’s costing study for its routine

immunization program. Immunization costs are rising, and Sri Lanka wanted to create a

stronger investment case in order to justify larger budgets. This required a proper account

of National Immunization Program (NIP) costs. However, the NIP costs were unknown,

with only vaccine and direct material costs available. Costing was further complicated by

the sharing of infrastructure facilities and staff between immunization and other public

health programs. While the vaccines, syringes, safety boxes and cold chain equipment are

supplied by the central government, all the other infrastructure and human resources are

provided by provincial governments. The costing team therefore wanted to ascertain

whether there were inter-district cost variations, and if so, why this was occurring.

Dr. Palihawadana led the Epidemiology Unit EPI in coordinating the study, and was further

supported by the MOH and district health offices. The first district of the study was

analyzed in September 2014, with four districts done the following year, and three later

analyzed under new MOH funding. The team eventually began using the EPIC costing

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mechanism. The cost estimates came in lower than expected at approximately $13 USD

per fully immunized child.

Day 2

Theme III: Legislative Analysis & Implementation

The session was chaired by Hon. Ranju Kumari Jha, Women, Children, Senior Citizen,

and Social Welfare Committee Chairwoman, Parliament of Nepal.

Ms. Dana Silver gave an overview presentation, describing the institutional work that

must happen to pass any law. Both government ministries and legislatures must

collaborate to draft and ultimately enact immunization-related laws. Many projects begin

but fail to reach fruition. In successful cases, governments and parliaments ultimately

came together to pass the legislation. She then displayed the legislative project statuses

of the present countries, as seen below:

She then presented the provisions of a model immunization law derived from the Latin

American experience. These provisions are described in a framework put forth in Trumbo

et al.’s Vaccination legislation in Latin America and the Caribbean (2012). Provisions fall

under three categories: Declarative, financial and operational. Ms. Silver compared

examples of provisions from both SIF and non-SIF countries, demonstrating varying levels

of detail and precision.

Phase III Phase V Phase VI Phase VII

Public Vets

Bill

Parliament

Registers Bill for

Vote

Parliament

Passes

Bill/Gov't

Adopts Decree

Immunization-

Related

Provisions

Implemented

Immunization Bill Apr13-Jun13

Immunization Sub-Decree July15-Present

Sri Lanka Immunization Bill Apr14

Nepal Immunization Bill Jul15 Jan16 Jan16

Indonesia Law on Health^

Law of Mongolia on Immunization^

Government Resolution on

Immunization Fund^

Law on Prenvetion and Control of

Infectious Diseases^Jul08-?

Immunization Decree

Immunization Legislation Processes Across SIF Program Countries (April 2016)

Country Legislative Project

Phase I Phase II Phase IV

National Counterparts

Devise Legislative Strategy

Drafting Workshops/Expert

Consultations

Government Submits Bill

to Parliament

Mar01

CambodiaJan11-Apr13

Dec14-Jan15

Feb10-Sep11 Nov11-Sep14 Jan15

VietnamNov07

Dec15-Current

Sep08

Mongolia

Apr00

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The countries were then given the floor to share their legislative advances.

Nepal

Mr. Rajeev Pohkrel, Planning & International Cooperation Division Undersecretary at

Nepal’s Ministry of Health, delivered Nepal’s presentation. The Kathmandu Declaration of

2010 started the process that led to the passage of Nepal’s Immunization Law. There

were many phases to the passage of the bill, which was passed by Parliament on January

4, 2016, and signed into law by the President on January 26, 2016.

Based on the law’s provisions, all vaccines will be free under the NIP, and the government

has the power to make vaccines compulsory in the event of epidemics or specific events.

The law also mandates a national budget line for immunization and establishes a national

immunization fund. Policy makers are planning to write tax exemption policy for

immunization, since this is not included in the law. The law also requires a defined

national immunization schedule, establishes regulations to ensure safe, efficacious vaccine

administration, establishes sanctions for failing to comply with the law’s provisions, and

legally charters a National Immunization Technical Advisory Committee.

The phases of work on the immunization bill were then laid out:

Phase I: Preparation of a conceptual framework, completed by the government in

collaboration with partner organizations

Phase II: Series of national and state-level meetings to seek feedback from various

ministries and institutions

Phase III: Bill was discussed with relevant stakeholders and the media

Phase IV: Ministry of Health registered bill in Parliament, Health Minister submitted

the bill, and parliamentary briefings took place

Phase V: Parliamentary committee reviewed the bill, and the committee chairperson

registered it for voting

Phase VI: Parliament passed the bill and the President of Nepal signed it into law

Phase VII: Ministry of Health formed task force to develop necessary regulations and

directives

Other highlights of the law include the following:

Establishment of a National Immunization Committee responsible for policy

development, managing resources, monitoring and evaluation, and multi-sectoral

coordination for expansion and development of NIP

Establishment of a National Immunization Advisory Committee to provide technical

advice for development and expansion of NIP including introduction of new vaccines

Establishment of AEFI Committee

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Cambodia

Cambodia’s Dr. Yong Vutthikol, NIP Deputy Manager, then presented. Cambodia does

not have a freestanding immunization law, but the National Immunization Programme

(NIP) oversees the immunization schedule and sets goals such as eliminating rubella and

reducing Hepatitis B prevalence to less than 1% by 2017. Cambodia’s DPT-HepB-Hib3

immunization coverage reached 98% in 2015, so they are overall pleased with the NIP’s

progress. The NIP is currently carrying out a Japanese Encephalitis vaccination campaign

supported by Gavi, with the routine vaccine costs procured through the MOH budget.

