Annual Regional Confenrence on Immunisation 10-12 December 2012 Dar es Salaam, Tanzania

1. Tracking Immunisation Financing Updates from Sierra Leone Annual Regional Confenrence on Immunisation 10-12 December 2012Dar es Salaam, Tanzania By The Sierra Leone Delegation

2. Content • Background • Advantages of Tracking Immunization Financing • Funding Pathways • Objectives of the Initiative • Basic Design of the Tool • Expected Outputs • Achievements • Challenges • Next Steps • Recommendations

3. Background • The performance and full benefits of immunisation can only be realised with rational and appropriate funding • The visibility of immunisation funding on the immunisation program performance has not yet been objectively demonstrated in some contexts. • Questions remain regarding the efficient and judicious utilisation of resources • Therefore, the need to establish a matrix around immunisation funding and expenditure in all countries cannot be overemphasized. • Objective facts on immunisation expenditure pattern will retain confidence of notable stakeholders, enhance immunisation financing and gear countries towards a sustainable immunization financing. • Donors • Politicians • Decision makers • ??

4. Background • The cMYP has innovatively served multiple purposes: • It is an advocacy tool • It mobilises resources for immunisation • It creates projections of the program’s cost for future years • The mechanisms for immunisation financing has traditional and contextual diversity in the various countries • Sierra Leone has so far not been able to track the complete range of immunisation funding and expenditure patterns. • Data presented in cash books and files is largely incomplete • Sierra Leone also presently lacks a comprehensive model/framework for economic analysis of the immunisation programme: • Cost effectiveness • Cost benefit • Cost efficiency • Program Outputs & Performance in relation to financing • The total routine recurrent cost of the EPI program (ie. cost per surviving infant) has not yet been quantified

5. Advantages of Tracking Immunisation Financing • Useful for resource mobilisation • Highlights gaps in immunisation financing • Serves as an eloquent platform for advocacy • Provides data for the cMYP • Better tracking of funds in immunisation programming and decision making • Guides the equitable distribution of resources between: • Programme components • Populations served (gender, socio-economic status, location) • Levels of the health care delivery system • Enhances the efficient use of available resources • Depicts funding trends and patterns by various stakeholders • It is the first step towards calculating socio-economic outputs of immunisation • Demonstrates the effectiveness of immunisation financing: For instance, • Funding vs coverage trends per annum • Cost per child immunised per year • Deaths from VPDs averted per year

6. Funding Pathways: Complex and difficult to track MOHS Pool Fund Donor Partners GOSL Pool Fund EPI Programme NGOs Local Council Private Sector District Institutions DHMT CBOs PHUs/CHWs Community Institutions

7. Objectives of the Initiative • To capture the complete picture of routine immunisation funding and expenditure • To store, retrieve and utilise immunisation financing data to improve programme effectiveness and efficiency through informed decision making • To use evidence based assessment matrix to progressively support work on SIF (by reducing the financial gap) • To build the confidence and ensure the participation of all stakeholders in immunization financial management processes and systems

8. Basic Design of Tool • The tool is complementary to the cMYP • The tool is designed to produce operational data periodically • Headings conform to functional pillars of immunisation service delivery • Advocacy and Communication • Logistics • Vaccine supply and quality • Service delivery • Surveillance • Programme Management • Overheads • Maintenance • Range of information explored • Type of activity or item • Timeframe • Quantification • Frequency • Total cost • Funding agency (Source of Funding) • Administrative Level where activity is executed (National, District)

9. Operations of immunization systems Vaccine Supply & Logistics Logistics Quality Service delivery Service delivery Advocacy & Surveillance Surveillance Communication

10. E.g. 1 - Improve VPD Surveillance and Monitoring

11. E.g. 2 - Vaccine Supply and Quality

12. Expected Outputs • Precise and evidence based advocacy messages on Immunisation financing. • A well organised matrix on immunisation financing and expenditure patterns • Funding by operational element • Funding by different players • Funding trends over periods (e.g. 3-5 yrs) • Annual funding scenarios (budgeted, allocated and disbursed) • Evidence-based gap analysis (for any given period) • Required • Available • Gap • Comparison between inputs and outputs of immunisation programmes • Funding trends (over given periods) • EPI coverage (over given periods) • Number of deaths from VPDs (disaggregated and aggregated over given periods) • Informed decision making based on evidence-based performance indicators

13. Achievements Accomplishments • Tool is developed • Shared with partners • Inputs have been incorporated • Tool is ready for field testing Attributes of the Tool • Tool is simple and user friendly • Can be used at any time • Applicable and relevant to situations • It can be used at any level of the health care delivery system • Based on the operational elements of immunisation • Easily reproducible

14. Challenges • Willingness of partners to fund the initiative • Weaknesses in Financial Management at all levels • Competence of staff in Financial Management • Transparency and accountability issues • Objectivity and accuracy of the data • Motivation of staff to maintain commitment to the process • Maintaining continuous collaboration and communication among all stakeholders (national and external partners) involved • Access to the financial records, since some agencies may not disclose the full content of their budget and expenditure • Immunisation financing is very complex in some contexts due to the multitude of stakeholders acting at various levels • Carefully track resources from each stakeholder involved in immunization financing

15. Next Steps

16. Recommendations • Build the capacity of countries to use the cMYP more effectively. • Support Sierra Leone to finalise and pilot the tool • Support countries to develop innovative ways to track immunisation resources • Strengthen the tracking of EPI resources in all countries • Utilise the tracking reports to strengthen National EPI and better program performance through evidence based decision making

17. Thank you For Your Attention!