1. Introduction: Immunization as a Public Good Dr. Michael McQuestion Ms. Diana Kizza Mugenzi Dr. Cliff Kamara Ms. Dana Silver Sustainable Immunization Financing Program Anglophone African Peer review workshop Abuja, Nigeria 19-21 April 2016

2. Introduction Sabin SIF Program: Funded by Bill & Melinda Gates Foundation (2008- present) and GAVI Alliance (2012-present) Fifteen pilot countries chosen in 2008 in consultation with GAVI partners, seven more (GAVI-graduating) countries in 2012 Seven Senior Program Officers based in Africa (4), Asia (2), Europe (1) backed by three Washington, DC-based Sabin staff

3. The Sustainable Immunization Financing Program The SIF Program facilitates and catalyzes efforts to secure sustainable funding for immunization programs in twenty-two lower and middle income countries SIF Senior Program Officers coordinate directly with counterparts in government ministries and parliaments, subnational decision makers and the private sector to develop innovative financing solutions

4. SIF Domains Financing Arrangements Budget, resource tracking Domestic advocacy Legislation

5. SIF Graduation Criteria Financing Arrangements: Self-sufficiency. Domestic financing covers all routine immunization functions except new vaccine introduction Composition. Federal, provincial, and municipal governments jointly finance routine immunization Sustainability. Financing is structured in a way that protects finance flows from economic, political, or institutional disruptions Legislation. Public financing for immunization is guaranteed by law

6. SIF Graduation Criteria Budget and oversight: Method. Routine immunization budget is based on actual expenditures Disbursement. Treasury disburses full approved immunization program budget to Ministry of Health Allocation. Ministry of Health allocates full disbursed budget to immunization program Resource tracking. In-year program expenditures are tracked at national and subnational levels Absorptive capacity. Immunization program spends 90% or more of its allocated budget Reporting. Allocated immunization budget and expenditures are reported to the finance office in the Ministry of Health Oversight. Legislators oversee execution of approved immunization budget

7. SIF Graduation Criteria Policy and advocacy: Policy. Routine immunization program explicitly supported in national health policy/plans/expenditure frameworks Transparency. Federal and subnational officials, parliamentarians, the public are regularly informed about immunization outputs and expenditures (value for money) Representation. Parliamentarians participate in immunization-related field activities

8. Public Goods Public (collective) good: “The achievement of a common goal, or satisfaction of a common interest” (Olson 1965) Under certain conditions, actors in a collectivity will provide a public good through collective action –Unattainable individually: can only be provided collectively –Jointness of supply: available to everyone if available to anyone –Non-excludability: cannot be feasibly withheld from any group member Examples: –A lighthouse, an army, a public education system, an immunized society, a world without polio (Smith et al. 2007) –The SIF Program’s public good is a sustainably financed national immunization program

9. Necessary conditions for collective action  Monitoring and feedback on the contributions each actor makes toward the public good  Monitoring and feedback on progress being made toward the goal (efficacy)  Strategies change as needed  Actors learn from one another  Individual actors are publicly recognized for their contributions Collective action

10. In practice, collective action is a process, a series of individual decisions about whether to participate or not An actor decides, taking into account the decisions of nearby others (threshold effect) (Oliver et al 1985) If there is an organizing group, or a critical mass of committed actors, it is more probable the collective action will succeed

11. Examples of collective activities for sustainable immunization financing  MoH, MoF and counterparts regularly analyze expenditures and program outputs together to make the investment case for immunization  MoH, MoF and parliamentary counterparts meet regularly to discuss this updated information and follow immunization budget performance throughout the year  Parliament participates actively in formulating sector budget  Parliamentarians regularly visit, assess immunization performance in their constituent areas SIF Program: Collective action

12. Collective action ends when the country finds its particular sustainable financing solution  Adequate, reliable funding  External dependencies minimized or eliminated  Supporting legislation enacted SIF Program: Collective action

13. Vaccine Action Plans Global Vaccine African Vaccine Action Plan (GVAP)Action Plan (RSPI)

14. Institutional change Institutional change occurs when a new practice (innovation) is scaled up and spreads across an organizational field Each organization is unique and experiences the innovation in its own way new practices emerge and spread in unpredictable fashion (Trenholm and Fairlie 2013)

15. Institutional change These are observable processes  Champions and those they engage produce texts- written, spoken, symbolic- for or against the new practice  Connecting these texts, actors construct the innovation, arriving at a common understanding of the meaning of the new idea or practice (Phillips and Malhotra 2008) Have you observed them? Are you a champion?

16. Innovation Indicators Nigeria SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP Mongolia SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP Vietnam SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP Congo SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP Sri Lanka SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP Indonesia SIF Domain 20112012201320142015 Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2 Legislation Advocacy Coalition Financing Mechanism Resource Tracking GVAP

17. Innovation Indicators

18. Thank You!!!