Cambodia’s MOH established a law drafting committee in February 2012, and Parliament

and Cambodian officials outlined a proposed law in 2013. The Health minister then

established a legislative working committee to drive the drafting process and create a

sub-decree on immunization.

Mongolia

Dr. Shinekhuu Amarsanaa of Mongolia’s Ministry of Health then presented. He

discussed the government’s immunization fund, which is mandated in the Mongolian Law

on Government Special Funds. The Ministers of Health and Finance are jointly ordered to

support the fund, which is then overseen by the National Center for Communicable

Diseases. The government’s contributions to the fund have been increasing each year,

with more than 90% of total funds now coming from the government rather than from

outside organizations. Several different funds and budgets are incorporated into overall

fund regulation. The total fund amount changes based on population growth, infectious

disease situations, and inflation according to Mongolia’s Law on Immunization and Law on

Government Special Funds.

Vietnam

Ms. Nguyen Mai Khanh presented Vietnam’s legislative status. The nation’s Law on the

Prevention and Control of Infectious Disease was passed in 2007. Provisions state that the

government is responsible for ensuring vaccine implementation, and children and

pregnant women are included under the EPI. In 2015, the Ministry of Health and the

Ministry of Justice collaboration to produce an Immunization Decree. It has been

submitted and will be promulgated by the government in 2016. The decree includes many

updated regulations such as sustaining an immunization fund that includes vaccines,

immunization materials, expenditures for the EPI service, and support for health workers

to respond to serious AEFIs.

Hon. Jha then offered a few comments on Nepal’s Immunization Act. The MOF, MOH, and

development partners worked together. The Government of Nepal has allocated 60 million

Nepalese rupees to its immunization fund. This will be used to support vaccines and

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delivery. Rotary created another fund to supplement the government’s fund, which will

help the country reach full domestic financing of its program and reduce dependency. As

Dr. Pohkrel mentioned, there is now a committee to give technical advice, including

introduction of new vaccines. Schools have the right to ask parents to see their children’s’

immunization cards before the child starts school. The country’s ministers have agreed on

the importance on the cause. Advocacy is important for the nation, and Nepal hopes that

Sri Lanka can use similar advocacy to follow in its example.

Small Groups: Theme III

This session was chaired by Mr. Visal Uy, Deputy Director General of the National

Assembly of Cambodia. Delegates were again randomly assigned to three small groups to

further discuss Theme III. The results of the small group work are found in Annex D.

Theme IV: Domestic Advocacy

Dr. Devendra Gnawali gave an overview presentation, discussing social contract theory.

Citizens empower the government to manage, create, and execute budgets. Each country

has its own institutional logic, and advocates must learn to formulate messages for their

particular audience.

Devendra showed a recent immunization advocacy video from Nepal, and then the

countries began their advocacy presentations.

Mongolia

Ms. Dambasuren then presented on Mongolia’s Reach Every District (RED) strategy. The

strategy aims to deliver essential health and social services to hard-to-reach populations.

This is a common issue in Mongolia, since geographic isolation and frequent migration

create limited availability of services. The MOH first carried out RED in a pilot district, and

thus learned to develop mobile teams and guidelines. The strategy also involved training,

supervision, and reporting of local teams. The RED program, funded by donor

organizations, covered areas where approximately 40% of the Mongolian population lives.

Teams had to go house-to-house at times to cover all the terrain, and found it was very

expensive to reach the last groups of the population who haven’t been vaccinated. They

now hope to scale the program up to a larger geographic area.

Vietnam

Ms. Nguyen Mai Khanh presented Vietnam’s domestic advocacy efforts. The National

Assembly and Ministries of Health, Finance, and Planning & Investment all contribute to

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government immunization agreements, but need to collaborate further. She spoke of the

need for a stakeholder meeting to discuss EPI implementation and difficulties. In 2015, a

successful advocacy activity was a meeting with Parliamentarians and relevant ministries

on the importance of the EPI to comminutes, and the difficulties it faces in amassing

government support.

Role Play Exercise

In the role play exercise, delegates were divided by country into groups. A few group

members self-selected to be decision-makers and the rest represented advocates. The

decision-makers were asked to find weaknesses and arguments against the advocates’

arguments, and the advocates therefore would need to develop new strategies. After

spending 45 minutes preparing their advocacy strategies, each country gave a 10-minute

example of its role-play.

