Nige­ria scram­bles to fund im­mu­ni­sa­tion, im­prove coverage in 10 years

Weekly Trust - - News - Judd-Leonard Okafor Dwin­dling fund­ing Pool­ing re­sources “Enough is enough”

Nige­ria has de­vel­oped a 10-year strat­egy to im­prove rou­tine im­mu­ni­sa­tion as sup­port from the Global Al­liance for Vac­cine and Im­mu­ni­sa­tion (GAVI) winds down. The goal of Nige­ria’s Strat­egy for Im­mu­niza­tion and PHC Sys­tem Strength­en­ing (NSIPSS) is to en­sure at least 84 in 100 chil­dren get rou­tine im­mu­ni­sa­tion across the coun­try by 2028.

Only 33 in 100 chil­dren get im­mu­nized around the coun­try, ac­cord­ing to a sur­vey re­leased in 2016. And up to 4.3 mil­lion chil­dren have never been im­mu­nized in the last two years - the largest co­hort of unim­mu­nized chil­dren any­where in the world, ac­cord­ing the Na­tional Pri­mary Health Care De­vel­op­ment Agency (NPHCDA).

“We were out­raged by the low coverage fig­ures re­leased in 2016,” said NPHCDA ex­ec­u­tive di­rec­tor Faisal Shuaib.

GAVI has his­tor­i­cally helped fund rou­tine im­mu­ni­sa­tion. The 2014 re­bas­ing of Nige­ria’s econ­omy changed the coun­try’s eco­nomic sta­tus from a de­vel­op­ing coun­try, mak­ing it in­el­i­gi­ble to con­tinue re­ceiv­ing GAVI sup­port.

On­go­ing GAVI sup­port lasts un­til 2021, when Nige­ria is ex­pected to bear to­tal cost of fund­ing im­mu­ni­sa­tion. Con­ver­sa­tions and meet­ings have been on about mak­ing Nige­ria’s grad­u­a­tion out of GAVI sup­port “flex­i­ble,” said Shuaib.

Doc­u­men­ta­tion on the NSIPSS has been sub­mit­ted to GAVI. “If GAVI board ap­proves, the pe­riod of grad­u­a­tion could ex­tend by seven years. It pro­vides us more time to plan for grad­u­a­tion from GAVI,” said Shuaib.

GAVI chief ex­ec­u­tive Seth Berke­ley vis­ited Nige­ria early March, in­sist­ing the coun­try needed to show “com­mit­ment” and “im­prove­ment” in ef­forts to close gaps in im­mu­ni­sa­tion coverage and fund­ing.

“The de­ci­sion that will be made on whether GAVI can con­tinue to pro­vide sup­port af­ter 2021 will be based upon the com­mit­ment that’s be­ing shown by the gov­ern­ment and the im­prove­ment that it’s done,” Berkley told in March.

“Many stake­hold­ers have in­vested huge amounts of money - so far $732m, and I think peo­ple want to see that re­sults are oc­cur­ring from that. That will de­cide on whether fur­ther sup­port is pro­vided.”

The over­all cost of NSIPSS is put at $2.72bn (around N979.2bn) over the 10 years in ques­tion.

Vac­cines for rou­tine im­mu­ni­sa­tion and spe­cial mop-up cam­paigns are es­ti­mated to cost $1.95bn. GAVI sup­port will pro­vide $773.2m within the pe­riod.

The cost of vac­cine pro­cure­ment is es­ti­mated at $295m a year when Nige­ria fi­nally ex­its GAVI sup­port, ac­cord­ing to the plan.

This year’s im­mu­ni­sa­tion cost is put at $186m (around N66.9bn) - split evenly be­tween Nige­ria and GAVI.

Nige­ria’s con­tri­bu­tion to the pool is ex­pected to rise steadily over the next 10 years un­til 2029 when it will solely fund its im­mu­ni­sa­tion re­quire­ments.

