Overview of the cMYP Process

1. Overview of the cMYP Process GAVI IRC Training, Geneva, 5 October 2012 Ahmadu Yakubu Claudio Politi

2. Planning cycle

3. Three types of EPI planning Vacc. Introduction SIAs Coverage Improvement Plans cMYPs aPOA Vacc forecast Distrib.system

4. cMYP – background • Multi-year plans, strategic plans have been in existence for a long time, before cMYP, before GAVI, but frequently… • …not comprehensive (separate plans for separate components of EPI) • … not strategic (more reactive to govt or donor direction) • … uncosted • cMYP was designed to change all this, replacing the GAVI Financial Sustainability Plan (FSP) • Common criticism of MYPs in the past: • Rapidly becomes irrelevant to the programme • Becomes a shelf document without consequence • Out of step with internal MoH or governmental planning • “Wish list” without financial or political backing • Inflexible, unable to address new situations, especially in later years • Perception that the primary incentive to develop a cMYP is to apply or extend support from GAVI

5. What is a comprehensive Multi-Year Plan (cMYP)? • A long term strategic and operational plan (3 - 5 years) • Comprehensive, consolidated, costedplan (including funding analysis and gap analysis), ideally aligned to the health sector planning cycle • Should be guided by GVAP in translating global and/or regional goals into national programme priorities, includes activities to solve identified problems and to reach national and global goals • Aims to improve the programme performance • Based on situational analysis (review or desk) and recent reviews and assessments • Comprehensive and integrating: • Addresses all components of the immunization system: management, logistics, social mobilization,… • Focus on immunization system, rather than on disease specific initiatives (e.g. Polio, MNT). • Integrates activities: solve shared problems, avoid duplication. • Links closely to the National Health Plan in terms of priorities, budgets and timing • Considers contextual issues and different scenarios • Articulates how annual Plans of Action (aPoA) would be monitored

6. Situational Analysis / EPI Review Global EPI Priorities FSP National Health Sector Plan Donor projects / requirement MTEF Other Multi-year Plan for EPI Annual Plans of Action Budgets Proposals to donor / funders ICC Documents & Activities

7. When should a MYP be developed? • Country decision, but ideally in synchronization with the national health sector planning cycle • Ideally 1 year before the expiry of the current plan, or earlier if current plan is out of date. • Will require annual review and updating • In initiating the development or revision of a cMYP, take a team approach: • call a meeting with all sections of the immunization system, • Provide and use as much recent data as possible • Joint analysis and identification of problems and solutions. • Obtain consensus about objectives, strategies, directions.

8. Steps for creating a cMYP Step 7 Step 2 Step 3 Step 1 Planning strategies and key activities by system components Conducting situationanalysis Setting national objectivesand priorities Step 4 Step 6 Using GVAP framework as a guide and checklist Analyzing the costs, financing, and financial gaps Step 5 Making an activity timeline Putting the cMYP into action: approval, dissemination, implementation, monitoring

9. Steps for creating an Annual Plan of Action (aPOA) Developing annual plan for relevant year from MYP Step 8 Integrating and consolidating activities for implementation Step 9 Prioritizing activities using district data analysis Step 10 Costing and completing the annual plan Step 11

10. Development of an aPOA • Ideally to be undertaken in Oct/Nov for the coming year, and should have elaboration of all the activities planned for the year • cMYP should have been updated if required • Key components • Description of all the planned activities for identified strategies in cMYP • Consolidation of the activities • Prioritization of activities • Dates and time frames for implementation – considering other planned activities • Resources required and source of financing • Responsible person/entity • Monitoring mechanism (including indicators)

11. Benefits of aPOA • Clear deliverables at all levels • Understandable and realistic targets • Opportunity to amend if required • Building team work and cooperation • Facilitating monitoring • Sense of accomplishment for staff based on step by step implementation approach. • Systematic process towards achieving the objectives of the Immunization programme.

12. Benefits of aPOA • aPOA- from development to evaluation • Developed with consensus • Approved by competent authority • Copy provided to all concerned • Consulted frequently • Monitoring implementation • Evaluation • Provide basis for next POA.

13. Key reasons for unmet targets • Overly-ambitious planning (time constraint!) • Unrealistic workload on existing staff • Delay in initiating the process • Weak regular monitoring • Lack of funds • Weak advocacy (for Govt. / Partners funds) • Financial constraints of Govt. /partners. • Geographic areas that become inaccessible to the programme due to security issues

14. Costing & financing analysis in cMYPs • Quite complex step requiring detailed cost information, understanding of the economic and health system financing context in order to: • Costing the cMYP objectives • Projecting sources of financing and gap analysis • Developing alternative costing and financing scenarios • Quantifying GAVI co-financing requirements • Detailed cMYP Costing • Vaccines & Injection Supplies (Routine and campaigns) • Personnel Costs • Vehicles & Transport Costs • Cold Chain Equipment, Maintenance & Overheads • Operational Cost of Campaigns • Program Activities and Other Recurrent Costs • Other Equipment Needs and Capital Costs • Building & Building Overheads

15. The tool • Excel File • 3 worksheets for data entry • 4 worksheets for results (tables and graphs) • 1 big worksheet for calculations (approx 6,000 rows) • Password protected • 3.4 MB file

16. A balanced tool • Standardization: • It requires to enter standardized information, for example: • According to standard cost categories • Gross monthly salary per each category of staff • Sources of financing as 1) secured or 2) probable • Flexibility: • It allows to introduce country specific features, for example: • Administrative structures • Typology of staff • Different programme activities

17. Financing and gap analysis in cMYPs

18. Limitations • It is a sensitive tool: • Data cannot be copied & pasted • A "," instead of "." can results in #VALUE • Data entry process is dataintensive - in countries that often lack of reliable data - and relatively time consuming. • Frequently data entry and data analysis need assistance by consultants, RO focal points and EPI/HQ "Hotline" • Methods for calculating shared costs are quite subjective (based on % of staff time, % car sharing, % building space) • High risks of poor quality data entry and mistakes

19. cMYP integration in National Health Plans Recentanalysis in GAVI eligible countries to document the extent of cMYPintegration in NHP, based on the followingcriteria: i) cMYP and NHP planning cycles cover the same time period; ii) cMYP situation analysis provides same information with regards to vaccine-preventable disease as the NHP situation analysis; iii) Key immunization goals and objectives are included in the NHP; iv) Key immunization specific milestones are reflected in the NHP; v) cMYP immunization M&E activities/indicators are incorporated into national M&E process/indicators.

20. cMYP integration in National Health Plans Preliminaryfindings on 43 countries analysed: • 18 countries (42%) have cMYPfullyintegrated in NHP • 23 countries (53%) have cMYPpartiallyintegrated in NHP • 2 countries (5%) Not integrated / NA

21. Vaccine Requirements reflected in National Budgets Preliminaryfindingsfrom 49 countries analysed: • 24 countries (49%) have vaccine requirements -estimated in cMYP- reflected in National Budgets • 25 countries (51%) have vaccine requirements –estimated in cMYP- reflected in National Budgets

22. Thank you