1. Overview of the cMYP Process GAVI IRC Training, Geneva, 5 October 2012 Ahmadu Yakubu Claudio Politi

2. Overview of cMYP process | 24 July 2012 2 Planning cycle Set goals and standards Make policies and decisions Plan and budget Implement Review and assess

3. Overview of cMYP process | 24 July 2012 3 Three types of EPI planning Multiyear strategic planning Annual planning Project planning cMYPs aPOA Vacc forecast Distrib.system Vacc. Introduction SIAs Coverage Improvement Plans

4. Overview of cMYP process | 24 July 2012 4 cMYP – background Multi-year plans, strategic plans have been in existence for a long time, before cMYP, before GAVI, but frequently… – …not comprehensive (separate plans for separate components of EPI) – … not strategic (more reactive to govt or donor direction) – … uncosted cMYP was designed to change all this, replacing the GAVI Financial Sustainability Plan (FSP) Common criticism of MYPs in the past: – Rapidly becomes irrelevant to the programme – Becomes a shelf document without consequence – Out of step with internal MoH or governmental planning – “Wish list” without financial or political backing – Inflexible, unable to address new situations, especially in later years – Perception that the primary incentive to develop a cMYP is to apply or extend support from GAVI

5. Overview of cMYP process | 24 July 2012 5 What is a comprehensive Multi-Year Plan (cMYP)? A long term strategic and operational plan (3 - 5 years) Comprehensive, consolidated, costed plan (including funding analysis and gap analysis), ideally aligned to the health sector planning cycle Should be guided by GVAP in translating global and/or regional goals into national programme priorities, includes activities to solve identified problems and to reach national and global goals Aims to improve the programme performance Based on situational analysis (review or desk) and recent reviews and assessments Comprehensive and integrating: – Addresses all components of the immunization system: management, logistics, social mobilization,… – Focus on immunization system, rather than on disease specific initiatives (e.g. Polio, MNT). – Integrates activities: solve shared problems, avoid duplication. – Links closely to the National Health Plan in terms of priorities, budgets and timing Considers contextual issues and different scenarios Articulates how annual Plans of Action (aPoA) would be monitored

6. Overview of cMYP process | 24 July 2012 6 Multi-year Plan for EPI MTEF Global EPI Priorities FSP National Health Sector Plan Situational Analysis / EPI Review Donor projects / requirement Other Proposals to donor / funders Annual Plans of Action Budgets ICC Documents & Activities

7. Overview of cMYP process | 24 July 2012 7 When should a MYP be developed? Country decision, but ideally in synchronization with the national health sector planning cycle Ideally 1 year before the expiry of the current plan, or earlier if current plan is out of date. Will require annual review and updating In initiating the development or revision of a cMYP, take a team approach: – call a meeting with all sections of the immunization system, – Provide and use as much recent data as possible – Joint analysis and identification of problems and solutions. – Obtain consensus about objectives, strategies, directions.

8. Overview of cMYP process | 24 July 2012 8 Conducting situation analysis Steps for creating a cMYP Setting national objectives and priorities Planning strategies and key activities by system components Analyzing the costs, financing, and financial gaps Putting the cMYP into action: approval, dissemination, implementation, monitoring Using GVAP framework as a guide and checklist Making an activity timeline

9. Overview of cMYP process | 24 July 2012 9 Steps for creating an Annual Plan of Action (aPOA) Developing annual plan for relevant year from MYP Integrating and consolidating activities for implementation Prioritizing activities using district data analysis Costing and completing the annual plan

10. Overview of cMYP process | 24 July 2012 10 Development of an aPOA Ideally to be undertaken in Oct/Nov for the coming year, and should have elaboration of all the activities planned for the year cMYP should have been updated if required Key components – Description of all the planned activities for identified strategies in cMYP – Consolidation of the activities – Prioritization of activities – Dates and time frames for implementation – considering other planned activities – Resources required and source of financing – Responsible person/entity – Monitoring mechanism (including indicators)

11. Overview of cMYP process | 24 July 2012 11 Benefits of aPOA Clear deliverables at all levels Understandable and realistic targets Opportunity to amend if required Building team work and cooperation Facilitating monitoring Sense of accomplishment for staff based on step by step implementation approach. Systematic process towards achieving the objectives of the Immunization programme.