Nepal

Nepal presented the case for an immunization fund sponsored by the government. The

knowledge needs to be shared among ministries and responsible parties. Budget

transparency is important to the requesting of funds.

Cambodia

Cambodia’s delegates focused their advocacy efforts on their current attempts at passing

an immunization sub-decree. They spoke about the impact of economic growth on

budgetary allocations.

Mongolia

Some participants represented the aimag EPI managers and others spoke about the need

for increased funding at the local levels.

Sri Lanka

Sri Lanka presented on advocating for funding for the HPV vaccination. They used the

results of the costing study to explain the need for these funds. They suggested a school-

based vaccination program.

Vietnam

Vietnam’s Parliament asks many questions about immunization program financing,

specifically to the Ministries of Health, Finance, and Planning & Investment. Parliament’s

first question is often, why does the community have to vaccinate? They also ask about

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social mobilization: the government will cover costs for poor areas, but for rich areas the

Parliament would like them to pay for themselves.

Day 3

Peer Review Exercise

Day 3 began with a peer assessment of each country’s institutional innovation case

studies. Delegates used a standard peer review guide to score each country (Annex E).

Twenty-one delegates from the five countries participated in the peer review session.

Raters used a standard guide to examine the innovative practices that governments and

parliaments are developing, or have developed, to move their countries closer to the

sustainable immunization financing goal. The guide included several open-ended and

multiple choice questions and a list of ten items scored on a Likert scale.

The peer review activity was divided into two consecutive sessions. In the first session,

reviewers interviewed their peers from Vietnam, Nepal, and Mongolia. After 45 minutes,

reviewers began additionally interviewing their peers from Cambodia and Sri Lanka. In

addition, raters jotted down comments and recommendations for the presenters. Sixty

completed forms were collected. Scores were tabulated by Sabin staff. Results are

summarized below.

Results

Twenty-one participants completed at least one review form. Of these, 8 (38%) were from

ministries of health, 3 (14%) designated themselves as both ministries of health and

other government institutions, 4 (19%) were from parliaments and 6 (29%) did not state

their institutional affiliations.

Raters classified the practices they assessed as resource tracking (13%), legislation

(7%), domestic advocacy (18%), financing (5%), or some combination of these areas

(57%). Thirty percent of the practices were occurring at national level, 15% at the

regional level, and 54% at the subnational or national and subnational levels. Raters were

asked whether the activity is already happening or aspirational, with 52 (87%) rated as

existing and 3 (5%) as aspirational. All of the innovations perceived as aspirational were

taking place in Mongolia.

Seventy-three percent of the assessments identified more than one public institution

involved in the new practice. Ministries of health were involved in every instance but two.

After that, most frequent were ministries of finance (56%) and parliaments (41%). When

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determining non-government involvement, 20% indicated CSO participation and 78%

indicated both CSO and business participation.

The practices were nearly evenly divided among originating in top-down, bottom-up, or

exogenous fashions. Eleven out of 57 (19%) of the practices began within the past 1-2

years with 36 (63%) ongoing for three years or more and 10 (18%) begin this year.

The raters determined that 10 out of 52 (19%) of the new practices were already fully

institutionalized, i.e., they were no longer innovations. Some 32 out of the 52 innovations

(62%) were still in pilot phase or in the process of becoming institutionalized. Ten cases

(19%) were still in the talking stage, and no innovations had been blocked. Responses to

this item are shown by country in Figure 1.

The ten subjective Likert-scaled items are described in Table 2. Raters assigned each item

a score of 1-5, with 1 being “No chance”, 2 “Not likely”, 3 “Unsure”, 4 “Likely” and 5

“Almost certain.”

Inter-rater reliability is a concern for data such as these. Raters likely differed in

systematic ways in how they assessed a given country’s innovation. Intra-class

correlations (ICCs) indicate how similarly (reliably) the raters rated each item for each

country. Three ICCs were statistically significant, although they were relatively low, with

values ranging from .18 to .69. The three reliably measured variables are described

below.

17


resist: In 25 out of 55 assessments (45%), raters perceived that resistance to the innovation was likely to certain. Resistance was most evident in Nepal (4/11).

approach: In 38 out of 59 assessments (64%), raters concluded that another approach would have been more suitable for solving the problem or improving the

sustainability of immunization. inst_nation: In 47 out of 59 assessments (79%), raters felt the innovation would

ultimately be institutionalized nationwide.

Based on the results, some evaluators likely misunderstood some of the concepts they

were measuring. Some many have understood the concept of institutional innovation

better than others. However, delegates commented on how much they learned from

listening to other countries’ strategies for immunization financing, and many were hopeful

that they could implement the same strategies in their own countries.

Workshop Evaluation

A standard workshop evaluation form was circulated to delegates. Fifteen completed

forms were collected, representing all five countries. Overall, delegates felt the workshop

would help them with their own work (14/15, 93%). Detailed results are tabulated in

Annex G.

