presentation: routes to sustainable immunization financing
DESCRIPTION
TRANSCRIPT
![Page 1: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/1.jpg)
Routes to sustainable immunization financing
Sabin Vaccine InstituteSustainable Immunization Financing Program
9 May 2013
![Page 2: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/2.jpg)
Outline
• Current global immunization situationFinancingLegislation
• Institutional innovations
• Sabin SIF Program
![Page 3: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/3.jpg)
Macroeconomics of health
• As their economies grow, countries spend more on health
• The trend is to move from private (out-of-pocket) to an increasing share of public financing
• Developing countries are in transition, increasing their public health investments
![Page 4: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/4.jpg)
Source: WHO 2011http://apps.who.int/nha/database/ScatterPlotPage.aspx
![Page 5: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/5.jpg)
Vaccination financing• Immunization costs are increasing• The world’s 71 poorest countries depend
highly on external partners to finance their national immunization (EPI) programs
• External funding has increased in recent years but have governments kept pace?
• As of 2011, the pattern shows increasing government investments but lingering dependency
![Page 6: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/6.jpg)
Vaccination financing
![Page 7: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/7.jpg)
Vaccination financing
![Page 8: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/8.jpg)
Vaccination financing
• A recent Sabin study found that, given the political will, countries could fully finance their EPI programs by 2016 without taking funds away from other programs
• They would need to capture around 20% of new revenues coming from continued economic growth over the 2013-16 period
![Page 9: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/9.jpg)
Countries could increase funding for immunization In the medium term
![Page 10: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/10.jpg)
Vaccination legislation
• Even if political will exists, legislative guarantees of publicly provided vaccination are lacking or insufficient
• Few countries have up-to-date legislation
• Ideally, a vaccination law should contain a range of provisions, including means of EPI financing, vaccine procurement mechanisms, vaccination regulations
![Page 11: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/11.jpg)
Vaccination legislation
![Page 12: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/12.jpg)
Change scenario
• How can we move from the current dependent situation to sustainable country ownership?
• Focus on the key public institutions: MoH, MoF, parliament, subnational governments
• Induce institutional changes through two intertwined pathwayscollective action social learning
![Page 13: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/13.jpg)
Change scenario• Institutional change (innovation) means
developing new ways of working, ie new best practicesMinistry of health begins to monitor and report
program efficiency (ie, expenditures per fully immunized child), allowing a stronger immunization investment case to be made
Parliament scrutinizes the annual health and EPI budgets, follows program execution (technical and budgetary), helps mobilize constituents, approves vaccine legislation
![Page 14: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/14.jpg)
Institutional innovation
• “…organizational change is unplanned and goes on largely behind the backs of groups that wish to influence it” (DiMaggio and Powell 1983:157).
![Page 15: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/15.jpg)
Institutional innovation
• Expected results of these innovations• Larger, more efficient immunization budgets• Up-to-date legislation guaranteeing those
budgets (earmarking) and providing for other aspects of vaccination
• More domestic stakeholders actively supporting immunization
• Public comes to expect a high-performing national immunization program provided by their government (public good)
![Page 16: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/16.jpg)
Sabin SIF Program
• First six-year grant (2008-2013), funded by Bill & Melinda Gates Foundation
• Fifteen pilot countries chosen in consultation with GAVI and partners (WHO, UNICEF, World Bank), three more added in 2012 with 2nd grant (GAVI)
• Six Senior Program Officers based in Africa (4), Asia (2) backed by three Washington, DC-based Sabin staff
![Page 17: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/17.jpg)
Sabin SIF ProgramStrategies
• Change organizational environments by engaging new stakeholders in immunization programs Elected officials Private firms Community service organizations
• Periodic parliamentary briefings, peer exchanges and presentations at national and international meetings
• Support collective action through inter-country meetings, a quarterly newsletter, an SIF Program blog
![Page 18: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/18.jpg)
SIF Program inputs
Senior Program Officer
Country SIF Visits to Target Countries
National Briefing
Sub-national Briefing
International Partner Meeting
Peer exchangers w/ SIF countries 2008 2009 2010 2011 2012
Total per Country:
Sierra Leone 0 8 0 12 14 2 15 6 7 4 34
Liberia 11 1 0 0 5 1 2 5 4 5 17
Nigeria 1 0 0 0 1 0 1 0 0 1 2
Nepal 0 7 0 9 2 0 0 8 4 6 18
Cambodia 16 4 2 0 2 0 2 6 5 11 24
Sri Lanka 10 2 1 0 0 0 1 4 5 3 13
Uganda 1 5 1 13 4 1 5 6 5 7 24
Kenya 8 2 0 0 1 0 3 3 3 2 11
Ethiopia 3 1 0 0 0 0 3 0 1 0 4
DR Congo 0 5 0 18 6 0 6 8 9 6 29
R Congo (Brazza) 9 1 0 0 1 0 0 0 3 8 11
Madagascar 7 3 0 0 0 0 1 1 4 4 10
Cameroon 9 3 0 27 4 0 4 16 10 13 43
Mali 14 4 0 0 6 0 3 4 6 11 24
Senegal 10 1 1 0 3 0 4 1 1 9 15
99 47 5 79 49 4 50 68 67 90 279
Summary of Milestone Activities - From Reporting Period 2008-12
Total per Activity:
Cliffod Kamara
Devendra Gnawali
Diana Kizza
Helene Mambu
Jonas Mbwangue
![Page 19: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/19.jpg)
SIF Program Results
• Government routine EPI expenditure increases
5/10 reporting countries, 2009-107/9 reporting countries, 2010-11
• Government routine EPI budget increases4/8 reporting countries, 2010-114/5 reporting countries, 2011-12
• Immunization legislation drafting underway in 12 countries
![Page 20: Presentation: Routes to sustainable immunization financing](https://reader033.vdocuments.us/reader033/viewer/2022061300/548e38d7b4795900208b460e/html5/thumbnails/20.jpg)
Thank you for your attention!