SABIN PEER REVIEW WORKSHOP ON SUSTAINABLE IMMUNIZATION FINANCING David Kiuluku Case: Development of Immunization Annual Work plan-Makueni County-Kenya 19th April 2016 4/19/2016

The new practice Description: Makueni County has been involved in the development of immunization specific Annual Work Plans(AWPs) with the County and sub-county health management teams. The AWPs costs activities, prioritizes activities and lists M&E indicators to track the plan. What problem is addressed by the new practice . Problem: County Government are responsible for immunizations services. -County Governments have limited funds and require to prioritize the funds for various functions. -There was a lack of clear and costed immunization plans -difficult to know the total immunization funding needs, prioritize interventions and to measure progress of the AWP. How it was identified: Inadequate planning and funding for immunization activities within the County Importance: Clearly articulated, costed and measurable plans are important as they make it possible to track activities and funds used. The new practice has been underway for the past one (1) year. 1st round was carried out in 2015. Of particular interest are new practices- new ways to work- in any of the key institutions concerned with immunization financing (ministry of health, ministry of finance, parliament, local government, non-government organization, other institutions) 4/19/2016

The new practice Institution(s) or organization(s) involved: County Government of Makueni, Clinton Health Access Initiative (CHAI), USAID-APHIA, How each organization/institution participates Activities/ interventions/ inputs: County and Sub-county Health Management Teams (CHMT and SCHMT) identified the need for costed plans. The County develop the AWP and provide costing inputs. CHAI provided the AWP templates, training and logistical support County Government fund raised for the Costed plans through County resources and partners. 50% of the plan is currently funded. Key individuals (positions) engaged: County Health Officer/Director, County Public Health Nurse, EPI Logistician, Sub-County Public Health Nurse, facility in charges! Proportion of their effort: CHMT – 50% CHMT identified resources and mobilized local and partner resources for the Makueni County plan. SCHMT – 50% The SCHMT focused on developing a detailed work plan. SCHMT focused on implementing the AWP. How often the activity takes place The AWP is developed annually and reviewed every quarter Of particular interest are new practices- new ways to work- in any of the key institutions concerned with immunization financing (ministry of health, ministry of finance, parliament, local government, non-government organization, other institutions) 4/19/2016

How it began The champions in the Department of Health who developed the new activity Roseline Kavata (County Public Health Nurse) took up the mantle in using the AWP as a basis to develop proposals and cabinet papers to seek funding for the specific activities articulated in the work plan. County Health Management Team(CHMT) supported the AWP by providing funds and fund raising for the plan from county resources and partner resources. CHAI supported the template development and trained the CHMT and SCHMT on how to develop the AWP template. Challenges or difficulties encountered and what the champion(s) did to overcome them. Funding for the work plan is challenging. The practice likely began in bottom-up (operational level), top-down (from the boss), collaborative or horizontal fashion (bringing in another organization). Describe the mechanism 4/19/2016

Significance Scale up and spread Has the new practice been taken up by other organizations/institutions? Yes, the development of immunization AWPs is currently carried out by five (5) counties in Kenya i.e. Garissa, Kilifi, Makueni, Nairobi and Nakuru Could the practice be adopted in other countries? Yes, other countries with devolved health functions could adopt this model Effectiveness How has the new practice moved the country closer to the sustainable immunization financing goal? It has increased knowledge/awareness of immunization funding needs It has improved tracking of immunization activities and funds The AWP has improved prioritization of activities Is the practice sustainable? Why or why not? Yes – with continued support from the County Government to develop and track the AWP Institutionalization is complete when the new practices are fully adopted across the organizational field and become taken-for-granted (Dacin et al 2002). 4/19/2016

Other comments Makueni County recognizes the importance of the Immunization services and prioritized development, funding and implementation of the AWP Makueni County has an immunization specific annual work plan that identifies all immunization specific activities in the county Prioritizes key immunization activities Cost all the immunization activities Identifies M&E indicators to track the AWP Makueni County was able to carry out 57% of the activities articulated in the annual work plan The total funding raised for these activities was USD 675,906 from the County resources and partner resources 4/19/2016

ASANTENI 4/19/2016