Country Action Points and Closing Comments

In the last workshop session, delegates worked by country to review their past action

points and develop new ones for the coming months. The results are shown in Annex F.

Each delegation then presented its action points in plenary. To close the workshop, each

delegation nominated a spokesperson to share final words about prospects for sustainable

immunization financing.

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Annexes

Annex A: Participant List

ATTENDANCE LIST FOR ANGLOPHONE AFRICA PEER EXCHANGE WORKSHOP ON SUSTAINABLE IMMUNISATION FINANCING-NIGERIA

S/N NAME Country Position Institution E-MAIL ADDRESS

1 Hon. Ranju Kumari Jha

Nepal Women, Children, Senior Citizen, and Social Welfare Committee Chairwoman

Parliament [email protected]

2 Hon. Dhani Ram Paudel

Nepal Member of Parliament, MP Caucus Member

Parliament [email protected]

3 Mr. Kanchha Dulal

Nepal Women, Children, Senior Citizen, and Social Welfare Committee Under Secretary

[email protected]

4 Mr. Jhalak Sharma Paudel

Nepal Senior Public Health Administrator, Policy, Planning & International Cooperation Division

MOH [email protected]

5 Mr. Rajeev Pokharel

Nepal Planning & International Cooperation Division Under Secretary


6 Hon. Visal Uy Cambodia Deputy Director General

Secretariat General of National Assembly

[email protected]

7 Mr. Kosal Lek Cambodia Senior Official, Multilateral Office of International Relations

Secretariat General of National Assembly

[email protected]

8 Dr. Yong Vutthikol

Cambodia NIP Deputy Manager MOH [email protected]

9 Ms. Bola Kan Cambodia Health Economist MOEF [email protected]

10 Dr. Paba Palihawadana

Sri Lanka Epidemiology Unit Chief


mailto:[email protected]




















19


11 Dr. Athula Liyanapathirana

Sri Lanka Epidemiology Unit Officer


12 Dr. N.Y. Samaraweera

Sri Lanka Consultant Epidemiologist


13 Dr. W.M.S.K. Sri Lanka [email protected]

14 Dr. S. Pandawawak

Sri Lanka [email protected]

15 Dr. W.Z.C.A. Liyanage


16 Dr. Isuri Sudasinghe


17 Dr. T.N. Yapa Sri Lanka [email protected]

18 Dr. Shinekhuu Amarsanaa

Mongolia MOH [email protected]

19 Ms. Baasandorj Dambasuren

Mongolia Immunization Division Health Department of Hentii aimag

[email protected]

20 Ms. Otgontuya Dari

Mongolia Public Health Institute

[email protected]

21 Dr. Enkhtuya Budbazar

Mongolia NCCD [email protected]

22 Ms. Nguyen Mai Khanh

Vietnam NEPI, NIHE NIHE [email protected]

23 Hon. Ho Thi Thuy

Vietnam Member of Parliament Parliament [email protected], [email protected]

24 Ms. Do Thi Thanh Huyen

Vietnam Department of Finance and Monetary Service

Ministry of Planning and Investment

[email protected]

25 Dr. Devendra Gnawali

Nepal SIF Senior Program Officer

Sabin [email protected]

26 Ms. Dana Silver

United States

Program Officer Sabin [email protected]





































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Annex B: Workshop Agenda

Agenda for the Second Asia Peer Exchange Workshop on Sustainable Immunization Financing

Sri Lanka, 2016

Agenda 17-19 May, 2016

Day One:

Time Content Presenters Location/Notes

8:15-8:45 Arrival of participants, Registration

Plenary; Moderator: Epidemiology Unit of MoH, Sri Lanka

8:45-8:50 National Anthem and lighting of traditional oil lamp

8:50-9:00 Welcome & Workshop Objectives Sabin

9:00-9:10 Welcome Remarks

Dr. Paba Palihawadana, Epidemiology Unit Chief, Sri Lanka

9:10-9:20 Introduction of Participants Sabin and delegations

9:20-9:30 Introductory Remarks

WHO Representative to Sri Lanka; UNICEF Country Representative

9:30-9:35 Introductory Remarks Health Secretary of Sri Lanka

9:35-9:50 Address by Chief Guest Hon. Dr. Rajitha Senarathne, Minister of Health, Sri Lanka

9:50-10:00 Vote of thanks

Dr. Palitha Mahipala, Director General for Health Services, Ministry of Health

10:00-10:15 Coffee Break

Theme I: Financing Arrangements

10:15-10:30 Overview of immunization financing arrangements

Sabin Plenary; Moderator: Dr. Palitha Mahipala, Director General for Health Services, Sri Lanka

10:30-11:30 Presentations on domestic financing arrangements in Asian sub-region

Country delegates

11:30-11:45 Discussion and small group work instructions (first round)

Sabin Plenary

11:45-12:30 First Round Small Groups: Developing & evaluating domestic immunization financing arrangements

