A’ishatu, a mom of six kids in Bauchi state, Nigeria, absolutely vaccinated her final little one on August 16, 2023. She was first launched to vaccination by a conventional delivery attendant in 2016 when her first little one was born.

In the final 4 years, the Nigerian authorities has labored diligently to make sure constant, seamless, and equitable entry to major healthcare and immunization companies to caregivers comparable to A’ishatu. In many low- and middle-income international locations like Nigeria, donors and improvement companions are the cornerstone for funding for choose major care applications, together with immunization companies. However, this funding is usually not long-term, and conditional on the nation finally taking full possession and accountability for financing the supported well being program. The Nigerian authorities has been making strides in direction of sustainable self-financing of its immunization companies over the previous few years. As the nation strikes away from its present reliance on Gavi assist, the progress it has made to date will stand as a sturdy basis guaranteeing the continuity and accessibility of those very important companies for folks like A’ishatu.

Nigeria stands among the many 73 Gavi implementing nations which have obtained assist from Gavi for delivering immunization-related companies. This help encompasses technical support, campaigns, bolstering well being techniques, and buying chilly chain provides. Through Gavi monetary assist, Nigeria launched life-saving vaccines such because the pneumococcal conjugate, inactivated poliovirus, pentavalent (PCV), rotavirus (RV), and human papillomavirus vaccines (HPV).

Figure 1: Nigeria Immunization program trajectory

Nigeria’s street to sustained self-financing.

From 2016-2018, Nigeria’s Gross National Income (GNI) per capita exceeded US$1,580 for 3 consecutive years, main it to surpass the Gavi’s assist threshold. Resultantly, Nigeria was thrusted into the Gavi’s accelerated transition to self-financing part. In response, Nigeria with assist from CHAI and different companions and donors comparable to Gavi, BMGF, WHO, UNICEF, USAID, Solina, and Sydani begun to arrange techniques in place to organize for sustained self-financing to make sure that caregivers like A’ishatu will proceed to have entry to all vaccinations kids will want.

Road Map and Accountability Framework. The improvement of the Nigeria Strategy for Immunization and PHC System Strengthening (NSIPSS) was the preliminary step in getting ready for the Gavi transition. Developed by the Federal Government of Nigeria (FGoN) in collaboration with CHAI and different technical companions and donors, the NSIPSS was accepted by the Gavi Board in 2019. The primary aim of this NSIPSS technique was to extend FGoN’s funding in immunization and first healthcare, in addition to the general well being system. A prerequisite for approval of the NSIPSS by the Gavi Board was the event of an Accountability Framework (AF) to trace the success of FGoN commitments yearly. The accountability framework was backed by a Letter of Commitment from a tripartite allegiance of the Federal Ministry of Finance, the Federal Ministry of Health, and the Federal Ministry of Budget and National Planning. The AF was designed to incorporate parameters that measure well being financing, programmatic efficiency, monetary administration, and governance parts with a complete of 15 indicators to trace the nation’s efficiency.

Strengthening Domestic Financing. Prior to the transition, immunization actions have been financed by loans and grants from donors comparable to Gavi and vaccine financing was not included within the nationwide funds. To guarantee caregivers comparable to A’ishatu proceed to have entry to vaccination through the transition, the Nigerian authorities wanted to begin financing its vaccination and first healthcare program by home assets. The authorities created a funds line for vaccine financing within the 2019 nationwide funds below the service-wide vote (a centralized pool of funds managed by the Ministry of Budget and National Planning used for contingencies and significant areas of nationwide curiosity) to satisfy its tripartite dedication per the NSIPSS. Since 2019, the nation has continued to make an annual incremental provision for vaccine financing by a service-wide vote with a 34.2 % improve between 2019 (US$60.7 million) and 2023 (US$148.1 million).[1] The authorities plans to construct on this progress by the inclusion of vaccine financing as a first-line cost merchandise on the nationwide funds which is a extra sustainable funding supply as it will likely be a statutory allocation from consolidated income and the discharge won’t be topic to bureaucratic delays.

