1. Overview of domestic immunization financing arrangements 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. Routine immunization costs

3. Source: UNICEF contract prices as of May 8, 2014. Calculations based on lowest available price. Abbreviations: RV=rotavirus; PCV=pneumococcal conjugate vaccine; Penta=pentavalent vaccine containing diphtheria-tetanus-pertussis- Haemophilus influenza type b (Hib)-Hepatitis B; DTP=diphtheria-tetanus-pertussis; MCV=measles-containing vaccine; MR=measles-rubella; OPV=oral polio vaccine; BCG=Bacillus Calmette-Guerin; HPV=human papillomavirus vaccine. Costs in current (2014) dollars. *Note: Adding a 3-dose course of HPV (4.50/dose) increases the 2014 vaccine cost to $35 for girls ages 9-13.

4. Increasing country investments

5. Improving JRF reporting Government R.I. expenditures per surviving infant (US$), SIF Country20102011201220132014 Armenia1525 86 Cambodia113624 Cameroon78456 Congo1591016 DR Congo01221 Ethiopia17213 Georgia4188214668 Indonesia215 410 Kenya4443 Liberia32 Madagascar1123 Mali9308 Moldova16 5247 Mongolia024214136 Nepal142663 Nigeria4 7 Senegal4 1727 Sierra Leone 0 26 Sri Lanka32 3515 Uganda 310 Uzbekistan11615 Vietnam67879 Mean913111319 Weighted mean51066 Sources: WHO/UNICEF Indicator 6730; UN Population Division Note: mid-year exchange rates used

6. Sources of immunization financing Domestic –Public revenues, royalties earmarked government funds –Private sector donations –Out-of-pocket (households) External –Foreign aid, loans –Gifts –Remittances (households)

7. Domestic financing mechanisms Public (governments) –Regular health budget federal sub-national –Social insurance programs –Special (ring-fenced) funds Private –Special funds (corporations) –Employment, private insurance (households)

8. Domestic financing mechanisms –National immunization financing by law actual: Georgia, Moldova, Mongolia, Nepal, Nigeria, Uganda proposed: Armenia, Cambodia, Cameroon, Congo Republic, DRC, Kenya, Liberia, Madagascar, Mali, Senegal, Sierra Leone, Sri Lanka, Uzbekistan –Shared federal and subnational financing actual: DRC, Sri Lanka, Vietnam proposed: Cameroon, Congo Republic, Kenya –Private trust fund actual: Nepal, Senegal proposed: Cambodia, Ethiopia, Georgia, Nigeria, Uganda, Uzbekistan (Status of SIF countries as of April 2016)

9. Thank You!!!

10. PEFA standards Credibility of the budget - The budget is realistic and is implemented as intended 2. Comprehensiveness and transparency - The budget and the fiscal risk oversight are comprehensive, and fiscal and budget information is accessible to the public. 3. Policy-based budgeting - The budget is prepared with due regard to government policy. 4. Predictability and control in budget execution - The budget is implemented in an orderly and predictable manner and there are arrangements for the exercise of control and stewardship in the use of public funds. 5. Accounting, recording and reporting – Adequate records and information are produced, maintained and disseminated to meet decision-making control, management and reporting purposes. 6. External scrutiny and audit - Arrangements for scrutiny of public finances and follow up by executive are operating