Three randomized small groups

Separate rooms

12:30-13:30 Lunch Break

13:30-14:15 Group Presentations: Financing arrangements Panel of rapporteurs Plenary

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Theme II: Budget & Resource Tracking

14:15-14:30 Immunization budgeting and expenditure tracking: best practices in SIF countries

Sabin Planery; Moderator: Dr. Paba Palihawadana, Epidemiology Unit Chief, Sri Lanka

14:30-15:15 Presentations on budget and resource tracking approaches

Country delegates

15:15-16:00 Second Round Small Groups: Developing & evaluating public immunization financing arrangements

Three small groups Separate rooms


16:15-17:00 Group Presentations: Financing arrangements Country delegates Plenary

17:00 End of Day One

17:00 Cocktail Reception

Day Two:

Time Presentations Presenters Location/Notes

Theme III: Legislative Analysis & Implementation

8:30-8:45 Summary of Day One Rapporteur Plenary; Moderator: Hon. Ranju Kumara Jha, Chairperson of Parliamentary Committee on Women, Children, Senior Citizens & Social Welfare, Nepal

8:45-9:00 Overview of aspirational & existing legislative provisions and implementation arrangements

Sabin

9:00-9:45

Presentations on legislative text and implementation

Country Delegates

9:45-10:45 Third Round Small Groups: Analyzing & implementing immunization legislation

Three randomized small groups

Separate rooms


11:00-11:45 Group Presentations: Legislation and implementation

Panel of rapporteurs Plenary

Theme IV.: Domestic Advocacy

11:45-12:00 Overview of advocacy best practices in SIF program countries

Sabin Plenary

12:00-12:45 Presentations on domestic advocacy Country delegations Plenary

12:45-13:45 Lunch Break

13:45-14:00 Role play scenario instructions Sabin Plenary

14:00-14:45 Role Play Preparation: Domestic advocacy practices

Country Delegations Separate rooms

14:45-15:45 Role Play Exercise: Domestic advocacy practices

Country Delegations: Sri Lanka Nepal Mongolia Cambodia Vietnam Indonesia

Plenary; Moderator: Sabin Vaccine Institute


16:00-16:15 Recap and discussion of Role Play Exercise Country Delegations Plenary

22


16:15-17:00 Country delegates meet to prepare peer review case study presentations

Country Delegations Plenary

17:00 End of Day Two

Day Three:

Time Presentation Presenters Location/Notes

Peer Review: Innovations in Sustainable Immunization Financing

8:30-9:00 Peer review instructions and demonstration Sabin Plenary; Moderator: Sabin Vaccine Institute

9:00-9:45 Peer review, part I: (Group A) Country delegates

9:45-10:30 Peer review, part II: (Group B) Country delegates


Way Forward

10:45-11:30 Discussion of next steps Country delegates Plenary; Moderator: Dr. Paba, Epidemiology Unit, MoH Sri Lanka

11:30-11:45 Workshop evaluations Country delegates

11:45-12:15 Closing words Sabin, country delegates

12:15-12:30 Closing remarks MoH, Sri Lanka

12:30-13:30 Lunch, End of workshop

Possible visit to Parliament of Sri Lanka after Workshop concludes

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Annex C: Terms of Reference

Terms of Reference Context Experience shows that sustainable financing for national immunization programs can be secured through the coordinated action of key national institutions. Ministries of health must show strong investment cases for their immunization programs. These cases may include demonstrating the cost-effectiveness of particular vaccines, documenting child mortality reductions due to vaccination, showing efficient program management and meeting other tests any public investment must meet. Ministries of finance must assure that funds allocated to the programs are disbursed in full and on time and that sources of public financing are adequate and dependable. Parliaments have important roles to play in promoting vaccination and public health in general. They do this by participating in selected field activities in their jurisdictions. Parliamentarians also scrutinize annual ministry of health budgets, and often craft immunization-related legislation. Since 2008, the Sabin Vaccine Institute’s Sustainable Immunization Financing (SIF) Program has been supporting this kind of institutional work in countries through a range of advocacy activities. These activities include briefings on immunization financing and legislation, peer exchanges between countries and support to the key public institutions as they develop particular innovations- new ways of doing things- that lead to increased domestic immunization financing and more efficient immunization programs. Examples of such innovations include: new ways to track and report immunization program expenditures; new laws or amendments to existing laws to guarantee public financing for immunization; use of media and social interactions to share immunization program information with new stakeholder groups; new financing mechanisms such as public-private trust funds. The Decade of Vaccines (2011-2020) envisions a world where all individuals and communities are free from vaccine-preventable diseases. To achieve this ambitious goal, the 65th World Health Assembly endorsed the “Global Vaccine Action Plan (GVAP)”. GVAP Strategic Objective 1 (all countries commit to immunization as a priority), Objective 3 (the benefits of immunization are equitably extended to all people) and Objective 5 (immunization programmes have sustainable access to predictable funding, quality supply and innovative technologies) are of particular focus in the SIF Program’s goals and activities. The SIF Program is currently engaged in six Asian countries: Cambodia, Nepal, Sri Lanka, Mongolia, Indonesia, and Vietnam. Each country has developed, or is developing, institutional innovations to achieve the sustainable immunization financing objective. The innovations may be in government institutions or parliament; they may be at national or subnational levels; they may be fully implemented, under field testing or still in the conceptual phase. Peers from seventeen Sabin/SIF countries scrutinized each other’s institutional innovations in the Second Colloquium on Sustainable Immunization Financing in Dakar, Senegal in August 2013. Using a standard guide, participants scored each project. Results were analyzed and the countries were ranked in terms of perceived innovativeness. A follow-up peer review workshop was held for the six Asian SIF countries (Phnom Penh, Cambodia, July 2014). The SIF Program is now organizing a second Asian Peer Review Workshop, to be held in Colombo, Sri Lanka on 26-28 April 2016. The workshop will again

