sabin sif country fact sheets vii.2016

Armenia

July 2016

The Republic of Armenia is pursuing a financially sustainable public immunization program through

legislation and enhanced budget oversight. Sabin’s Sustainable Immunization Financing (SIF) Program

began its efforts in Armenia in March 2015.

Immunization Program Structure

The Armenian Expanded Program on Immunization (EPI) is managed through two Ministry of Health

entities: the State Hygiene and Anti-epidemic Inspection (SHAEI) and the National Center for Disease

Control.

Armenia’s Progress to Date

Government Spending on Immunization

Legislation for Sustainability

Expenditure Tracking

SIF Program Inputs


Over the period 2006-2014, Armenia’s Gross National Income increased 91 percent from US$1,990 to

$3,810 per capita. According to the WHO/UNICEF Joint Reporting Form (JRF), the Armenian government

spent $2 on routine immunization per surviving infant in 2006. By 2014, government contributions had

increased forty-fold, to $84. The government share of total routine immunization expenditures rose from 50

percent to 99 percent over the period. Though JRF financial indicators have been reported inconsistently

since 2010, the data nevertheless suggest that Armenia has progressed towards country ownership of its

immunization program. Among SIF countries, Armenia ranked first in terms of routine immunization

spending per surviving infant in 2014.

ARMENIA’S JRF FINANCING FEEDBACK REPORT, 2006-2014. Legislation for Sustainability Armenia’s constitution provides protections for health and health care, but there is no specific immunization law. Chapter 2, Article 33.2, of Armenia’s Constitution (1995) states, “Everyone shall have the right to live in an environment favorable to his/her health and well-being and shall be obliged to protect and improve it in person or jointly with others.” Chapter 2, Article 48, of Armenia’s Constitution (1995) states that a basic task of the state is “to implement health care programs for the population and contribute to the effective and affordable medical service for the population.” In Armenia, immunization is regulated by ministerial decrees on sanitary norms and rules. For each vaccine, including new vaccines, there is a separate ministerial decree that sets instructions and conditions for implementation.

http://www.sabin.org/sites/sabin.org/files/sif_newsletter_vol_7_no_2.pdf

http://www.sabin.org/sites/sabin.org/files/armenia_financial_report.pdf

http://www.parliament.am/parliament.php?id=constitution&lang=eng

The Ministry of Health (MOH) is formulating a Public Health Law which is slated to provide for public immunization financing. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. Armenian counterparts analyzed national immunization program budget flows for 2012-2013 and 2014-2015 using the SIF Budget Process tool. SIF Program Inputs

March 2016: Sabin Senior Program Officer meets with MOH Finance Unit Director to analyze

proposed and approved budget, EPI Manager and team to complete the SIF budget flow analysis

for 2014-2015

October 2015: SIF Director, Sabin Senior Program Officer and national immunization manager

meet with members of the Parliamentary Health Committee

March 2015: Sabin Senior Program Officer meets with representatives from EPI, National Center

for Disease Control & Prevention, and Head of MOH Financing-Economic Unit to analyze the

immunization budget flow and to document the immunization budget process

Financial Indicators, WHO/UNICEF - Joint Reporting Form (JRF) The amount a country spends on its routine immunization program is a direct measure of country ownership and an indicator of the financial sustainability of the program. Each year, countries report these expenditures through the WHO/UNICEF Joint Reporting Form (JRF).

Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 44 65 69 59 60 66 63 66 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 90,000 157,353 N/A 420,000 630,000 N/A 1,029,000 N/A 1,067,452

US$ per Surviving Infant 2.02 3.63 N/A 9.50 14.18 N/A 23.54 N/A 25.19

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A N/A N/A 1,583,000 N/A 2,692,500

US$ per Surviving Infant N/A N/A N/A N/A N/A N/A 36.21 N/A 63.54

Reported % of Total Expenditure on Vaccines Financed by Government

(JRF 6530) 30 33 N/A 60 N/A N/A 65 N/A 60

Government Expenditure on Routine Immunization - US$ (JRF 6540) 75,000 N/A N/A 450,000 630,000 N/A 1,029,000 N/A 3,548,305

US$ per Surviving Infant 1.69 N/A N/A 10.18 14.18 N/A 23.54 N/A 83.74

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 960,000 N/A 1,583,000 N/A 3,572,814

US$ per Surviving Infant N/A N/A N/A N/A 21.60 N/A 36.21 N/A 84.32

Reported % of Total Expenditure on Routine Immunization Financed by

Government (JRF 6560) 50 N/A N/A 63 66 75 65 N/A 99

Data Accuracy Indicators Met* 0/1 N/A N/A N/A 3/3 N/A 5/6 N/A 5/6

*Data Accuracy Indicators represent number of logical tests satisfied divided by number of tests run

ARMENIA

Reported JRF Financial Indicators 6510-6560

JRF Financial Indicator Reporting Consistency

http://www.who.int/immunization/programmes_systems/financing/data_indicators/en/

Cambodia July 2016

Cambodia is pursuing financial sustainability for its immunization services primarily through legislation. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Cambodia in December 2008. Immunization Program Structure Cambodia’s national immunization program (NIP) is located in the Health Directorate, Ministry of Health (MOH). Cambodia’s Progress to Date Government Spending on Immunization Legislation for Sustainability SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, Cambodia’s Gross National Income rose from US$510 to $1010 per capita, a 98 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Cambodian government spent $2 on routine immunization per surviving infant in 2008. By 2014, this figure had risen to $26, increasing thirteen-fold. From 2006-2014, the government share of total routine immunization expenditures increased from 17 percent to 55 percent. Though JRF financial reporting has been inconsistent since 2010, the data nevertheless suggest that Cambodia has progressed towards country ownership of its immunization program. Among SIF countries, Cambodia ranked fourth in terms of routine immunization spending per surviving infant in 2014.

CAMBODIA’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability Chapter VI, Article 72 of Cambodia’s 1993 constitution states: “The health of the people is to be guaranteed. The State gives full consideration to disease prevention and medical treatment. Poor citizens receive free medical consultation in public hospitals, infirmaries, and maternities.” The MOH established a Legal Drafting Committee in February 2012. The Committee met with MPs as well as representatives from the NIP, MOH, and Ministry of Economy and Finance in October 2012 and March 2013. In September 2014, at the request of the National Assembly, the MOH shifted from drafting a law to drafting a ministerial sub-decree on immunization. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In March 2012, Sabin Senior Program Officer and MOH counterparts used the SIF tool to analyze 2010-12 NIP budgets. Reporting errors were detected and rectified. SIF Program Inputs

March 2011, July 2012, July 2014, May 2016: Cambodian counterparts join Nepali, Sri Lankan, Mongolian, Indonesian, and Vietnamese delegates in peer review workshops


http://www.sabin.org/sites/sabin.org/files/cambodia_financial_report.pdf

http://www.constitution.org/cons/cambodia.htm

January 2015: SIF sponsored a visit by a Nepali peer working on that country’s immunization bill to the Cambodian MOH to discuss the new sub-decree.

October 2014: Sabin Senior Program Officer, SIF Program Director and MOH counterparts organize GVAP briefing

May 2013: Sabin Senior Program Officer organizes national legislative workshop

October 2012: Cambodian counterparts join Nepalese peers in financing & legislative peer exchange

February, April, October 2010, April 2012: Sabin Senior Program Officer and SIF Program Director organize parliamentary briefings

February 2011: Sabin Senior Program Officer, government and National Assembly counterparts organize Cambodia's first provincial-level briefing on immunization financing

December 2008: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Cambodian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,35 7 8 9 10 11 14 16 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 0 298,095 824,844 767,338 1,130,366 1,068,217 1,174,231 1,997,291 2,246,340

US$ per Surviving Infant 2 0 0.91 2.46 2.24 3.24 2.92 3.32 5.64 6.34

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 2,808,589 4,695,909 4,789,135 5,228,651 4,976,806

US$ per Surviving Infant N/A N/A N/A N/A 8.05 12.83 13.55 14.76 14.04

Reported % of Total Expenditure on Vaccines Financed by Government (JRF

6530) 0 17 41 22 40 23 25 38 45

Government Expenditure on Routine Immunization - US$ (JRF 6540) 1,390,700 1,584,800 2,231,044 1,161,164 277,814 305,596 1,131,083 2,275,105 9,163,487

US$ per Surviving Infant 4.31 4.86 6.67 3.39 0.80 0.84 3.20 6.42 25.85

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 473,544 2,422,036 2,020,796 8,958,495 16,768,710



Government (JRF 6560) 17 33 46 N/A 59 13 56 25 55

Data Accuracy Indicators Met* 1/1 1/1 1/1 1/1 4/6 4/6 4/6 6/6 6/6


Sources: 1 World Bank; 2 UN Population Division; 3 WHO - National Health Accounts