12. Overview of cMYP process | 24 July 2012 12 Benefits of aPOA aPOA - from development to evaluation – Developed with consensus – Approved by competent authority – Copy provided to all concerned – Consulted frequently – Monitoring implementation – Evaluation – Provide basis for next POA.

13. Overview of cMYP process | 24 July 2012 13 Key reasons for unmet targets Overly-ambitious planning (time constraint!) Unrealistic workload on existing staff Delay in initiating the process Weak regular monitoring Lack of funds – Weak advocacy (for Govt. / Partners funds) – Financial constraints of Govt. /partners. Geographic areas that become inaccessible to the programme due to security issues

14. Overview of cMYP process | 24 July 2012 14 Costing & financing analysis in cMYPs Quite complex step requiring detailed cost information, understanding of the economic and health system financing context in order to: – Costing the cMYP objectives – Projecting sources of financing and gap analysis – Developing alternative costing and financing scenarios – Quantifying GAVI co-financing requirements Detailed cMYP Costing – Vaccines & Injection Supplies (Routine and campaigns) – Personnel Costs – Vehicles & Transport Costs – Cold Chain Equipment, Maintenance & Overheads – Operational Cost of Campaigns – Program Activities and Other Recurrent Costs – Other Equipment Needs and Capital Costs – Building & Building Overheads

15. Overview of cMYP process | 24 July 2012 15 The tool Excel File 3 worksheets for data entry 4 worksheets for results (tables and graphs) 1 big worksheet for calculations (approx 6,000 rows) Password protected 3.4 MB file

16. Overview of cMYP process | 24 July 2012 16 A balanced tool Standardization: – It requires to enter standardized information, for example: According to standard cost categories Gross monthly salary per each category of staff Sources of financing as 1) secured or 2) probable Flexibility: – It allows to introduce country specific features, for example: Administrative structures Typology of staff Different programme activities

17. Overview of cMYP process | 24 July 2012 17 Financing and gap analysis in cMYPs

18. Overview of cMYP process | 24 July 2012 18 Limitations It is a sensitive tool: – Data cannot be copied & pasted – A "," instead of "." can results in #VALUE Data entry process is data intensive - in countries that often lack of reliable data - and relatively time consuming. Frequently data entry and data analysis need assistance by consultants, RO focal points and EPI/HQ "Hotline" Methods for calculating shared costs are quite subjective (based on % of staff time, % car sharing, % building space) High risks of poor quality data entry and mistakes

19. Overview of cMYP process | 24 July 2012 19 cMYP integration in National Health Plans Recent analysis in GAVI eligible countries to document the extent of cMYP integration in NHP, based on the following criteria: i ) cMYP and NHP planning cycles cover the same time period; ii) cMYP situation analysis provides same information with regards to vaccine-preventable disease as the NHP situation analysis; iii) Key immunization goals and objectives are included in the NHP; iv) Key immunization specific milestones are reflected in the NHP; v) cMYP immunization M&E activities/indicators are incorporated into national M&E process/indicators.

20. Overview of cMYP process | 24 July 2012 20 cMYP integration in National Health Plans Preliminary findings on 43 countries analysed: 18 countries (42%) have cMYP fully integrated in NHP 23 countries (53%) have cMYP partially integrated in NHP 2 countries (5%) Not integrated / NA

21. Overview of cMYP process | 24 July 2012 21 Vaccine Requirements reflected in National Budgets Preliminary findings from 49 countries analysed: 24 countries (49%) have vaccine requirements -estimated in cMYP- reflected in National Budgets 25 countries (51%) have vaccine requirements –estimated in cMYP- reflected in National Budgets

22. Overview of cMYP process | 24 July 2012 22 Thank you