financing Sabin Vaccine Institute Sustainable Immunization - - PowerPoint PPT Presentation

Routes to sustainable immunization financing

Sabin Vaccine Institute Sustainable Immunization Financing Program 9 May 2013

Outline

• Current global immunization situation
• Financing
• Legislation
• Institutional innovations
• Sabin SIF Program

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

Source: WHO 2011 http://apps.who.int/nha/database/ScatterPlotPage.aspx

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

Vaccination financing

Vaccination financing

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%
• f new revenues coming from continued

economic growth over the 2013-16 period

Countries could increase funding for immunization In the medium term

40 US$ 20 US$ 43 US$ 34 US$ 26 US$ 18 US$ 23 US$ 5 10 15 20 25 30 35 40 45 50 2011 Reference Year 2012 2013 2014 2015 2016

Government Expenditure on Routine Immunization (US$) per Surviving Infant Projected Years Alternative Investment Functions Based on the Regression of 2011 Government Expenditure for Routine Immunization per Surviving Infant on Gross National Income, 37 Phase II GAVI-eligible countries

Required Expenditure per Infant Assumes elasticity = 30% Assumes elasticity = 20%

*Based on a 2011 elasticity of 5.9% and an annual 5% increase in Gross National Income US$ (GNI) per Capita (Atlas Method)

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

Vaccination legislation

Change scenario

• How can we move from the current

dependent situation to sustainable country

• wnership?
• Focus on the key public institutions: MoH,

MoF, parliament, subnational governments

• Induce institutional changes through two

intertwined pathways

• collective action
• social learning

Change scenario

• Institutional change (innovation) means

developing new ways of working, ie new best practices

• Ministry 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

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).

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)

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

Sabin SIF Program

Strategies

• 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

SIF Program inputs

Senior Program Officer Country

2008 2009 2010 2011 2012

Total per Country: Sierra Leone 8 12 14 2 15 6 7 4

34

Liberia 11 1 5 1 2 5 4 5

17

Nigeria 1 1 1 1

2

Nepal 7 9 2 8 4 6

18

Cambodia 16 4 2 2 2 6 5 11

24

Sri Lanka 10 2 1 1 4 5 3

13

Uganda 1 5 1 13 4 1 5 6 5 7

24

Kenya 8 2 1 3 3 3 2

11

Ethiopia 3 1 3 1

4

DR Congo 5 18 6 6 8 9 6

29

R Congo (Brazza) 9 1 1 3 8

11

Madagascar 7 3 1 1 4 4

10

Cameroon 9 3 27 4 4 16 10 13

43

Mali 14 4 6 3 4 6 11

24

Senegal 10 1 1 3 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

SIF Program Results

• Government routine EPI expenditure

increases

• 5/10 reporting countries, 2009-10
• 7/9 reporting countries, 2010-11
• Government routine EPI budget increases
• 4/8 reporting countries, 2010-11
• 4/5 reporting countries, 2011-12
• Immunization legislation drafting underway

in 12 countries

Thank you for your attention!