CAMBODIA




Cameroon July 2016

Cameroon is pursuing financial sustainability for its routine immunization services through new financing arrangements, budget advocacy and resource tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Cameroon in October 2008. Immunization Program Structure Cameroon’s Expanded Program on Immunization (EPI) is a division within the Ministry of Health (MOH). Cameroon’s Progress to Date Government Spending on Immunization Legislation for Sustainability Budget Advocacy Expenditure Tracking SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, Cameroon’s Gross National Income rose from US$960 to $1,350 per capita, a 41 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Cameroonian government spent $6 on routine immunization per surviving infant in 2006. By 2014, this figure had increased 17 percent, to $7. During the same period, the government share of total routine immunization expenditures dropped from 57 percent to 21 percent. Since 2010, Cameroon has reported complete and consistent JRF financial data. The data show that Cameroon has progressed towards country ownership of its immunization program. Among SIF countries, Cameroon ranked 15th in terms of routine immunization spending per surviving infant in 2014. CAMEROON’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability The Constitution of Cameroon, Part X (Articles 55–62), states that 10 semi-autonomous regions, ruled by regional councils, have responsibility for “economic, social, health, educational, cultural and sports development.” In July 2011, a committee designated by the Minister of Health (MOH) and Parliament prepared a draft bill establishing a national immunization fund. In November, the council of ministers directed that the bill be revised to set aside funds for all communicable disease control programs, including immunization. In 2013, an MOH-led working committee began drafting regulations for the proposed Health Support Fund, which would be included in a larger proposed Health Law. In November 2014, the scope of the proposed fund was reduced to cover just vaccines and antiretroviral drugs. The Inter-Ministerial Committee approved the completed Health Law containing the HIV section in March 2015. In October 2015, the draft bill was expanded to include a National Public Health Agency. After the draft bill was finalized and approved by the Ministry of Finance Health Budget Director in November 2015, the bill was then submitted to the MOH Cabinet Legal Department for review. In April 2016, the draft bill was revised to remove a proposed tax earmark and substitute a voluntary government financing mechanism. Budget Advocacy In September 2015, the EPI team used budget data to successfully advocate for an approved FY2016 immunization budget increase.


http://www.sabin.org/sites/sabin.org/files/cameroon_financial_report.pdf

http://www.assemblenationale.cm/images/stories/DOCUMENTS_PDF/constitution.pdf

In February 2016, a Cameroonian MP attended and signed a Parliamentary Statement in Support of the Ministerial Conference on Immunization in Africa. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In September 2015, an EPI team completed annual SIF budget flow analyses for 2010-15. SIF Program Inputs

September 2010, November 2012, December 2014, June 2016: Cameroonian counterparts join DRC, Congo, Malgache, Malian, and Senegalese peers in Sabin-sponsored peer review workshops

May 2012, November 2014, October, November 2015, April 2016: Resident Sabin Senior Program Officer co-organizes national legislative and financing workshops

June 2015: Cameroonian counterparts join Malian and Senegalese peers for Sabin-sponsored resource tracking workshop in Dakar, Senegal

September 2014: Resident Sabin Senior Program Officer, EPI team, and NGO Immunization Platform integrate SIF budget flow analysis, cMYP costing tools

August 2014: Resident Sabin Senior Program Officer, WHO, and UNICEF counterparts organize advocacy technique workshop for MPs, Association of Women Mayors

August, December 2009, June, July 2011: Resident Sabin Senior Program Officer organizes parliamentary briefings

October 2008: Resident Sabin Senior Program Officer and SIF Program Director introduce SIF program to government and parliament


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,3 10 11 12 15 17 22 20 23 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 1,173,490 1,436,151 2,494,510 2,102,420 2,257,870 1,963,100 2,591,200 2,852,100 3,272,320

US$ per Surviving Infant 2 1.77 2.14 3.65 3.02 3.19 2.72 3.54 3.84 4.33




6530) 20 40 51 34 96 9 13 12 15

Government Expenditure on Routine Immunization - US$ (JRF 6540) 3,755,260 10,716,876 13,220,441 2,684,790 4,859,660 6,378,620 2,702,320 4,326,220 5,081,960


All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 27,759,700 26,463,700 20,205,900 27,819,600 23,978,700



Government (JRF 6560) 57 36 44 13 18 24 13 16 N/A




CAMEROON




Congo

July 2016

The Republic of Congo is pursuing financial sustainability for its immunization services primarily through budget

advocacy. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Congo in February

2012.


Congo’s Expanded Program on Immunization (EPI) is located in the Family Health Department, Ministry of

Health.

Congo’s Progress to Date


Vaccination Financing Mechanism



Budget Advocacy

SIF Program Inputs


Over the period 2006-2014, the country’s Gross National Income rose from US$1,210 to $2,680 per capita, a

121 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Congolese government

spent $3 on routine immunization per surviving infant in 2006. By 2014, this figure had increased more than five-

fold to $17. In addition, the government share of total routine immunization expenditures increased from 26

percent to 40 percent over the period. Since 2010, Congo has reported consistently on JRF financial indicators.

The data suggest that Congo has progressed towards country ownership of its immunization program. Among

SIF countries, Congo ranked sixth in terms of routine immunization spending per surviving infant in 2014.

CONGO'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014.


In October 2014, the MOH began developing guidelines for a “Special Appropriation Account,” which will be used

for vaccine procurement and will be subsidized by an airline tax.


SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In 2013, the

EPI team analyzed its 2011-12 budgets using the SIF Budget Flow Analysis tool.

Ministerial and parliamentary officials participated in a sub-regional peer review workshop in December 2014 and

received recommendations on their resource tracking approach from peers. In February 2016, the EPI Manager

began engaging departmental health directors in resource tracking activities.


Title I, Article 34 of the 1992 Constitution states: “The State is the guarantor of public health. Every citizen has

the right to a standard of living adequate for the health and well-being of himself and his family, including food,

clothing, housing, medical care and necessary social services. The right to create private social and health

institutions is guaranteed. Social and health institutions are subject to approval by the State and governed by

law.”

The government of Congo began drafting a new immunization bill in June 2012. In February 2013, the draft bill

was amended.


http://www.sabin.org/sites/sabin.org/files/congo_financial_report.pdf

http://www.servat.unibe.ch/icl/cf00t___.html

In February 2016, a Congolese MP signed the Parliamentary Statement in Support of the Ministerial Conference

on Immunization in Africa.

Budget Advocacy

In August 2015, the National Assembly Health Committee (NAHC) Chairman began organizing a Parliamentary

Coalition for Immunization. Among its purposes is to advocate for appropriate immunization budgets.

In February 2016, the EPI Manager and NAHC Committee Chairperson briefed departmental health directors on

resource mobilization.

In February 2016, a Congolais MP attended and signed a Parliamentary Statement in Support of the Ministerial

Conference on Immunization in Africa.

SIF Program Inputs

September 2010, November 2012, December 2014, June 2016: Cameroonian counterparts join DRC,

Congo, Malgache, Malian, and Senegalese peers in Sabin-sponsored peer review workshops

August 2015: Sabin Executive Vice President, SIF Program Director and Sabin Senior Program Officer

attend briefing of the National Assembly Health Committee

June 2015: National Assembly Health Committee Chairman joins DRC Advocacy Coalition mission to

Katanga province

November 2012: Congolese counterparts join DRC, Malgache, Cameroonian, Malian, and Senegalese

delegates in legislative peer review workshop

February 2012: Sabin Senior Program Officer conducts introductory briefings with the MOH and EPI


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 500,000 140,000 360,000 360,000 295,130 159,901 397,915 635,680 1,604,940





6530) 75 100 100 100 N/A 9 11 15 34

Government Expenditure on Routine Immunization - US$ (JRF 6540) 420,000 672,990 541,520 483,556 87,647 768,239 810,078 883,891 1,342,690


All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 441,772 2,602,375 5,083,170 6,951,420 6,571,120







CONGO




Democratic Republic of Congo

July 2016

The Democratic Republic of the Congo is pursuing financial sustainability for its immunization services through legislation, budget advocacy, and expenditure tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in DRC in June 2009. Immunization Program Structure DRC’s Expanded Program on Immunization (EPI) is located in the Disease Control Directorate, Ministry of Public Health (MOPH). DRC’s Progress to Date Government Spending on Immunization Expenditure Tracking Budget Advocacy Legislation for Sustainability SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, the country’s Gross National Income rose from US$230 to $410 per capita, almost doubling. According to the WHO/UNICEF Joint Reporting Form (JRF), the government spent $1 on routine immunization per surviving infant in 2006. In 2014, the government spent the same amount. The government share of total routine immunization expenditures dropped from 9 percent to 5 percent over the period. Since 2010, DRC has reported consistently on JRF financial indicators. The data suggest that DRC has not progressed towards country ownership of its immunization program. Among SIF countries, DRC ranked 20th in terms of routine immunization spending per surviving infant in 2014. THE DEMOCRATIC REPUBLIC OF CONGO'S FINANCIAL FEEDBACK REPORT, 2006-2014. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In 2014, EPI team completes annual SIF Budget Flow Analyses for 2010-14 using the SIF Budget Process Tool. The EPI team captures subnational expenditures using a tool called Formulaire 6, which distinguishes public from external partner contributions. In October 2015, the team analyzed the Formulaire 6 data from four districts. Budget Advocacy In May 2012, the National Assembly established the Parliamentary Support Network for Immunization. The network includes around fifty Members of Parliament, ministry officials, EPI staff, other health professionals and partners. Network members have visited eleven provinces to advocate for increased immunization budgets. Increases have been reported in eight. The DRC’s national parliamentary network served as a model for a similar Africa-wide effort. In February 2016, an MP from DRC attended and signed a Parliamentary Statement in Support of the Ministerial Conference on Immunization in Africa. The statement calls on all 47 African countries to form a Regional parliamentary immunization support network. Legislation for Sustainability Section VII, Article 204 of the Constitution empowers provinces to organize basic health services, including immunization campaigns. The government began drafting an immunization bill in 2012. In June 2014, work shifted from a stand-alone bill to an immunization-related health bill. In September 2015, the committee completed the immunization-related


http://www.sabin.org/sites/sabin.org/files/drc_financial_report.pdf

http://www.constitutionnet.org/files/DRC%20-%20Congo%20Constitution.pdf

section of a legal proposal to draft the health bill. In March 2016, a companion national immunization policy paper was finalized and presented with the draft bill to the National Assembly for review. SIF Program Inputs



March 2016: Resident Sabin Senior Program Officer co-organizes legislative consultation on immunization-related health bill

October 2015: Resident Sabin Senior Program Officer organizes expenditure tracking workshop

August 2015: Resident Sabin Senior Program Officer and SIF Program Director brief the Senate Vice Chairman and National Assembly President on immunization financing issues

October 2013- December 2014: Resident Sabin Senior Program Officer and MP network members visit Maniema, Orientale, Kasai-Occidental and Kasai-Oriental, Bas-Congo and Katanga provinces

July 2013: Sabin Senior Program Officer co-facilitates provincial financial management workshop

June 2013: Resident Sabin Senior Program Officer organizes a legislative workshop

June 2012: DRC counterparts review Madagascar’s draft immunization law in Sabin-organized study tour

July 2010: Resident Sabin Senior Program Officer and SIF Program Director brief authorities in Katanga and Bas-Congo provinces

June 2010: Resident Sabin Senior Program Officer and WHO co-organize MP briefing

September 2009: Resident Sabin Senior Program Officer organizes first MP briefing

June 2009: Resident Sabin Senior Program Officer and SIF Program Director introduce SIF program to DRC government

Financial Indicators, WHO/UNICEF - Joint Reporting Form (JRF) The amount a country spends on its routine immunization program is a direct measure of country ownership and an indicator of the financial sustainability of the program. Each year, countries report these expenditures

through the WHO/UNICEF Joint Reporting Form (JRF).

Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 0 0 0 892,653 0 0 4,466,399 3,727,193 2,628,012





6530) 0 0 0 2 0 0 11 7 4

Government Expenditure on Routine Immunization - US$ (JRF 6540) 3,206,520 N/A 0 1,870,993 90,640 1,828,000 4,469,057 4,999,802 3,845,799

US$ per Surviving Infant 1.39 N/A 0.00 0.76 0.04 0.70 1.68 1.83 1.37




Government (JRF 6560) 9 N/A 3 2 2 31 8 7 N/A




DRC




Georgia

July 2016

Georgia is reviewing existing legislation and tracking expenditures to secure sustainable financing for its

national immunization program. Sabin’s Sustainable Immunization Financing (SIF) Program began its

efforts in Georgia in July 2014.


Georgia’s National Immunization Program (NIP) is located in the National Center for Disease Control and

Public Health (NCDC), Ministry of Health.

Georgia’s Progress to Date Government Spending on Immunization



Budget Advocacy


SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Georgia’s Gross National Income rose from US$1,680 to $3,720 per capita, a 121 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Georgian government spent $13 on routine immunization per surviving infant in 2006. By 2014, this figure had risen to $61, more than a four-fold increase. In addition, the government share of total routine immunization expenditures increased from 58 percent to 77 percent over the period. Since 2010, Georgia has reported consistently on JRF financial indicators. The data suggest that Georgia is progressing towards country ownership of its immunization program. Among SIF countries, Georgia ranked second in terms of routine immunization spending per surviving infant in 2014. GEORGIA’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability The Georgian Law on Public Health mandates that the Government organize and supervise the supply, storage, transportation, of all necessary vaccines as defined by the National Immunization Calendar. The Law also creates healthcare provider accountability for vaccine provision by requiring that they provide timely and comprehensive information about vaccination and submit documentation of preventative vaccination refusals. Moving forward, the Parliamentary Health Care Committee Chairman and Deputy Chairman have committed to building consensus to legislate obligatory immunizations. Vaccine Financing Mechanism Until 2010, vaccines were procured through UNICEF Supply Division. Now, Georgia oversees the purchase of vaccines and injection supplies through a state procurement mechanism. Budget Advocacy In response to a proposed cut in the immunization budget in 2015, the resident Sabin Senior Program Officer organized a national briefing. The Minister of Finance restored the budget after Members of Parliament highlighted the country’s impending GAVI graduation and the proportionate impacts on child health that would accompany an EPI budget cut.


http://www.sabin.org/sites/sabin.org/files/georgia_financial_report.pdf

http://www.vertic.org/media/National%20Legislation/Georgia/GE_Law_Public_Health.pdf

Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. Using the SIF Budget Process Tool, the NCDC team completed an analysis of the 2014 immunization budget. The NCDC is adapting the SIF Budget Process tool to better suit local needs. In 2016, the NCDC Deputy Director initiated work on new Results-Based Financing approach which will analyze data from district and facility immunization managers. SIF Program Inputs

April 2016: Resident Sabin Senior Program Officer briefs Health Care Committee Chairman and Deputy Chairman

November 2015: Resident Sabin Senior Program Officer organizes national briefing

April 2015: Resident Sabin Senior Program Officer and MOH counterparts map immunization-

related legislation

July 2014: Resident Sabin Senior Program Officer introduces SIF program to Georgian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 342000 375000 545455 951800 2059783 780300 905544 2274878 1599639


All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 2594257 1003320 1574943 3691853 2509139



6530) 71 43 63 88 79 78 57 62 64

Government Expenditure on Routine Immunization - US$ (JRF 6540) 712000 918000 1015758 1144580 2104293 4520000 1066354 2319163 3465081


All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 3292572 4520000 2821297 4745229 4501581

US$ per Surviving Infant N/A N/A N/A N/A 58.16 75.75 49.12 82.83 79.17Reported % of Total Expenditure on Routine Immunization Financed by

Government (JRF 6560) 58 67 68 97 64 100 38 49 77



GEORGIA




Indonesia

July 2016

Indonesia is pursuing financial sustainability for its immunization services through legislation and expenditure tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Indonesia in July 2013. Immunization Program Structure Indonesia’s National Immunization Program (NIP) is located in the Immunization and Quarantine Directorate, Division of Communicable Disease Control and Environmental Health, Ministry of Health (MOH). Indonesia’s Progress to Date Government Spending on Immunization



SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Indonesia’s Gross National Income rose from US$1,390 to $3,650 per capita, a 163 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Indonesian government spent $8 on routine immunization per surviving infant in 2006. By 2014, this figure had risen to $9, a 13 percent increase. While increasing in absolute terms, the government share of total routine immunization expenditures dropped from 95 percent to 64 percent over the period. Since 2010, Indonesia has reported inconsistently on JRF financial indicators. The data suggest that Indonesia has progressed towards country ownership of its immunization program. Among SIF countries, Indonesia ranked 10th in terms of routine immunization spending per surviving infant in 2014. INDONESIA'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability The Indonesian Health Law was passed in 2009. In November 2014, the MOH and Ministry of Planning (MOP) began reviewing all immunization-related legislation. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. MoH counterparts used the SIF budget flow analysis tool to analyze 2011-2014 immunization budgets. SIF Program Inputs

July 2014: Indonesian counterparts join Cambodian, Mongolian, Nepali and Sri Lankan peers in a Sabin-sponsored peer review workshop

November 2013: Indonesian counterparts join Vietnamese and Mongolian peers in Sabin-sponsored peer review workshop


http://www.sabin.org/sites/sabin.org/files/indonesia_financial_report.pdf

July 2013: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Indonesian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014




All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A N/A 61,795,661 N/A 59,942,908 48,313,540

US$ per Surviving Infant N/A N/A N/A N/A N/A 13.60 N/A 12.06 9.52


6530) 87 92 100 100 N/A 100 100 85 78

Government Expenditure on Routine Immunization - US$ (JRF 6540) 34,516,798 119,597,657 32,910,671 44,550,470 8,634,252 68,509,010 N/A 18,127,289 47,323,717

US$ per Surviving Infant 7.78 26.85 7.36 9.88 1.89 15.08 N/A 3.65 9.32

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 10,418,766 69,083,024 N/A 30,080,098 73,482,802

US$ per Surviving Infant N/A N/A N/A N/A 2.28 15.21 N/A 6.05 14.48


Government (JRF 6560) 95 86 100 80 83 99 N/A 60 64

Data Accuracy Indicators Met* 0/1 1/1 1/1 1/1 2/3 6/6 N/A 4/6 6/6


Sources: 1 World Bank; 2 UN Population Division; 3 WHO/UNICEF Joint Reporting Form (JRF); 4 WHO - National Health Accounts

INDONESIA




Kenya July 2016

Kenya is pursuing financial sustainability for its immunization services primarily through a new financing arrangement. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Kenya in October 2008. Immunization Program Structure Kenya’s Expanded Program on Immunization (EPI) is in the Immunization Division, Department of Family Health, Ministry of Public Health and Sanitation (MOPHS). Kenya’s Progress to Date Government Spending on Immunization



SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Kenya’s Gross National Income rose from US$600 to $1,290 per capita, a 115 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Kenyan government spent $4 on routine immunization per surviving infant in 2006. Government contributions fluctuated over the period but remained at $4 per surviving infant in 2014. The government share of total routine immunization expenditures rose from 10 percent to 14 percent over this period. Since 2010, Kenya has reported inconsistently on JRF financial indicators. The data suggest that Kenya has progressed towards country ownership of its immunization program. Among SIF countries, Kenya ranked 18th in terms of routine immunization spending per surviving infant in 2014. KENYA’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Vaccination Financing Mechanism In 2010, the Health Sector Services Fund began disbursing funds, including those for immunization, directly to county-level facilities, dispensaries, and health centers. Provincial and district health management teams provide oversight and district-level accountants report how the funds are used. Faced with devolution, federal and county-level EPI authorities met to agree on financing responsibilities between the national and subnational levels in September 2015. Legislation for Sustainability In 2011, parliament began drafting a bill covering vaccines and vaccination activities. In January 2012, the MOPHS began mapping of all immunization-related legislation in Kenya.


http://www.sabin.org/sites/sabin.org/files/kenya_financial_report_0.pdf

By October 2014, two draft immunization-related bills existed: a vaccine procurement bill, which introduces a vaccine procurement trust fund, and the general health bill, which includes a section on vaccinations. Recent SIF Program Inputs