http://www.sabin.org/updates/pressreleases/dakar-conference-countries-showcase-increased-efforts-fund-their-own

http://www.sabin.org/updates/pressreleases/dakar-conference-countries-showcase-increased-efforts-fund-their-own

http://www.sabin.org/updates/blog/following-regional-workshop-asian-countries-accelerate-progress-towards-sustainable

http://www.sabin.org/updates/blog/following-regional-workshop-asian-countries-accelerate-progress-towards-sustainable

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focus on the broad areas of immunization legislation, financing, domestic advocacy, and resource tracking, and will measure progress since the previous workshop. Countries are invited to send three delegates each, representing ministries of health, ministries of finance and parliaments. The workshop will involve three rounds of small group work, and will culminate with a formal peer review wherein each delegate scores the other countries in terms of the innovativeness of their work. Each delegation will produce a set of follow-up action points which will move their country closer to the sustainable immunization financing objective. Objectives: The main objectives of this workshop are the following:

1. Assess implementation of the country-specific action points developed at the

previous Sabin/SIF Asia Peer Exchange Workshop (Phnom Penh, July 2014)

2. Document and evaluate best practices in immunization financing, resource tracking,

and domestic advocacy

3. Identify strategies to use resource tracking to strengthen domestic advocacy efforts

4. Review and improve draft laws and regulations on immunization that exist or are

under preparation in the participating countries, and troubleshoot implementation

issues

5. Develop new set of country-specific short-term action points for achieving

sustainable immunization financing

Methodology: The workshop will cover four themes across two and a half working days. Following each brief thematic introduction, country delegates will form a panel and present their activities related to that theme. Peers will then work in randomly assigned small groups to further discuss and integrate the material. Nominal group techniques will be used. Rapporteurs from each group will report the results in a series of plenary panels. The thematic sessions will be followed by a formal peer review exercise. Sabin staff members and external partner agency counterparts will act as facilitators. In preparation for the workshop, each country delegation will be given a guide to preparing their presentations, as well as supplementary reference materials. Each country delegation is expected to present at least one innovative practice in the areas of financing, budget/resource tracking, domestic advocacy or legislation. Expected Results:

Best resource tracking, domestic advocacy, financing, and legislative practices are

documented and shared

Countries develop ways to make their current efforts more effective, and later

implement these new methods

Each country peer network prepares and presents at least one innovative practice

in the areas of financing, budget/resource tracking, domestic advocacy or

legislation

Peer review generates innovativeness scores for each country

Progress against GVAP Strategic Objectives 1, 3 and 5 is documented

Updated country action points are produced

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Annex D: Small Group Results

Round I: Financing Arrangements Group 1: Dr. N.Y. Samaraweera of Sri Lanka presented the group’s finding. Most important solutions include long term funding means—high level policy, secure funding from domestic private partners. Apart from high level advocacy and stakeholder buy-in, the countries need public awareness campaigns to make processes easier. Social health insurance or amending existing public health laws could help secure more funds. Local government budgets are also important. New fiscal space, including sin taxes, such as on tobacco or alcohol, taxes on telecommunications companies, hotels, petrol, or other means, could help improve financing. The group also discussed investment in local vaccine production, and special campaigns for fundraising, such as at religious events. Group 2: Ms. Mai Khanh represented her group in discussing five problems. The main ones were inadequate funding from central and local levels, and lack of data from local government about EPI. Solutions include sensitizing decision makers, public-private partnerships. Collect enough data that can convince everyone of importance of immunization and ask them to support it. Finally, a law is required to fully secure immunization tracking. Cold chain equipment issues: need technical staff to be adequately funded. Group 3: Ms. Bola Kan presented about the group’s major findings. Chiefly, there are many issues with allocating financial resources into needed areas. There is a need for immunization budget lines and more private sector/stakeholder buy-in and support. There is a large need for costing studies so that program costs and cost per FIC can be more accurately understood. This would therefore help advocacy efforts. Round II: Legislative Analysis & Implementation Group 1: Mr. Dulal presented on legislation and implementation. Solutions included provisions of orientation by evidence based advocacy, a series of evidence-based advocacy meetings with policy makers and high level government officials, increased inter-sectoral coordination, and high-level briefings at on the economics of immunization. Group 2: Mr. Rajeev Pokhrel presented the group’s findings. The group broke out problems and solutions by country. Sri Lanka has an immunization policy but no law, wants to focus on highlighting mandatory immunization for children, briefings to discuss legal drafts. Mongolia addressed the need for more advocacy, discussions with Parliamentarians, and new regulations that would ensure a separate immunization budget. Vietnam wants a freestanding immunization law and wants to highlight the local government role in immunization. Vietnam could do this by creating a law committee to work with the MOH, and advocating to policy makers. Cambodia needs stakeholder advocacy in order to advance its immunization sub-decree, and needs to ensure full government commitment.

