Sabin peer review workshop on sustainable immunization financing Abuja, Nigeria April 2016 Sierra Leone Case: Allocating budget line for routine immunization services

The new practice Description of the new practice?  That the Government of Sierra Leone allocates budget line for routine immunization services What problem does the new practice address? Identify the problem  No budget line for EPI Service delivery. Actual routine immunization program costs were unknown.  Immunization program funds combined with other directorates and departments of the Ministry of Health and Sanitation. How was the problem identified?  Limited budget allocated for EPI Service delivery.  Delayed payment of Government co-financed portion for the GAVI vaccines. Explain why the problem is important Immunization program costs are rising. A strong investment case is needed to justify larger budgets. How long has the new practice been underway? The practice has been underway since 2006.

The new practice Which institution(s) or organization(s) are involved in the new practice?  CH/EPI Program  Directorate of Financial Resources  Ministry of Finance and Economic Development (MoFED), and  Parliament (the Legislature)  At the District level, the Local Councils oversee the activities of the District Health Management Teams (DHMTs) …includes immunization How does each organization/institution participate?  CH/EPI Program does the implementation of all immunization services.  The Directorate of Financial Resources in the Ministry of Health and Sanitation oversees the financial allocation and supervises the expenditure.  The MoFED does the budget allocation and,  Parliament approves the budget.

The new practice Activities/ interventions/ inputs CH/EPI Program:  Plans immunization activities based on cMYP and costs them  Submits request to the Directorate of Financial Resources for budgeting/funding  Receives the funds and expend them according to the plan at national, districts and health facility levels  Monitors and supervises implementation of activities and  Report on the activities/finances

The new practice Key individuals (positions) engaged  Dr. Brima Kargbo, Chief Medical Officer  Dr. Santigie Sesay, Director of Reproductive and Child Health  Dr. Dennis H. Marke, Child Health/EPI program Manager  Mr. Alusine Kargbo, Director of Financial resources, MoHS Proportion of their effort Dr. Dennis H. Marke: 70% Dr. Brima Kargbo, 10% Dr. Santigie Sesay, 10% Mr. Alusine Kargbo, 10% How often does the activity take place (continuously, periodically, one-off)?  Plans are developed and submitted annually  Immunization financial budget allocation is done annually, and  Disbursement is done quarterly. The reporting on financial expenditure are also done quarterly.

How it began Describe the champions in each institution/organization who developed the new activity In August MoHS, MoFED and Parliament jointly finalized the TOR & composition of multi-institutional network on Immunization. January the network was established. May Peer exchange meeting in Freetown on reactivating Post-Ebola resource mobilization and immunization financing advocacy: Agreed to implement immunization resource tracking framework.

How it began In August resolutions were made to: a.Enact, promulgate & implement legislation on immunization b.Mobilize immunization funds through the imposition of “sin” taxes (on tobacco & alcohol); c.Establish National Immunization Trust Funds. August 2015 – Held planning meeting with Parliamentary clerks:  Resolved to pass immunization provision through the Public Health Act of 1960 (currently being revised)

How it began What challenges or difficulties were encountered and what did the champion(s) do to overcome them? Challenges  Periodic change of parliamentarians  Frequent changes of CH/EPI Programme Managers How they were overcomed?  Recruited Focal Point & establishment of immunization financing advocacy committee.  Reduced regular transfers of EPI Programme Managers.

Significance Scale up and spread Has the new practice been taken up by other organizations/institutions?  Not quite. Advocacy is ongoing to the level of ensuring match amongst different layers of immunization budget. Could the practice be adopted in other countries?  Yes. Effectiveness How has the new practice moved the country closer to the sustainable immunization financing goal?  Improved JRF financial reporting improved. Awareness raised on immunization financing. Immunization bill development is ongoing. Is the practice sustainable? Why or why not?  With Enact of an immunization bill and establishing an immunization trust fund, immunization financing will be sustained.

Thank you