October 2015, April 2016: Kenyan counterparts join Nigerian, Kenyan, Sierra Leonean, and Liberian peers in Sabin-sponsored peer review workshops

September 2015: Sabin Senior Program Officer organizes county-level briefings in Naivasha and Nairobi

September 2010, March 2011, February 2012, September 2014: Sabin Senior Program Officer organizes national briefings

June 2012: Sabin Senior Program Officer and parliament organize legislative workshop

October 2008: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Kenyan government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 956,742 4,273,440 N/A N/A 3,500,750 4,500,250 N/A 4,277,138 5,133,400

US$ per Surviving Infant 0.75 3.32 N/A N/A 2.57 3.25 N/A 3.01 3.57

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 7250750 7850700 N/A 27,727,538 34,220,900



(JRF 6530) 80 N/A 100 N/A 48 57 N/A 15 15

Government Expenditure on Routine Immunization - US$ (JRF 6540) 5,417,050 10,436,900 7,063,500 N/A 6,263,408 6,463,301 N/A 5,739,293 5,311,200

US$ per Surviving Infant 4.27 8.12 5.38 N/A 4.59 4.67 N/A 4.04 3.69

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 7,363,408 7,373,400 N/A 39,255,293 38,417,200



Government (JRF 6560) 10 10 90 10 85 88 N/A 15

Indicator

Removed

Data Accuracy Indicators Met* 1/1 1/1 N/A N/A N/A 5/6 N/A 6/6 5/5


KENYA

Reported JRF Financial Indicators 6510-6560 [2]



Liberia July 2016

Liberia is pursuing financial sustainability for its immunization services through legislation and expenditure tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Liberia in November 2008. Immunization Program Structure Liberia’s Expanded Program on Immunization (EPI) is located in the Preventative Services Division, Health Services Department, Ministry of Health & Social Welfare (MOHSW). Liberia’s Progress to Date Government Spending on Immunization Budget Advocacy Legislation for Sustainability SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, Liberia’s Gross National Income rose from US$130 to $370 per capita, a 185 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Liberian government spent $1 on routine immunization per surviving infant in 2006. By 2014, this figure had doubled to $2. In addition, the government share of total routine immunization expenditures rose from 3 percent to 6 percent over this period. Since 2010, Liberia has reported inconsistently on JRF financial indicators. The data nonetheless suggest that Liberia has progressed towards country ownership of its immunization program. Among SIF countries, Liberia ranked 19th in terms of routine immunization spending per surviving infant in 2014. LIBERIA’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Budget Advocacy In June 2012, Liberian parliamentarians visited Uganda to study its Parliamentary Network for Immunization. The same MPs formed the Liberian Parliamentary Network for Immunization in March 2013. The Network participates directly in annual national budget negotiations. In September 2015, Network members briefed House and Senate Health Committee members on immunization during the FY2016 budgetary preparations. Legislation for Sustainability Chapter II, Article 8 of the 1984 Liberian Constitution states that guaranteeing a healthy citizenry is one of the essential government policy goals. Many current childhood immunization policies stem from the 1956 Public Health Law, which offers several relevant provisions but no immunization financing clauses. The Parliamentary Network for Immunization and the MOHSW began preparing a draft immunization bill in March 2013. The following June, the draft bill was submitted to the Senate. In July and October 2013, a few amendments were made following a public vetting process. The Senate approved the bill for passage in May 2014. The bill awaits consideration by the House of Representatives.


http://www.sabin.org/sites/sabin.org/files/liberia_financial_report.pdf

http://www.onliberia.org/con_1984_1.htm

http://mohsw.gov.lr/documents/Liberian%20Public%20Health%20Law%201976%20(2).pdf

SIF Program Inputs

October 2015, April 2016: Liberian counterparts join Nigerian, Sierra Leonean, Kenyan, and Ugandan peers in Sabin-sponsored peer review workshops

August 2015: Liberian counterparts join Nigerian and Sierra Leonean peers in Sabin-sponsored peer exchange workshop

November 2013, May 2015: Liberian counterparts join Sierra Leonean peers in Sabin-sponsored peer exchange workshop

March 2013: Sabin Senior Program Officer organizes MP briefing

June 2012: Liberian MP and MOHSW counterpart survey Ugandan MP network and immunization bill in Sabin-sponsored peer exchange to Uganda

August 2010: Liberian Ministry of Finance officer visits Uganda in Sabin-sponsored study tour

July 2009: Sabin Senior Program Officer and EPI counterparts co-organize briefing in Margibi county

November 2008: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Liberian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 0 6,026 177,125 N/A 121,980 155,623 158,236 120,132 232,500

US$ per Surviving Infant 0 0.05 1.39 N/A 0.91 1.15 1.14 0.86 1.65

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 2132880 171432 1,881,164 2,564,374 4,329,252



(JRF 6530) 0 1 4 N/A 6 91 8 5 5

Government Expenditure on Routine Immunization - US$ (JRF 6540) 100,000 66,000 217,125 N/A N/A N/A N/A 406,012 265,591

US$ per Surviving Infant 0.83 0.54 1.71 N/A N/A N/A N/A 2.90 1.88

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A N/A N/A N/A 1,425,430 4,520,173

US$ per Surviving Infant N/A N/A N/A N/A N/A N/A N/A 10.19 32.03


Government (JRF 6560) 3 3 2 N/A N/A N/A N/A 28

Indicator

Removed

Data Accuracy Indicators Met* 2/2 2/2 2/2 N/A 1/1 3/3 1/1 5/6 5/5


LIBERIA




Madagascar July 2016

Madagascar is pursuing financial sustainability for its immunization services primarily through legislation. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Madagascar in December 2009. Immunization Program Structure Madagascar’s Expanded Program on Immunization (EPI) is located in the Immunization Department, Maternal and Child Health Directorate, General Secretariat, Ministry of Health & Family Planning (MOHFP). Madagascar’s Progress to Date Government Spending on Immunization



Budget Advocacy

SIF Program Inputs

Government Spending on Immunization Over the period 2006-2013, Madagascar’s Gross National Income rose from US$280 to $440 per capita, a

57 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Malgache

government spent $1 on routine immunization per surviving infant in 2006. By 2013, this figure had risen to

$3, a 300 percent increase. While increasing in absolute terms, the government share of total routine

immunization expenditures dropped from 13 percent to 6 percent over the period. Since 2010, Madagascar

has reported inconsistently on JRF financial indicators. The data nonetheless suggest that Madagascar

has progressed towards country ownership of its immunization program.

MADAGASCAR’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Expenditure Tracking Immunization is a mandatory expense for the Ministry of Finance and Budget. The government uses a Monthly Activity Report (rapport mensuel d’activité, RMA) to track expenditures from the health district level. Legislation for Sustainability Section II (Economic, Social and Cultural Rights and Duties), Article 19 of the 1992 Constitution of Madagascar states: “The State shall recognize every individual’s right to protection of his health, starting from conception.” Decree 2003‐1162 (Organisant la Médecine d’Entreprise), Article 13, Chapter II, states that corporate medical providers must offer preventive care to workers and their families. In February 2012, an immunization law drafting committee was established. The committee finalized a draft immunization bill thereafter. Peers from other Francophone African SIF countries proposed amendments to the draft bill in November 2012. The committee incorporated these amendments. In June 2015, Members of Parliament (MPs) and government officials worked on the bill. Budget Advocacy In February 2016, two Malgache MPs attended and signed a Parliamentary Statement in Support of the

Ministerial Conference on Immunization in Africa.

http://www.sabin.org/sites/sabin.org/files/madagascar_financial_report_0.pdf

http://www.servat.unibe.ch/icl/ma00000_.html

http://www.servat.unibe.ch/icl/ma00000_.html

http://www.mfptls.gov.mg/Decret%20travail/decret2003-1162smie.pdf

SIF Program Inputs

September 2010, November 2012, December 2014, June 2016: Cameroonian counterparts join

DRC, Congo, Malgache, Malian, and Senegalese peers in Sabin-sponsored peer review

workshops

August 2015: Sabin Senior Program officer convenes NAHC Chairman, Senatorial Secretary’s

Cabinet Chief, and seven Committee Members to track progress towards establishment of an

advocacy committee

June 2015: Sabin Senior Program Officer co-organizes third legislative workshop

June 2012: Malgache counterparts share draft immunization bill with DRC officials in Sabin-

sponsored study tour

November 2011: Sabin Senior Program Officer organizes national advocacy and legislative

workshop

June 2011: Sabin Senior Program Officer and SIF Program Director organize MP briefing

February 2011: Sabin Senior Program Officer organizes MP briefing

December 2009: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Malgache government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 655,000 770,132 783,133 752,471 381,163 874,747 614,218 1,907,315 337,615





6530) 18.00 26.00 10.00 9.00 5.00 21.00 4.00 6.00 2.00

Government Expenditure on Routine Immunization - US$ (JRF 6540) 677,525 1,190,459 1,340,822 2,912,052 413,955 911,352 1,296,420 2,126,347 N/A

US$ per Surviving Infant 1.06 1.82 2.02 4.30 0.60 1.29 1.79 2.88 N/A

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 8,534,024 3,936,215 19,518,800 37,136,162 N/A

US$ per Surviving Infant N/A N/A N/A N/A 12.34 5.57 27.02 50.23 N/A



Data Accuracy Indicators Met* 1/1 1/1/ 1/1 1/1 6/6 5/6 6/6 6/6 4/4



MADAGASCAR




Mali July 2016

Mali is pursuing financial sustainability for its immunization services through budget advocacy and expenditure

tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Mali in December

2008.


Mali’s Expanded Program on Immunization (EPI) is located in the Immunization Section, Disease Control &

Prevention Division, National Health Directorate, Ministry of Health (MOH).