26


Nepal’s Parliament needs to discuss regulations to ensure full dissemination and implementation of the new law’s provisions, Group 3: Ms. Mai Khanh presented the group’s findings. She discussed legislative problems including a focus on policy rather than technical issues, old and out-of-date immunization laws, and a lack of government commitment to immunization, as well as implementation difficulties. Solutions included the use of research data to convince decision makers to support and advocacy for immunization, as well as building new immunization laws, establishing drafting committees for new and updated laws, and outreach to local community leaders.

27


Annex E: Peer Review Guide

Sustainable Immunization Financing Peer Review Guide

Colombo, Sri Lanka | May 2016 Description Since 2009, the Sabin Sustainable Immunization Financing (SIF) Program has been working with African and Asian countries to develop and refine institutional innovations-new ways of working, new practices- that contribute to financially sustainable immunization programs. In today’s peer review session, delegates will present their practices (case studies) in three broad areas:

Financing arrangements

Legislative Provisions & Implementation

Budgeting, resource tracking and domestic advocacy This checklist was prepared to help you perform this peer review. The focus is on state institutions, i.e., government agencies and elected bodies, whose responsibilities include the financing, budget execution, legislation and oversight of public immunization services. The institutions may operate at national level, sub-national level or both. We wish to understand how the innovative activity or strategy began. Was it proposed by an individual in a particular institution? Was it proposed by a group of champions, perhaps representing two or more institutions? . A successful innovation is one that has passed from being new to having been institutionalized- it has become routine. Perhaps the innovation you evaluate is still developing. Many, perhaps most, innovations ultimately fail. The ideas behind it may not have been well adapted to the local context or not thought through well enough. There could have been resistance to it. Perhaps key people changed positions and support for the innovation was lost. Other background factors might have changed such that the innovation lost relevance. It is important to assess these innovations and whether or not they succeeded. Methods The peer review will take place in two consecutive 30-minute sessions. In the first session, reviewers will assess the countries in “Group A”. In the second session “Group B” countries will be assessed. Group A includes: Vietnam, Mongolia, Nepal Group B includes: Cambodia, Sri Lanka Each peer reviewer is asked to prepare up to four assessments- one per country excepting his or her own. The goal is to generate as many individual assessments per country as possible. All assessments will be anonymous. Information for the peer assessments will be obtained through discussion with the country delegates. Each reviewer should interview two or three delegates from each country being reviewed. Conversations must be kept short. Ten minutes have been allotted for each assessment.

28


SABIN SUSTAINABLE IMMUNIZATION FINANCING PEER REVIEW GUIDE ************************************************************************************ Reviewer’s country: _______________________________________________ Reviewer’s home institution (check one):

___Min health ___Min finance ___parliament ___other (specify: ___________________) ___Partner agency counterpart

Country studied: ___________________________________________ ********************************************************************************* Classify the innovative activity or strategy by functional area (check one or more):

____ financing ___ budget, resource tracking ___ legislation ___advocacy activity ___other (specify: ________________________________________________________)

Is the activity/strategy already happening or still aspirational (check one) ___existing ___aspirational ___unclear (specify why: ________________________________) Describe the innovative activity/strategy. What problem or opportunity does it address? Do you think a different practice or approach would have better addressed the issue at hand? If so, please describe it. When- how long ago- did the innovation begin (check one)? ___three or more years ago ___past 1-2 years ___this year How did the innovation begin (check one)? ___ Top -> down ___ Bottom -> up ___ Outside third party introduced it On which level of governance did the innovation originate (check one)?

_____ regional or sub-regional multiple countries) ___ national ___sub-national ___ both levels together

Which institutions are or were involved in developing the innovation (check one or more)? Government

___ ministry of health ___ ministry of finance ___ elected body

29


___ other government ministry or agency (identify: ___________________________________) Non-government

___ community service organization (identify: ____________________________________) ___ domestic business sector (identify: ______________________________________) ___ other (identify: ______________________________________)

At this point, how advanced is the innovation (check one)?

