1. ROUTINE IMMUNISATION FINANCIAL RESOURCE NEEDS: 2016-2020 April, 2016 SAVING 716,662 LIVES BY 2020

2. PRESENTATION OUTLINE  CONTEXT  TOTAL RESOURCE REQUIREMENT  REASONS FOR RISING COST  FEDERAL GOVERNMENT OF NIGERIA PAST COMMITMENT  EFFORTS MADE  INITIATIVES TO BE EXPLORED SAVING 716,662 LIVES BY 2020

3. CONTEXT  Need to ensure availability of vaccines plus devices  Delays in budget passage  Delays in release of actual cash  Dwindling revenues  Increasing costs of new vaccines  Includes routine vaccines, supplementary vaccines, special vaccines, devices  Provision made for import related costs and distribution  Lead times for procurements of vaccines (4 months) and devices (7 months).  Significant funding AND cashflow implications. SAVING 716,662 LIVES BY 2020

4. TOTAL RESOURCE REQUIREMENTS SAVING 716,662 LIVES BY 2020  Total requirement:  Shared health system costs, vaccines, devices, advocacy, monitoring and disease surveillance, SIAs, program management costs etc.  2016: $1.4bn ($590m)*  2017: $1.54bn ($640m)*  2018: $1.55bn ($690m)*  2019: $1.52bn ($760m)*  2020: $1.51bn ($820m)*  *Vaccine supply & logistics (Routine only). Also includes cold chain and devices  **N199/$

5. ANTIGENS AND DEVICES ONLY SAVING 716,662 LIVES BY 2020  2016: $221.6m  2017: $211.6m  2018: $255.8m  2019: $326.1m  2020: $288.7m  *Includes logistics from ports to cold stores.

6. GoN Resource Requirement 2016-2020 SAVING 716,662 LIVES BY 2020  2016: $72.6m (GAVI: $149m)  2017: $90.6m (GAVI: $121m)  2018: $125.8m (GAVI: $130m)  2019: $183.1m (GAVI: $143m)  2020: $190.7m (GAVI: $98m)  GAVI-funded vaccines: routine: DTP-HepB-Hib, IPV, PCV10, RV1, Men A, HPV2, MR-10; supplementary: Men A. MR and HPV

7. REASONS FOR RISING RI COST SAVING 716,662 LIVES BY 2020  New and expensive vaccines  6 new vx planned btw 2014 and 2018  PCV (2 nd /3 rd stages), IPV, Rota, Men A, HPV.  Malaria Vx.  GDP Rebasing=Graduation from GAVI financing  GAVI graduation calculated linear increase in co-financing obligation between 2018 co-financing price and the 2021 vaccine price.  In 2021, the full market price occurs, and the GoN pays the full cost of vaccines and devices, and average freight; for new vaccines, the ramp-up is from the time of introduction to 5 years after introduction.

8. HISTORICAL APPROPRIATION FIGURES: GoN COMMITMENTS TO RI.  Appropriations for:  2010: N2.2 billion  2011: N5 billion  2012: N6 billion  2013: N4.15 billion  2014: N2.156 billion  2015: N2.615 billion  Augmentation through extra budgetary provisions SAVING 716,662 LIVES BY 2020

9. SOURCES OF FUND FOR IMMUNIZATION SAVING 716,662 LIVES BY 2020  There are two main sources available to the Government of Nigeria for funding total vaccine requirements as follows:  The annual appropriations  Foreign grants/Loans  World Bank IDA Facility  GAVI Alliance  Bill & Melinda Gates Foundation  UNICEF  Rotary International  Government of Germany (kfw)  Government of Japan (JICA)  DFID

10. Naira Requirements for Vaccines & Devices: 2016 - 2020 SAVING 716,662 LIVES BY 2020  2016: $72.6m (N14.4bn)  2017: $90.6m (N18bn)  2018: $125.8m (N25bn)  2019: $183.1m (N36.4bn)  2020: $190.7m (N37.9bn)  **at N199/$

11. CURRENT EFFORTS AT ENHANCING IMMUNIZATION FINANCING IN NIGERIA  Advocacy for Increased Budgetary Allocation  Engagement of the National Assembly  Governors’ Forum  Private Sector Health Alliance  Individual foundations  National Health Insurance Scheme  The National Health Act  Establishment of NIFT/NITF/LVP SAVING 716,662 LIVES BY 2020

12. THE CROSSROADS…  A decision has to be made:  Scale back our Routine Immunisation plans  OR  Look for alternative sources of funds to bridge the funding gaps (including the States). SAVING 716,662 LIVES BY 2020

13. QUESTIONS TO BE ADDRESSED SAVING 716,662 LIVES BY 2020  Is vaccine supply the responsibility of only the federal government?  How can other stakeholders fund vaccines  Budgetary releases at all levels  Feasibility of local production  Can the funding basket arrangement for Polio be replaced by that for Routine Immunization?  Creation of a vaccine security fund (VSF) financed by donations and private sector donations-the Lagos State Security Trust Fund model  Roles of Tetfund and NHIS wrt contributions to the VSF.

14. QUESTIONS TO BE ADDRESSED SAVING 716,662 LIVES BY 2020  Evidenced based advocacy-up to 800,000 lives to be saved  Role of Social media  Consistent messaging  The Corporate Social Responsibility budgets of companies  Immunisation must be on the political agenda: need for an advocacy plan to make this happen.  Telecommunications companies.

15. THE WAY FORWARD SAVING 716,662 LIVES BY 2020  FEDERAL GOVERNMENT AND STATES/LGAs MUST WORK TOGETHER TO CO-FINANCE VACCINES.  The Basic Health Fund may not solve the problem fully.

16. HOW?  FG should pay 52% of the costs, in line with the federal revenue allocation formula  The remaining 48% of costs should be divided between states in line with the Federal revenue allocation formula  With some adjustments to ensure equity  States should progress slowly towards paying their full share in 2021 SAVING 716,662 LIVES BY 2020

17. POSSIBLE OPTIONS SAVING 716,662 LIVES BY 2020  By target population  Each state pays in proportion to population with a single cost per child  By Federal Revenue allocation formula  Each state pays in proportion to the federal revenues received  By a combination of population and revenue  The federal revenue formula is adjusted to increase equity around cost per child

18. PRINCIPLES OF THE ADJUSTMENT OF THE FEDERAL REVENUE FORMULA SAVING 716,662 LIVES BY 2020  No state should pay more than they would without co-financing  States with large revenues compared to their populations should help to ensure immunization in other states  No state should pay a proportion of their revenue which is much greater than the weighted average of 0.44% (Total vaccines cost as percentage of each state’s federal revenue).

19. END SAVING 716,662 LIVES BY 2020  THANK YOU.