Mali’s Progress to Date



Expenditure tracking

Budget Advocacy

SIF Program Inputs


Over the period 2006-2014, Mali’s Gross National Income rose from US$470 to $720 per capita, a 53 percent

increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Malian government spent less than

$1 on routine immunization per surviving infant in 2006. In 2013, this figure rose to $8, an eight-fold increase. In

addition, the government share of total routine immunization expenditures rose from 7 percent to 17 percent over

the period. Since 2010, Mali has reported inconsistently on JRF financial indicators. The data suggest that Mali

has progressed towards country ownership of its immunization program. Among SIF countries, Mali ranked 12th

in terms of routine immunization spending per surviving infant in 2014.

MALI’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014.


Chapter III, Article 17 of Mali’s Constitution (1992) recognizes the citizens’ right to health.

In August 2012, government and parliament finalized a draft immunization bill. Amendments were incorporated

the following November. The draft bill was sent to the Health Minister in July 2014.


SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In 2013, the

EPI team utilized this tool to analyze the program’s 2010-2012 budget performance.

Budget Advocacy

The National Assembly established a Parliamentary Network for Immunization in January 2013.In August 2015,

sixty MPs belonged to the Network.

In July 2015, the EPI Manager analyzed budget execution, presented corrected expenditure figures to the Inter-

Agency Coordinating Committee and used the information to secure a budget increase for FY2016.

In February 2016, a Malian MP attended and signed a Parliamentary Statement in Support of the Ministerial

Conference on Immunization in Africa.


http://www.sabin.org/sites/sabin.org/files/mali_financial_report.pdf

http://confinder.richmond.edu/admin/docs/Mali.pdf

SIF Program Inputs



March 2016: Senior Program Officer, EPI Manager, Ministry of Health Budget Office Director, and parliament

co-organize Action Plan meeting

September 2015: Senior Program Officer briefs EPI Manager

June 2015: Malian EPI officials join Senegalese and Cameroonian peers in Sabin-sponsored resource

tracking peer exchange

August, December 2009, October 2011, January, February 2013, November 2014: Sabin Senior Program

Officer organizes MP briefing

December 2013: Sabin Senior Program Officer and WHO counterparts co-organize cMYP workshop

May 2012: Sabin Senior Program Officers from Cameroon and DRC, WHO, UNICEF, and AMP co-organize

cMYP workshop

December 2009: Malian counterparts join Senegalese legislators in MP briefing

December 2008: Sabin Senior Program Officer, SIF Program Director introduce SIF program to Malian

government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 212,496 1,609,060 2,356,940 3,155,950 5,577,700 N/A 2,051,456 2,717,494 4,816,882

US$ per Surviving Infant 2 0.39 2.91 4.11 5.33 9.16 N/A 3.23 4.20 7.31

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 27,557,500 N/A 16,676,881 19,875,721 19,811,382

US$ per Surviving Infant N/A N/A N/A N/A 45.28 N/A 26.24 30.71 30.07


6530) 77 100 20 100 20 N/A 12 14 24

Government Expenditure on Routine Immunization - US$ (JRF 6540) 127,498 1,793,510 1,177,220 61,228 6,066,690 N/A 2,193,072 13,145 5,482,191

US$ per Surviving Infant 0.24 3.24 2.05 0.10 9.97 N/A 3.45 0.02 8.32

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 28,046,500 N/A 30,669,803 26,070,948 33,078,851



Government (JRF 6560) 57 36 44 13 18 N/A 13 16 N/A

Data Accuracy Indicators Met* 0/1 1/1 0/1 0/1 6/6 N/A 6/6 5/6 5/5





MALI


Mongolia July 2016

Mongolia is pursuing financial sustainability for its immunization services primarily through expenditure tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Mongolia in June 2012. Immunization Program Structure Mongolia’s National Immunization Program (NIP) is located in the National Center for Communicable Disease Control, Ministry of Health (MOH). Mongolia’s Progress to Date Government Spending on Immunization Legislation for Sustainability Vaccination Financing Mechanism Expenditure Tracking Government Spending on Immunization Over the period 2006-2014, Mongolia’s Gross National Income rose from US$1,120 to $4,320 per capita, a 286 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Mongolian government spent less than $1 on routine immunization per surviving infant in 2006. The government reported spending the same amount in 2014. The government share of total routine immunization expenditures dropped from 29 percent to 0 percent over the period. Since 2010, Mongolia has reported inconsistently on JRF financial indicators. The data suggest that Mongolia has not progressed towards country ownership of its immunization program. Among SIF countries, Mongolia ranked 21st in terms of routine immunization spending per surviving infant in 2014. MONGOLIA’S JRF FEEDBACK REPORT ON FINANCIAL INDICATORS, 2006-2014. Legislation for Sustainability The Constitution of Mongolia (1992) guarantees certain rights and freedoms, including “the right to the protection of health and health care. The procedure and conditions of free medical aid shall be defined by law.” In Mongolia, legislation has to determine from time to time what health services should be free and to whom. Mongolia’s Government passed the Law on Immunization in April 2000. The law regulates activities for the “prevention of the Mongolia population from and immunization against infectious diseases.” An Immunization Fund was later established under this law to mobilize and manage funds for immunization from various sources. The Immunization Law was amended in 2010. Vaccination Financing Mechanism Adopted in March 2001, Government Resolution 67 approved regulations establishing the Immunization Fund and its operations. The Fund was established as an independent legal entity governed by a Fund Council. The Immunization Fund finances routine, non-routine and emergency vaccines and organizes the transportation of routine and non-routine vaccines to local centers. Expenditure Tracking In May and November 2014, Mongolia’s Tax Department (Ministry of Finance), National Department of Communicable Diseases (NCCD) and two parliamentarians visited two aimags (provinces), Hovd and Umnogobi, to brief local authorities on federal immunization and health expenditures and to propose local expenditure tracking.


http://www.sabin.org/sites/sabin.org/files/mongolia_financial_report_0.pdf

http://www.servat.unibe.ch/icl/mg00000_.html

In May and September 2015, NCCD, MOF and parliamentarian counterparts carried out similar resource tracking activities in two additional aimags, Huvsgul and Hentii. In February 2016, NCCD, MOF and a parliamentarian joined local officials in Hentii to examine sub-aimag (soum) health expenditure flows. SIF Program Inputs

July 2014, May 2016: Mongolian counterparts join Nepalese, Sri Lankan, Cambodian, Indonesian and Vietnamese peers in Sabin-sponsored peer review workshops

May and November 2014, May and September 2015: Sabin Senior Program Officer joins Sabin-sponsored subnational resource tracking workshops

February 2016: Resident Sabin Senior Program Officer convenes Mongolian counterparts to review, plan subnational immunization resource tracking activities

January 2013, November 2015: Resident Sabin Senior Program Officer organizes parliamentary briefings

October 2014: Mongolian counterparts host Ugandan and Vietnamese peers in Sabin-sponsored peer exchange

November 2013: Mongolian counterparts join Mongolian and Indonesian delegates in Sabin-sponsored peer exchange workshop

June 2012: Resident Sabin Senior Program Officer and SIF Program Director introduce SIF program to Mongolian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,3 41.7 55.2 84.0 66.8 89.1 120.2 145.7 147 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 4,500 510,169 1,271,186 1,082,488 1,307,970 1,474,722 1,344,102 2,373,153 4


All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 1,634,840 2,138,556 1,802,974 2,815,597 5



6530) N/A 19 61 64 80 69 75 84 88

Government Expenditure on Routine Immunization - US$ (JRF 6540) 1,640 190,000 183,613 528,649 10,277 1,539,363 1,357,274 2,668,095 4


All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 43,455 2,242,682 1,829,472 2,821,634 6



Government (JRF 6560) 29 19 22 46 24 69 74 95 74




MONGOLIA




Nepal July 2016

Nepal is pursuing financial sustainability for its immunization services through legislation, expenditure tracking and new financing arrangements. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Nepal in December 2008. National Immunization Program The Nepali National Immunization Program (NIP) is in the Child Health Division (CHD), Department of Health Services (DOHS), Ministry of Health and Population (MOHP). Nepal’s Progress to Date Legislation for Sustainability




SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Nepal’s Gross National Income rose from US$350 to US$730 per capita, more than doubling. According to the WHO/UNICEF Joint Reporting Form (JRF), the Nepali government spent $12 on routine immunization per surviving infant in 2006. By 2014, this figure had fallen to $4, a 67 percent decrease. In addition, the government share of total routine immunization expenditures dropped from 63 percent to 22 percent over the period. Since 2010, Nepal has reported inconsistently on JRF financial indicators. The data suggest that Nepal has not progressed towards country ownership of its immunization program. Among SIF countries, Nepal ranked 17th in terms of routine immunization spending per surviving infant in 2014. NEPAL’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability The Constitution of Nepal, enacted on 20 September 2015, stipulates in Article 51(h)(5) that, “[t]he State shall gradually increase necessary investment in the public health sector in order to make citizens healthy,” and in Article 51(h)(8) that “[t]he State shall gradually increase investment in the health sector and make it service-oriented by regulating and managing the investment of the private sector in it.” In 2010, MPs signed the Kathmandu Declaration, which called for the passage of immunization-related legislation. Nepal’s government and parliament drafted the immunization bill in 2011-2014. The bill was passed in January 2016. The President enacted the bill 22 days later In February 2016, four committees were assigned to develop regulations and oversee the implementation of the immunization law Vaccination Financing Mechanism Both a public immunization fund — the National Immunization Fund — and a public-private immunization fund — the Sustainable Immunization Support Fund — are under development. National Immunization Fund: An earmarked tax is proposed. Any unused health budget funds will be rolled into the fund at the end of each fiscal year. Sustainable Immunization Support Fund: Being capitalized by Rotary and Lions club members, other private domestic stakeholders. Donors to the private fund will be given tax credits.


