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Immunization Financing News, the Group Discussed How New Legislation Will Establish Vol 6, Issue 1] VOL. 6, ISSUE 4, FEBRUARY 2015 Immunization Financing News Quarterly news from the Sustainable Immunization Financing (SIF) Program J VOL. 6, ISSUE 4, FEBRUARY 2015 A PRESIDENTIAL BOOST MOVES Dr. Ram Baran Yadav. On 31 October, President Yadav hosted a briefing in his office to learn more about this NEPAL CLOSER TO THE FINISH LINE work. Attending were Sabin Senior Program Officer Dr. This quarter, Nepal advanced further toward its Devendra Gnawali and, representing Rotary sustainable immunization financing goal. New International/Nepal, Rotarians Ram Prasad Bhandari, immunization legislation is nearing passage, Rabindra Jang Thapa, Gopal Pokhrel and Rishi Raj inaugurating a public-private immunization financing Adhikari. arrangement. Four years in the making, the project Nepal's President, Hon. Dr. Ram Baran Yadav, with Sustainable recently received a boost from Nepal’s President, the Immunization Financing Senior Program Officer Devendra Honorable Dr. Ram Baran Yadav, who announced he Gnawali, and delegates from Rotary International/Nepal: Mr. was joining the growing network of supporters working District Governor Rtn. Rabindra Piya, Rtn. Ram Prasad Bhandari, on immunization financing solutions for the country. Rtn. Rabindra Jang Thapa, Rtn. Gopal Pokhrel and Rtn. Rishi Raj Adhikari. Like many lower income countries, Nepal’s economy is growing and revenues are increasing. But vaccine and delivery costs are rising faster. The country has already introduced inactivated polio vaccines in September 2014 and is on track to introduce pneumococcal and human papillomavirus in 2015, which will push immunization costs to well over US$30 per child- far more than the government can currently allocate to the program. The solution: establish two immunization funds, one governmental, and the other private. Backed by a new vaccine law, the public fund will guarantee a minimal vaccine budget safeguarded from budgetary shocks. It will be matched by a private fund, dubbed the Sustainable Immunization Financing Support Fund, which was launched by the country’s Rotary and Lions clubs in October 2012 [see related stories: Summary Digest, Vol 5, Issue 1, Immunization Financing News, The group discussed how new legislation will establish Vol 6, Issue 1]. Government officials are currently the funds and guide their administration. The Ministry of working on a provision granting tax benefits to induce Health and Population (MOHP) began the project in domestic firms to contribute to the private fund. May 2011. In April 2014, the Ministry of Finance allocated an initial NPR 10 million (around These efforts to achieve sustainable immunization US$100,000) for the new fund. The prospects of financing caught the attention of Nepal’s President, Hon. enacting the supporting legislation dimmed when a www.sabin.org/fr (en français) page 1 www.sabin.org/sif VOL. 6, ISSUE 4, FEBRUARY 2015 constitutional crisis led to the dissolution of Parliament discussants analyzed technical issues of the national in July 2012. Undaunted, officials in the Ministries of immunization program, the immunization law and the Finance and Law and Justice turned to crafting immunization fund in detail. The Health Minister, H.E. regulations for the funds. Local governments and a range Khag Raj Adhikari, disclosed that the draft would be of non-governmental organizations, as well as WHO and registered into the parliament very soon, and the MPs UNICEF experts were consulted during this process. committed to pass the immunization bill. At this writing, the National Immunization Law is now on the docket of the recently re-established Parliament and could be passed as early as March 2015. “Now H.E. Khag Raj Adhikari, Minister of Health and Population, is calling for the immunization law”, reported Gnawali. “We are very close to the goal”, he concluded. Following Nigeria, Nepal now stands to be the second SIF country to enact legislation guaranteeing public financing for immunization. SIF INSTITUTIONAL KNOWLEDGE CATALOGUE From Left to Right: Hon Ranju Kumari Jha, Chairperson of Women, Children, Senior Citizen and Social Welfare Committee of Parliament, Hon Khag Raj Adhikari, Minister of Health and Population, Mr. Shant Bahadur Shrestha, Secretary for Health, Dr. Krishna Poudel, Director of Child Health Division, Dr. Hendrikus Raaijmakers, Chief of Health, UNICEF and Dr. Rajendra Bohara, National Coordinator, WHO The launching of the private fund by Rotarians and Lions Clubs in October 2012 added impetus to the government’s efforts. Former Minister of Health Hon. Vidyadhar Mallik guided the final government approval process, culminating in January 2014 with the publication of the fund regulations in the Nepal Gazette. A compendium