Figure 2: Nigeria’s projected co-financing obligation till transition

Efficient Forecasting and a Financing Plan. The transition necessitated the necessity for correct and efficient forecasting reflecting the nation’s wants. Nigeria has carried out a number of changes to the forecasts to develop capability and institutionalize the method and make the projections as almost exact as attainable. For instance, previous to the transition, the annual forecast was carried out on the nationwide degree, resulting in incorrectly estimated demand on the state degree. With technical assist from CHAI and different companions comparable to UNICEF, this has been optimized and is now state-specific. In addition to transitioning to a state-specific forecast, the service-wide vote budgeting cycle wanted to make sure the forecast is built-in into the nationwide funds. Currently, the nationwide logistics working group is tasked with forecasting the vaccines want by May of yearly in time for submission to the funds workplace by July, when the budgeting cycle commences.

Upon conclusion of the forecast, the Vaccine Finance Plan (VFP) for financing the procurement of antigens and gadgets shall be developed with the Federal Government of Nigeria and Gavi as the 2 principal funders. The VFP will see an annual lower in Gavi’s dedication over the 10-year transition interval with a corresponding improve within the Federal Government of Nigeria’s share. After the VFP is developed, it’s accepted by the ICC, the Ministers of Health, Finance and Budget, and National Planning. The quantity allotted to the Federal Government is communicated to the funds workplace for inclusion within the National Budget.

Figure 3: Nigeria’s forecasting and budgeting timeline

Novel Tools for Visibility and Data use. To present visibility and advocate for change, the vaccine distribution course of wanted to be clarified. The authorities with companions’ and MDAs assist developed a complete course of map overlaying vaccine funding from forecasting by the ultimate disbursement of funds for procurement from the UNICEF provide division. The course of map was created to enhance understanding of the vaccine financing course of, draw consideration to course of bottlenecks, and encourage effectivity of the vaccine financing course of.

Figure 4: Nigeria’s Vaccine Fund request course of map

Developing a Multi-Sectoral Approach. Stakeholders in any respect ranges have been essential to Nigeria’s efforts to finance immunization actions sustainably. The Vaccine Finance and Accountability Task Team (VFATT), constituting conventional and non-traditional stakeholders, has been arrange with an overarching aim of guaranteeing environment friendly and sustainable vaccine financing over the Gavi transition interval. It was additionally tasked with guaranteeing that Nigeria constantly meets the agreed targets for all the indications on the Accountability Framework for the NSIPSS. The roles and tasks of the duty crew embrace, monitoring the progress of implementation of the accepted NSIPSS Accountability Framework, monitoring immunization funds and vaccine utilization, growing the annual vaccine financing (VF) plan, and strengthening advocacy for immunization and first healthcare financing. The activity crew meets month-to-month to debate funds budgeting, disbursement, utilization, and the standing of the AF indicators. The activity crew performs an necessary function in proffering options to immunization financing challenges and guaranteeing that the nation meets its co-financing obligation.

A Call to Action. The authorities of Nigeria has made immunization and PHC financing a precedence since 2018 and thru sturdy advocacy and political dedication, elevated its co-financing for immunization by 34.2 %.[2] The consequence has been the institutionalization and resiliency of immunization self-financing. However, the monetary stability of immunization actions stays unsure within the face of a constrained fiscal coverage and the necessity for newer vaccines. Gavi reported that out of the 19 international locations which have transitioned as of 2022, 13 haven’t but launched at the very least considered one of pneumococcal conjugate, rotavirus, or human papillomavirus vaccines.[3]

Figure 5: Nigeria evaluation of fund launched since transition

To retain the immunization beneficial properties achieved through the years and proceed the introduction of recent vaccines put up Gavi assist, the federal government wants to make sure:

• well timed focused high-level stakeholder engagement
• quantification and forecasting
• advocacy and political dedication
• enhanced and sustainable financing
• the continual monitoring of the accountability framework

For different international locations heading towards transition, there’s a want for sturdy collaboration and alignment between the nation’s monetary decision-makers and the EPI stakeholders/ministries of well being. This could be achieved by steady advocacy and the identification of a champion amongst lawmakers. Several instruments and processes can support advocacy, nonetheless, a key lesson for sustainability is that this course of needs to be government-owned and led.

*Name modified to guard anonymity.

Written by Kikelomo Lambo, Sima Unogu, Akachi Mbogu, Shadrack Mngemane and Dr. Owens Wiwa / Clinton Health Access Initiative, Nigeria