http://www.sabin.org/sites/sabin.org/files/nepal_financial_report_0.pdf

https://www.ilo.org/dyn/natlex/docs/MONOGRAPH/100061/119815/F-1676948026/NPL100061%20Eng.pdf

Tracking Expenditure Flows SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In 2014, the NIP team used this tool to analyze the performance of the Program’s 2011-2013 budgets. In June 2015, the NIP team distributed expenditure tracking guidelines to district immunization authorities. In September 2015, the district authorities submitted budget data to the NIP team. SIF Program Inputs

July 2014, May 2016: Nepalese counterparts join Sri Lankan, Cambodian, Mongolian, Vietnamese, and Indonesian delegates in Sabin-sponsored peer review workshops

March 2013, January, March 2016: Parliamentary Coalition for Immunization, Ministry of Finance Revenue Management Division, Rotary leaders discuss immunization financing strategies

March 2012, January 2013, June 2014, September 2015: Resident Senior Program Officer organizes legislative workshops

February, June 2014, June 2015: Resident Sabin Senior Program Officer and Child Health Division, Ministry of Health and Population, organize subnational resource tracking workshop

September 2009, January 2010, May 2014, September 2014, December 2014, April 2015: Resident Sabin Senior Program Officer, Ministry of Health and Population organize parliamentary briefings

February 2014, September 2015: Senior Program Officer organizes media briefings

October 2012: Nepalese counterparts join Cambodian peers in peer exchange workshop

May 2012: Senior Program Officer, UNICEF, and Nepalese government co-organize two subnational briefings

March 2012: Nepalese counterparts join Sri Lankan and Cambodian delegates in Sabin-sponsored peer exchange workshop

December 2008: Resident Sabin Senior Program Officer and SIF Program Director introduce SIF program to Nepalese government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,36.9 8.3 10.6 11.5 14.8 18.8 14.2 17.0 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 798,025 1,794,132 3,129,007 1,946,871 3,918,544 1,781,114 1,963,750 2,170,476 1,904,662





6530) 18 29 43 16 39 20 45 36 29



All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 12,801,592 14018614.3 23689422.2 9,754,334 9,735,011



Government (JRF 6560) 63 25 30 15 8 22 84 46 22




NEPAL




Nigeria July 2016

Nigeria is pursuing financial sustainability for its immunization services through a new financing arrangement, budget advocacy and legislation. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Nigeria in February 2009. Immunization Program Structure The National Program on Immunization (NPI) is located in the National Primary Health Care Development Agency (NPHCDA), a parastatal institution under the Federal Ministry of Health. Nigeria’s Progress to Date Government Spending on Immunization Vaccination Financing Mechanism Legislation for Sustainability Budget Advocacy SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, Nigeria’s Gross National Income rose from US$840 to $2,970 per capita, a 254 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Nigerian government spent $17 on routine immunization per surviving infant in 2006. By 2014, this figure had fallen to $8, a 53 percent decrease. In addition, the government share of total routine immunization expenditures dropped from 87 percent to 24 percent over the same period. Since 2010, Nigeria has reported inconsistently on JRF financial indicators. The data suggest that Nigeria has not progressed towards country ownership of its immunization program. Among SIF countries, Nigeria ranked 13th in terms of routine immunization spending per surviving infant in 2014. NIGERIA’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Vaccination Financing Mechanism A Public Health Fund was established by the National Health Law in February 2014. The Fund is to be financed by contributions from federal and state revenues. In 2015, the Nigerian National Immunization Financing Task Force (NIFT) was established. One of the NIFT’s main directives is to establish an external public-private partnership Immunization Financing Trust Fund (IFTF) to complement the Public Health Fund. Legislation for Sustainability Chapter I, Part 1, Article 17 of Nigeria’s 1999 Constitution states: “The State shall direct its policy towards ensuring that there are adequate medical and health facilities for all persons.” Parliament began drafting the National Health Bill in 2004. In 2013, the Senate Health Committee inserted a provision guaranteeing public vaccine financing. The Bill was passed by Congress in February 2014 and approved by the President in December 2014.


http://www.sabin.org/sites/sabin.org/files/nigeria_financial_report.pdf

http://www.nigeria-law.org/ConstitutionOfTheFederalRepublicOfNigeria.htm

Budget Advocacy In 2015, NIFT began sensitizing domestic stakeholders and channeling advocacy messages on sustainable immunization financing through local and social media. SIF Program Inputs

October 2015, April 2016: Nigerian counterparts join Kenyan, Ugandan, Liberian, and Sierra Leonean peers in Sabin-sponsored peer review workshops

December 2015: Sabin Senior Program Officer invited to attend National Roundtable on Local Vaccine Production and the National Immunization Financing Trust Fund

August 2015: Nigerian counterparts join Sierra Leonean and Liberian peers in Sabin-sponsored peer exchange workshop

October 2010: Sabin Senior Program Officer and SIF Program Director organize parliamentary briefing

February 2009: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Nigerian government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 20.1 26.8 32.5 23.2 21 28.9 28.2 26.2 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 26,133,100 N/A 21,000,000 11,920,800 14,400,000 N/A N/A 40,629,508 37,227,051

US$ per Surviving Infant 4.98 N/A 3.84 2.13 2.51 N/A N/A 6.59 5.91

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 20290900 N/A N/A 73,764,508 90,962,051

US$ per Surviving Infant N/A N/A N/A N/A 3.54 N/A N/A 11.97 14.44


(JRF 6530) 100 N/A 90 74 71 N/A N/A 55 41

Government Expenditure on Routine Immunization - US$ (JRF 6540) 89,599,000 N/A N/A N/A 23,825,400 N/A N/A N/A 49,205,698

US$ per Surviving Infant 17.07 N/A N/A N/A 4.15 N/A N/A N/A 7.81

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 26,836,300 N/A N/A N/A 204,675,066

US$ per Surviving Infant N/A N/A N/A N/A 4.68 N/A N/A N/A 32.50


Government (JRF 6560) 87 N/A 70 N/A 89 N/A N/A N/A

Indicator

Removed

Data Accuracy Indicators Met* 1/1 N/A N/A N/A 5/5 N/A N/A 4/4 5/5

NIGERIA




Senegal July 2016

Senegal is pursuing financial sustainability for its immunization services primarily through budget advocacy. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Senegal in December 2008. Immunization Program Structure Senegal’s Expanded Program on Immunization (EPI) is located in the Medical Prevention Department of the Ministry of Health and Prevention (MOHP). Senegal’s Progress to Date Government Spending on Immunization



Budget Advocacy

SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Senegal’s Gross National Income rose from US$800 to $1,050 per capita, a 31 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Senegalese government spent $4 on routine immunization per surviving infant in 2006. Senegal spent the same amount in 2014. The government share of total routine immunization expenditures dropped from 58 percent to 8 percent over the period. Since 2010, Senegal has reported inconsistently on JRF financial indicators. The data suggest that Senegal has not progressed towards country ownership of its immunization program. Among SIF countries, Senegal ranked 16th in terms of routine immunization spending per surviving infant in 2014. SENEGAL’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Vaccination Financing Mechanism An MoH steering committee began developing a private immunization trust fund in April 2011. Legislation for Sustainability Chapter I, Article 7 of the Senegalese Constitution (2001) guarantees citizens the right to health, and. Article 17 guarantees that the state will provide health services to families. In November 2012, a drafting committee began drafting a national immunization bill. The bill was later amended to incorporate suggestions from a Sabin-sponsored peer exchange workshop. In October 2015, the immunization law project was inserted as an activity in the country’s comprehensive multi-year plan (cMYP). In January 2016, The Ministries of Health and Finance began reviewing the draft bill. In February 2016, MPs and MOH counterparts agree to insert the draft immunization law into a draft universal health care law. Budget Advocacy In January 2015, a Parliamentary Coalition for Immunization was established.


http://www.sabin.org/sites/sabin.org/files/senegal_financial_report.pdf

http://www.gouv.sn/IMG/pdf/Constitution.pdf

In July 2015, the EPI team and Parliamentary Coalition for Immunization convinced the Finance Minister to increase the 2016 immunization budget by 83 percent. In February 2016, a Senegalese MP attended and signed a Parliamentary Statement in Support of the Ministerial Conference on Immunization in Africa. SIF Program Inputs

September 2010, November 2012, December 2014, June 2016: Cameroonian counterparts join DRC, Congo, Malgache, Malian, and Senegalese peers in Sabin-sponsored peer review workshops

August, December 2009, September 2010, June, July 2013, November 2014, January, November 2015, February, April 2016: Sabin Senior Program Officer organizes parliamentary briefings

October 2015: Sabin Senior Program Officer co-organizes GVAP/cMYP workshop

June 2015: Malian and Cameroonian counterparts join Senegalese peers in Dakar for a Sabin-sponsored resource tracking peer exchange

May 2012, November 2013: Sabin Senior Program Officer, MOH partner agency counterparts co-organize immunization financing workshop

December 2008: Sabin Senior Program Officer, SIF Program Director introduce SIF program to Senegalese government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) N/A 1,709,620 2,001,270 1,736,050 1,639,610 1,856,220 1,018,136 2,012,336 2,272,920

US$ per Surviving Infant 2 N/A 4.11 4.69 3.95 3.61 3.97 2.08 3.96 4.32




6530) 37 31 100 17 100 32 27 27 8

Government Expenditure on Routine Immunization - US$ (JRF 6540) 1,561,120 5,430,560 1,700,000 51,061 1,639,610 N/A 7,980,174 881,332 2,272,920