of program inputs and observed outputs in nineteen At the request of Hon. Ranju Kumari Jha, Chairperson SIF countries nears publication. of the Women, Children, Senior Citizens & Social Welfare Committee, the Ministry of Health and Since 2009, the SIF Program has been working with an Population, WHO and SIF/Sabin jointly organized a array of countries to build the capacity of governmental "Symposium on Shared Responsibility for a Sustainable and domestic non-governmental counterparts to develop Immunization Program" for parliamentarians in and institutionalize their own innovative financing Kathmandu, Nepal. The Symposium was chaired by Mr. solutions. All but one of the original countries have Shanta Bahadur Shrestha, MOHP Secretary. The remained with the SIF program to this day, and three Chief Guest was Hon. Khag Raj Adhikari, Minister of more have joined since the program’s inception. Health and Population, and the Special Guest was Hon. Ranju Kumari Jha. Also attending were reporters, SIF has been operating on a unique international more than twenty MPs from the Women, Children, development frontier. The Program seeks to catalyze the Senior Citizens & Social Welfare Committee, and transition of national immunization systems from officials from the MOHP, EPI team, WHO, UNICEF, financial precariousness and dependency to self- and Sabin. Using the appreciative inquiry method, sustainability and country ownership. www.sabin.org/fr (en français) page 2 www.sabin.org/sif VOL. 6, ISSUE 4, FEBRUARY 2015 Little documentation exists on transitions of this nature, whether in the field of global health or elsewhere in international development. With six years of documentation to work from, SIF Program Coordinator Mr. Andrew Carlson recently produced the “SIF Institutional Knowledge Catalogue”. The Catalogue contains a monthly time-log of SIF Senior Program Officer activities linked to steps a country has taken toward one of five dimensions of financial sustainability: Legislation protecting federal immunization budgets against institutional, political, or economic shocks An inter-institutional or parliamentary coalition to advocate for an increased immunization budget A financing mechanism which ensures adequate, predictable domestic funding to the EPI program, such as a trust fund or a national immunization fund The regular, independent use of resource tracking MP briefing between REPACAV representatives and Orientale tools by the appropriate government entity Province legislators, 8 October 2014. Photo courtesy of REPACAV. The integration of GVAP Strategic Objectives #1 and REPACAV’s President, Hon. Gregoire Lusenge, #5 into national immunization work plans established the coalition in May 2012. The REPACAV Charter states that, The five dimensions were derived from country presentations at the second SIF Colloquium (Dakar, In our country, children die every year from vaccine- August 2013). The catalogue will be updated monthly preventable diseases…an action by parliament would and is already being used for qualitative and quantitative allow the Democratic Republic of Congo to benefit from analyses. The catalogue will be available on the SIF autonomy over its immunization financing efforts, and website by April 2015. better organize its national immunization program. REPACAV was created to “support vaccine-related MAJORITY OF DRC PROVINCES NOW activities through advocacy on the parliamentary level COMMITTED TO CO-FINANCE and sensitization campaigns on the community level.” IMMUNIZATION Hon. Lusenge, Hon. Louis Kaswende, Hon. Celestin DRC continues to increase immunization financing at Bondomiso, and Hon. Richard Makuba of REPACAV the provincial level. In October and December 2014, and SIF Senior Program Officer Dr. Helene Mambu- government authorities from three more provinces made Ma-Disu embarked on the first advocacy mission, to formal commitments to mobilize local funding and pass Bas Congo Province, on 11 December 2013 (see related legislation to support their immunization programs. In story, Immunization Financing News, 5(4)). This past all, six of DRC’s eleven provinces have begun December, three REPACAV members, Hon. Makuba, developing such solutions. Driving the process is the Hon. Yukula, and Mr. Muntuntete-Vanloy, paid a Réseau des Parlementaires Congolais pour l’Appui à la return visit to Bas Congo where they assisted the Vaccination (Congolese Parliamentary Network for provincial EPI team in preparing the program’s budget Immunization Support). Known as REPACAV, the for 2015. Network includes parliamentarians and government officials working together at federal and provincial On 5 & 7 May 2014, REPACAV members visited levels. Oriental and Kasai-Occidental provinces (see related story, Immunization Financing News, 6(2)). Among the www.sabin.org/fr
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