The only guar­an­teed source of fund­ing to fi­nance NSIPSS is the im­mu­ni­sa­tion bud­get of both the fed­eral health min­istry and NPHCDA, but they are in­ad­e­quate.

To­tal health al­lo­ca­tion pro­posed for health in 2018 is N340.4bn. All vac­cines -for rou­tine im­mun­si­a­tion, sub­na­tional im­mu­ni­sa­tion, emer­gency, out­breaks and hajj - get around N12.3b in fund­ing al­lo­ca­tion from NPHCDA 2018 bud­get as pro­posed.

Cur­rent al­lo­ca­tion is only a third of what is re­quired, said Chi­zoba Wonodi, coun­try di­rec­tor for In­ter­na­tional Vac­cine Ac­cess Cen­tre (IVAC).

She pre­sented an in­vest­ment case for im­mu­ni­sa­tion seek­ing sup­port from civil so­ci­ety groups and pri­vate sec­tor to in­crease fund­ing for im­mu­ni­sa­tion at a break­fast meet­ing in Abuja.

Wonodi calls the NSIPSS a “tes­ta­ment to one plan” reached by var­i­ous stake­hold­ers to have a uni­fied voice in seek­ing more fi­nanc­ing for im­mu­ni­sa­tion.

“We are not ask­ing for a big­ger piece of the same pie. We are bak­ing a big­ger pie by in­creas­ing gov­ern­ment rev­enue,” she said.

Be­yond the bud­get, po­ten­tial fund­ing sources in­clude the Ba­sic Health Care Pro­vi­sion Fund, equiv­a­lent to a min­i­mum 1% of con­sol­i­dated rev­enue, but that is yet to be im­ple­mented.

Talks are also on about mak­ing im­mu­ni­sa­tion a “first-line charge” item in the bud­get-es­sen­tially free­ing it from any de­bate or de­layed re­lease of fund­ing.

Loans, con­tri­bu­tions from states, taxes and some in­no­va­tive fi­nanc­ing are also po­ten­tial sources, along­side match­ing grants. Some N2.4b is pro­posed as coun­ter­part fund­ing to match grants from UNFPA, USAID, UNICEF and BMGF.

“We need a voice to en­gage the pri­vate sec­tor,” said Sa­muel Us­man, of the CORE Group Part­ners Project.

“We are try­ing to move away from a sit­u­a­tion where we go cap-in-hand to donors to pay for vac­cines that our chil­dren need,” said Shuaib.

The NSIPSS con­sid­ers hin­drances be­yond just fi­nance. “For the first time, we are say­ing, enough is enough,” said Shuaib. “We have to fix all the prob­lems that pre­vent our kids from get­ting the vac­cines they re­quire.”

An im­ple­men­ta­tion planned around Africa Vac­ci­na­tion Week starts next week -the first of sev­eral phases tar­geted at the 18 states with the low­est im­mu­ni­sa­tion coverage.

Called Op­ti­mised and In­te­grated Rou­tine Im­mu­ni­sa­tion ses­sions (OIRIS) it will bun­dle im­mu­ni­sa­tion along­side ser­vices as vi­ta­min A sup­ple­men­ta­tion, fam­ily plan­ning, malaria and di­ar­rhoea treat­ment, de­worm­ing, health talks -any­thing that brings chil­dren to health fa­cil­i­ties.

A sur­vey by the agency, which co­or­di­nates pri­mary health care, found 43 in 100 care­givers were not aware of rou­tine im­mu­ni­sa­tion; they only knew of cam­paigns.

“A lot of it is hinged around tra­di­tional lead­ers mo­bi­liz­ing from the grass­roots, cre­at­ing aware­ness about the im­por­tance of vac­cines,” said Shuaib.

The NSIPSS con­sid­ers hin­drances be­yond just fi­nance. “For the first time, we are say­ing, enough is enough,” said Shuaib. “We have to fix all the prob­lems that pre­vent our kids from get­ting the vac­cines they re­quire

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