US$ per Surviving Infant 3.80 13.05 3.98 0.12 3.61 N/A 16.30 1.73 4.32

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 1,639,610 N/A 26,466,465 5,925,873 27,587,200







SENEGAL




Sierra Leone 2016

Sierra Leone is pursuing financial sustainability for its immunization services through legislation and expenditure tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Sierra Leone in October 2008. Immunization Program Structure Sierra Leone’s Expanded Program on Immunization (EPI) is located in the Medical Services Directorate, Primary Health Care Division, Ministry of Health and Sanitation (MOHS). Sierra Leone’s Progress to Date Government Spending on Immunization Expenditure Tracking Legislation for Sustainability Budget Advocacy SIF Program Inputs Government Spending on Immunization Over the period 2006-2014, Sierra Leone’s Gross National Income rose from US$330 to $720 per capita, more than doubling. According to the WHO/UNICEF Joint Reporting Form (JRF), the Sierra Leonean government spent less than $1 on routine immunization per surviving infant in 2007. By 2014, this figure had risen to $7. In addition, the government share of total routine immunization expenditures rose from 0 percent to 22 percent over the period. Since 2010, Sierra Leone has reported inconsistently on JRF financial indicators. The data suggest that Sierra Leone has progressed towards country ownership of its immunization program. Among SIF countries, Sierra Leone ranked 14th in terms of routine immunization spending per surviving infant in 2014. SIERRA LEONE'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Expenditure Tracking In June 2012, the EPI team developed a subnational expenditure tracking tool for routine immunization. The EPI team performed partial budget flow analyses for 2010-13 using the SIF budget flow analysis tool. District-level disbursements were included in the analyses. Legislation for Sustainability Chapter II, Section 8 (Social objectives), Provision 3 of the 1991 Sierra Leonean Constitution states that the government will ensure that all citizens have easy access to adequate medical and health facilities. An MOHS team began drafting a cabinet paper in October 2015. The paper is to facilitate preparation and submission of a private member’s immunization bill to Parliament. Budget Advocacy In January 2014, a Multi-Institutional Network on Immunization was established. Members include representatives from MOHS, Ministry of Finance and Economic Development (MOFED), and parliament. In July 2015, the Parliamentary Health Committee Chairman visited Bombali district to assess immunization resource mobilization and execution.


http://www.sabin.org/sites/sabin.org/files/sierra_leone_financial_report.pdf

http://www.sierra-leone.org/Laws/constitution1991.pdf

SIF Program Inputs

October 2015, April 2016: Sierra Leonean counterparts join Kenyan, Ugandan, Nigerian, and Liberian peers in Sabin-sponsored peer review workshops

August 2015: Sierra Leonean counterparts join Nigerian and Liberian peers in Sabin-sponsored peer exchange workshop

March 2010, November 2013, May 2015: Sierra Leonean counterparts join Liberian peers in Sabin-sponsored peer exchange workshops

August, October, November 2009, June 2012: Resident Sabin Senior Program Officer organizes parliamentary briefing

November 2011: Sierra Leonean officials visit Makeni and Bo municipalities under Sabin sponsorship

August 2010: MOFED official surveys Ugandan budgetary strategies in Sabin-sponsored study tour

December 2009: Liberian EPI Manager visits Sierra Leonean counterparts in Sabin-sponsored peer exchange

October 2008: Resident Sabin Senior Program Officer and SIF Program Director introduce SIF program to Sierra Leonean government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 0 0 56,000 55,000 N/A 89,500 N/A 322,000 360,000

US$ per Surviving Infant 0 0 0.29 0.28 N/A 0.44 N/A 1.60 1.78

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A N/A 3610500 N/A 4,985,272 5,070,999



(JRF 6530) N/A 0 2 N/A N/A 2 N/A 6 7

Government Expenditure on Routine Immunization - US$ (JRF 6540) N/A 0 908,941 N/A N/A 7,837 N/A 459,907 1,395,039

US$ per Surviving Infant N/A 0 4.66 N/A N/A 0.04 N/A 2.28 6.90

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A N/A 3,618,337 N/A 5,283,362 6,466,038



Government (JRF 6560) N/A N/A N/A N/A N/A 0 N/A 9

Indicator

Removed

Data Accuracy Indicators Met* 1/1 1/1 1/1 N/A N/A 5/6 N/A 6/6 5/5


SIERRA LEONE




Sri Lanka

July 2016 Sri Lanka is pursuing financial sustainability for its immunization services through expenditure

tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Sri

Lanka in December 2008.

Immunization Program Structure Sri Lanka’s immunization services are managed by the Epidemiology Unit, located in the Family Health Bureau, Ministry of Health (MOH).

Sri Lanka’s Progress to Date




SIF Program Inputs

Government Spending on Immunization Over the period 2006-2014, Sri Lanka’s Gross National Income rose from US$1,350 to US$3,400 per capita, a 152 percent increase. According to WHO/UNICEF Joint Reporting Form (JRF), the Sri Lankan government spent $25 on routine immunization per surviving infant in 2006. By 2014, this figure had dropped to $19, a 24 percent decrease. While decreasing in absolute terms, the government reported that its share of total routine immunization expenditures rose from 77 percent to 93 percent over the period. Since 2010, Sri Lanka has reported inconsistently on JRF financial indicators. The data nevertheless suggest that Sri Lanka has progressed towards country ownership of its immunization program. Among SIF countries, Sri Lanka ranked fifth in terms of routine immunization spending per surviving infant in 2014.

SRI LANKA'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Vaccination Financing Mechanism A National Immunization Policy was approved by the Ministry of Health in April 2014. Chapter 5 of the policy guarantees that the government will provide sufficient funding for the timely procurement and supply of quality vaccines and logistical support. It further stipulates that the government will establish a separate line item for the National Immunization Program (NIP) within the Ministry of Health budget, and that all provincial authorities must ensure the timely availability of adequate funds and other resources. Chapter 5 also establishes a mechanism to monitor the financial sustainability of the NIP.


http://www.sabin.org/sites/sabin.org/files/sri_lanka_financial_report.pdf

Expenditure Tracking The Epidemiology (EPI) Unit examined immunization costs in Kalutara district in September 2014. The immunization costing study was expanded to include seven out of the nation’s twenty five districts, and revealed that the estimated cost to immunize one child under five years is about $13. SIF Program Efforts

July 2014, May 2016: Sri Lankan counterparts join Nepalese, Cambodian, Mongolian,

Vietnamese, and Indonesian delegates in Sabin-sponsored peer review workshops

June 2013: Sabin Senior Program Officer organizes national briefing

February 2013: Sabin Senior Program Officer, Ministry of Health counterparts organize subnational briefing, propose immunization co-financing

February 2012: Ministry of Health begins series of SIF-assisted district-level costing studies

February, July 2010, August 2011, March 2012: Sabin Senior Program Officer, Ministry of

Health, partner agency counterparts organize parliamentary briefings

December 2008: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Sri Lankan government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,327 28 31 31 37 39 34 45 N/A

Government Expenditure on RI Vaccines - US$ (JRF 6510) 1,810,416 1,553,225 40,000 2,000,000 218,013,000 2,040,225 N/A 1,961,203 4,514,300

US$ per Surviving Infant 2 4.94 4.28 0.11 5.53 608.82 5.77 N/A 5.84 13.77

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 8,050,000 5,264,025 N/A 4,772,203 4,812,650



6530) 68 31 90 100 57 39 N/A 41 94

Government Expenditure on Routine Immunization - US$ (JRF 6540) 9,040,711 9,764,756 N/A 4,000,000 12,384,000 N/A N/A 13,913,997 6,139,013

US$ per Surviving Infant 24.68 26.93 N/A 11.06 34.58 N/A N/A 41.41 18.73

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 16,139,721 N/A N/A 13,953,000 6,595,363



Government (JRF 6560) 90 67 95 95 77 97 N/A 100 93

Data Accuracy Indicators Met* 1/1 1/1 N/A 1/1 4/6 2/2 N/A 6/6 6/6



SRI LANKA




Uganda July 2016

Uganda is pursuing financial sustainability for its immunization services through legislation and expenditure

tracking. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Uganda in

September 2008.


The Ugandan National Expanded Program on Immunization (UNEPI) is located in the Directorate of Clinical

and Community Services, Department of National Communicable Disease Control, Ministry of Health

(MOH).

Uganda’s Progress to Date




Budget Advocacy

SIF Program Inputs


Over the period 2006-2014, Uganda’s Gross National Income per capita doubled from US$340 to $680.

According to the WHO/UNICEF Joint Reporting Form (JRF), the Ugandan government spent $3 on routine

immunization per surviving infant in 2006. In 2014, government contributions rose to $11 per surviving

infant, more than tripling. In addition, the government share of total routine immunization expenditures rose

from 13 percent to 49 percent over the period. Since 2010, Uganda has reported inconsistently on JRF

financial indicators. The data suggest that Uganda has not progressed towards country ownership of its

immunization program. Among SIF countries, Uganda ranked eighth in terms of routine immunization

spending per surviving infant in 2014.

UGANDA'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014.


An earmarked immunization fund is provided for in Uganda’s 2016 National Immunization Act.


The Constitution of Uganda lacks a substantive provision on the right to health; the right is mentioned under

the directive principles of government policy. Parliament has the mandate to make laws to operationalize

that constitutional right.

A desk review of immunization-related by-laws was completed in 2010. Work on an immunization bill began

in September 2011. In October 2014, Sabin arranged a study tour for a team of MPs and government

officials to Mongolia where a law and immunization fund already exist. In March 2015, the Ugandan

counterparts incorporated provisions for an immunization fund into the draft bill. The bill was sent to the

Health Committee in November, 2015, where it was approved and sent up for a full parliamentary vote. The

bill was passed the following month. The President signed the National Immunization Act into law on 10

March 2016. Regulations for implementing the law are under preparation.