___ aspirational: people are just talking about it ___ the new practice(s) is (are) now being tried

___the new practice(s) is (are) becoming institutionalized ___the new practice(s) is (are) fully institutionalized

___ the innovation is being blocked

What feedback and recommendations do you wish to convey to these delegates about this particular innovation? (continue writing on back of page if needed) On a scale of one to five, with 1 being no chance and 5 being almost certain, please answer the following questions. Circle one response per item.

Item

1 2 3 4 5 No chance Not likely Unsure Likely Almost certain

The innovation is well conceptualized. The proposed solution matches the problem or opportunity it addresses.

1 2 3 4 5

Another approach would have been more suitable for solving the problem/improving the sustainability of the immunization program.

1 2 3 4 5

The right mix of institutions is or was involved in developing the innovation.

1 2 3 4 5

There is or was a lot of resistance to this innovation.

1 2 3 4 5

This innovation is or was carried out without incurring significant new costs.

1 2 3 4 5

The innovation will help the country reach sustainable immunization financing sooner.

1 2 3 4 5

The innovation will ultimately be institutionalized nationwide.

1 2 3 4 5

If successful, the innovation will increase country ownership of the immunization program.

1 2 3 4 5

Considering all the factors, how likely is the innovation to succeed, to become institutionalized?

1 2 3 4 5

This innovation would likely succeed in your own country.

1 2 3 4 5

List below and briefly describe any other innovations you observed in this country.

30


Annex F: Country Action Points

Cambodia

Coverage for immunization is around 95% but maintaining sustainable

immunization requires more follow up

Work on sub-decree and present it to Minister of Health, who will submit it to

legislative council

Resource tracking: need standardized reporting, information system to track budget

monitoring, develop evaluation to assess program objectives

For sustainable immunization financing, need to advocate and submit law

Mongolia Would like to do local level costing study to better plan for future of financing

Learned about advocacy techniques and hopes to replicate these, wants to

influence decision makers, MPs, local authorities such as local EPI managers

Nepal Within next two weeks will develop draft immunization regulations

Organize advocacy meeting with Parliamentary and committee members regarding

immunization budget

Organize Colloquium workshop in Kathmandu with House and Parliament members

with participation from other Asian SIF countries

Sri Lanka Costing study needs to be finalized, analyzed and presented, and then publish the

information

Policy needs to become legal document: expert legal draftsmen will be consulted

and they will write up the law

Strategic plan on immunization needs to be printed and distributed

Awareness: district level politicians

Vietnam Has learned to gather advocacy support from private sector, has learned

importance of costing studies and would like to use these lessons to create more

sustainable financing solutions.

Has drafted an immunization decree, separate from the law, and intends to

promulgate by this year and publish/disseminate to all provinces

Advocacy for immunization: invite all ministries to work together with MPs for EPI

annual meeting

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Annex G: Workshop Evaluation

Main objectives that motivate participation in SIF workshop: Countries wanted to commit to immunization law, budget tracking, financing, and

advocacy

Situational analysis of the budgeting regarding immunization

See what other countries experiences have been and where they stand compared to

other countries

How the workshop contributed to their efforts in reaching sustainable immunization financing:

Learned about what has been successful in other countries and applying it to their

own

Now feel confident in engaging parliament to understand the importance of

immunization financing

Observed the effectiveness of costing studies for immunization financing

evaluations

Activities or work that they have planned to move sustainable immunization financing in their countries:

Organize a meeting and collaborate with high level officials on immunization

financing

Develop laws on immunization financing

Begin or expand costing studies

Do they have plans on briefing colleagues from their institution on material and discussion that took place at workshop? What messages in particular do they plan on disseminating?

Most plan on briefing colleagues about the importance of sustainable immunization

financing

Plan on advocating a costing study to high level and local government officials so

that they can then advocate for evidence based policy

Summary of the main messages and discussions that took place at workshop: Immunization is an important and cost effective program to protect and improve

the community’s health

All of the countries share common challenges to achieving sustainable immunization

financing. Identifying the problems can lead to solutions such as strong

immunization legislation, sustainable financing, and advocacy.

Recommendations for future workshops

Workshops should be well organized, particularly technical arrangements (laptop,

microphone, etc.)

Plan time for sight seeing

One person wants the same workshop in Mongolia

32


Less presentations, more working groups and shared experiences

Workshop was rushed, should be more relaxed

Add more theoretical short presentations to the workshop

Have more countries participate, including countries that have been successful in

achieving resource tracking and domestic advocacy

Thank you remarks “My colleagues and myself especially appreciate the major effort that Sabin

institute and our hosts have made in organizing this Asian workshop on sustainable

immunization, and giving us the opportunity to share our experiences on

immunization”

Two people said: “Thank you very much from our side providing this opportunity to

participate in this peer review work shop. Please provide a nice bag for participants-

written SABIN for Advocacy”

prepared by dana silver, devendra gnawali, mike mcquestion · 2016-08-08 · after the opening...

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