Budget Advocacy

A Parliamentary Network on Immunization was established in February 2012.


http://www.sabin.org/sites/sabin.org/files/uganda_financial_report.pdf

http://www.uganda.at/Geschichte/verfassung_der_republik_Uganda_2008.pdf

http://www.sabin.org/sites/sabin.org/files/uganda_immunization_act_2015.pdf

SIF Program Inputs

June 2012, October 2015, April 2016: Ugandan counterparts join Kenyan, Nigerian, Sierra Leonean, and Liberian peers in Sabin-sponsored peer review workshops

March 2015: Resident Sabin Senior Program Officer organizes legislative workshop

September 2009, September, November 2014: Resident Sabin Senior Program Officer organizes

parliamentary briefings

October 2014: Ugandan counterparts study Mongolia’s immunization law and fund in Sabin-

sponsored study tour

February 2010, April 2012, April 2013, March 2014: Resident Sabin Senior Program Officer,

Ugandan Local Government Association, other counterparts organize national briefings

November 2011, January 2012: Resident Sabin Senior Program Officer and ULGA co-organize subnational briefings

September/October 2008: Resident Sabin Senior Program Officer introduces SIF program to Ugandan government


Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 2,000,000 2,906,977 4,413,620 2,021,228 1,639,048 2,860,099 N/A 3,006,424 4,337,739

US$ per Surviving Infant 1.66 2.36 3.49 1.55 1.23 2.09 N/A 2.10 2.96

All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A 4575450 15096699 N/A 18,949,424 29,851,928



(JRF 6530) 8 15 N/A 13 36 19 N/A 16 15

Government Expenditure on Routine Immunization - US$ (JRF 6540) 3,500,000 2,965,117 939,470 3,605,904 N/A 2,031,691,005 N/A 4,987,097 16,150,943

US$ per Surviving Infant 2.90 2.41 0.74 2.77 N/A 1485.03 N/A 3.49 11.03

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A N/A 2,032,617,887 N/A 20,939,393 33,056,604



Government (JRF 6560) 13 15 60 21 21 100 N/A 24

Indicator

Removed

Data Accuracy Indicators Met* 1/1 1/1 0/1 1/1 N/A 6/6 N/A 6/6 5/5


UGANDA




Uzbekistan July 2016

Uzbekistan is pursuing financial sustainability for its immunization services primarily through

legislation. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in

Uzbekistan in September 2015.


Uzbekistan’s National Immunization Program (NIP) is located in the Department of Sanitary and

Epidemiological Surveillance, Ministry of Health.

Uzbekistan’s Progress to Date



Resource Tracking

SIF Program Inputs


Over the period 2006-2014, Uzbekistan’s Gross National Income increased from US$600 to

$2,090 per capita, a 248 percent increase. According to the WHO/UNICEF Joint Reporting Form

(JRF), the Uzbekistani government spent $2 on routine immunization per surviving infant in 2006.

By 2014, this figure had risen to $13, more than a six-fold increase. In addition, the government

share of total routine immunization expenditures rose from 64 percent to 72 percent over the

period. Since 2010, Uzbekistan has reported inconsistently on JRF financial indicators. The data

nevertheless suggest that Uzbekistan has progressed towards country ownership of its

immunization program. Among SIF countries, Uzbekistan ranked seventh in terms of routine

immunization spending per surviving infant in 2014.

UZBEKISTAN’S JRF FINANCIAL FEEDBACK REPORT, 2006-2014. Legislation for Sustainability Uzbekistan enacted its Law on the Sanitary & Epidemiological Welfare of the Population in August

2015. The law defines the responsibilities of immunization authorities within government and is

intended to promote greater accountability.

The NIP and Ministry of Health Economics & Funding Forecasting Directorate are analyzing immunization-related legislation. Resource Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. In April 2016, the NIP team completed the SIF budget flow analysis for 2010-15. The analysis revealed the approved budget for immunizations sextupled from 2010 to 2016.


http://www.sabin.org/sites/sabin.org/files/uzbekistan_financial_report.pdf

SIF Program Inputs

April 2016: Sabin Senior Program Officer orients counterparts to SIF budget flow analysis tool

September 2015: Sabin Senior Program Officer introduces SIF program to Uzbekistani Parliamentary Labor & Social Affairs Committee, NIP team, and the MOH Economics, Finance, & Forecasting Directorate

Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014


Government Expenditure on RI Vaccines - US$ (JRF 6510) 1,010,418,224 1,297,377 1,469 2,557,201 2,687,500 3,323,710 4,345,992 3,575,000 3,444


All Source Expenditures on Vaccines - US$ (JRF 6520) N/A N/A N/A N/A N/A N/A 6,689,655 7,280,500 5,201,560

US$ per Surviving Infant N/A N/A N/A N/A N/A N/A 10.61 11.35 8.03


6530) 64 64 55 58 N/A N/A 41 49 0

Government Expenditure on Routine Immunization - US$ (JRF 6540) 1,010,418,224 1,297,377 1,469 301,608,579 318,750 N/A N/A 9,366,500 8,669,267

US$ per Surviving Infant 1952.25 2.42 0.00 520.10 0.53 N/A N/A 14.60 13.38

All Source Expenditures on Routine Immunization - US$ (JRF 6550) N/A N/A N/A N/A 3,006,250 N/A N/A 13,072,000 10,836,584



Government (JRF 6560) 64 64 2 N/A 11 N/A N/A 72 80

Data Accuracy Indicators Met* 1/2 1/2 1/2 1/2 2/3 N/A 1/2 6/6 6/6



UZBEKISTAN



Vietnam

July 2016 Vietnam is pursuing financial sustainability for its immunization services through expenditure tracking and legislation. The Sabin Sustainable Immunization Financing (SIF) Program began efforts in Vietnam in October 2012. Immunization Program Structure

Vietnam’s Expanded Program on Immunization (EPI) is located in National Institute for Hygiene & Epidemiology (NIHE), Ministry of Health. Vietnam’s Progress to Date

Government Spending on Immunization Legislation for Sustainability Expenditure Tracking Budget Advocacy Government Spending on Immunization

Over the period 2006-2014, Vietnam’s Gross National Income rose from US$760 to $1,890 per capita, a 149 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Vietnamese government spent $5 on routine immunization per surviving infant in 2006. By 2014, this figure had risen to $9, an 80 percent increase. While increasing in absolute terms, the government share of total routine immunization expenditures dropped from 65 percent to 44 percent over the period. Since 2010, Vietnam has reported consistently on JRF financial indicators. The data suggest that Vietnam has progressed towards country ownership of its immunization program. Among SIF countries, Vietnam ranked 11th in terms of routine immunization spending per surviving infant in 2014. VIETNAM'S JRF FINANCIAL FEEDBACK REPORT, 2006-2014.


Of 63 provinces, the number reporting any immunization spending with local revenues rose from 24 in 2012 to 38 in 2015. Subnational financing represents less than ten percent of total government immunization spending. Legislation for Sustainability

The Constitution of Vietnam, Chapter III, article 39 states: “The state shall invest in, develop and exercise its unified management over health care activities for the people. It shall mobilize and organize all social forces to build and develop Vietnamese medicine, especially preventive medicine; combine disease prevention with medical treatment; develop and combine modern and traditional medicine and pharmaceutical practices; combine the development of state health care with folk medicine; offer health insurance; and create conditions for citizens’ access to medical care.” Passed in 2007, the Law on Prevention and Control of Infectious Diseases guarantees immunization financing. Clause 1, Article 30 states that “the State shall ensure funds for the use of vaccines and medical bio-products.” The Ministry of Health and Ministry of Justice drafted a new immunization decree in 2015 with financing provisions complementing the 2008 Law on Prevention and Control of Infectious Diseases. Expenditure Tracking SIF provides a tool for analyzing how efficiently recent immunization budgets have been executed. The EPI

team performed annual SIF budget flow analyses for 2011-2015. Prior to 2013, nearly half of Vietnam’s provincial immunization programs tracked expenditures. Since 2013, nearly all have been doing so. In September-October 2015, a parliament and government team visited three provinces to survey the past year’s subnational expenditures.


http://www.sabin.org/sites/sabin.org/files/vietnam_financial_report.pdf

Budget Advocacy

In October 2015, parliamentarians used subnational resource tracking results to defend the FY2016 budget.

2014: Using budget flow results, Vietnamese counterparts averted a proposed cut, won an EPI budget increase. During 2015-2016, parliamentarians and EPI team organized annual provincial-level stakeholder workshops to discuss immunization financing, share expenditure data. Provincial governments increased their immunization spending 55 percent during 2012-2014. Central government EPI budget increased by 35 percent 2014-2015. SIF Program Inputs

July 2014, May 2016: Vietnamese counterparts join Mongolian, Indonesian, Nepalese, Sri Lankan, and Cambodian peers in Sabin-sponsored peer review workshops

October 2015: Sabin Senior Program Officer organizes Sabin-sponsored parliamentarian briefing

May 2013, May 2014, September, October 2015: Sabin Senior Program Officer joins Sabin-sponsored subnational immunization financing workshops

October 2014: Vietnamese counterparts survey Mongolia’s immunization law, fund in Sabin-sponsored study tour

November 2013: Vietnamese counterparts hosted Sabin-sponsored peer review workshop for Mongolian and Indonesian peers

October 2012: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Vietnamese government


1

Variables 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total Government Expenditure on Health in US$ per capita 1,315.1 22.9 24.0 30.1 38.5 42.3 43.6 47 N/A






6530) 80 87 88 80 28 30 34 43 43






Government (JRF 6560) 65 70 70 85 39 33 36 40 44




VIETNAM




sabin sif country fact sheets vii.2016

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