Measles Initiative Financing February 28, 2007 Washington, D.C. Andrea Gay UN Foundation for Measles Partners

SUMMARY OF ACHIEVEMENTS mortality reduction goal achieved 60% reduction worldwide 75% in Africa >360 million children vaccinated in SIAs 2.3 million additional deaths prevented HOW ACHIEVED? Commitment, Proven Strategy and Resources [$] 7th year of partnership meetings 6th year of financial reports Initial 2 years MI had 3 grants/year for WHO AFRO (total nightmare) 3rd year moved to annual budget and to WHO EMRO, SEARO Now in 7th year moving to biannual budget with front-loaded funding to all WHO regions This is PROGRESS!

Measles Initiative Funding History : total $20 million (CDC, ARC, UNF) in AFRO * [20] 2002: total $20 million (CDC, ARC, UNF) plus CIDA $3 million in AFRO [23] 2003: total $18.25 million (CDC, ARC, UNF, Vodafone Fdn) plus CIDA $11.3 million in AFRO; $4.0 million in EMRO/SEARO** [33.55] 2004: total $21.75 million (CDC, ARC,UNF, LDS, Vodafone Fdn, Gates Fdn) plus CIDA $12.4 million in AFRO [34.15] 2005: total $ million (CDC, UNF, ARC, GAVI, Vodafone) plus CIDA $6.3 million in AFRO and EMRO; tsunami funds from ARC totaling $81.2 million for S.E. Asia [ plus 81.2] 2006: total $34.22 million (CDC, UNF, ARC, GAVI, LDS) plus CIDA approx $9 million in AFRO & EMRO [43.22] TOTAL $ million plus country contributions, UNICEF (CDC, JICA, others) * IFRC contributed funds for national RC society volunteers since 2001 ** LDS contributed volunteers in country for campaigns since 2003

Measles Initiative Funds

Year After Year One Question Remains the Same Are anticipated resources sufficient to attain goal? Original 2005 goal attained New GIVS goal of 90% reduction in measles deaths by 2010 (vs. 2000) Additional Regional WHO targets: complete at least one follow-up campaign for all AFRO countries by end of 2009 (unless conflict country) – 30 country follow-ups will be complete by end 2007; all countries start follow-ups by end 2008 complete catch-up (Somalia, Sudan, Pakistan) campaigns in EMRO in 2007 Measles elimination in EMRO and EURO by 2010 Measles elimination in WPRO by 2012 SEARO? Target population during at least 274 million --- more resources available to increase speed and scope of SIA implementation

Measles Initiative Funding

Measles Initiative Funding Outlook : $11,333,000 (CDC, UNF) 2010: $11,333,000 (CDC, UNF) 2007 – 2010 estimated funding need is $479 million (Measles Investment Case II) excluding country contributions (notably India) MI has (if all goes well) $ million through 2010 GAP = $ million minus country contributions [India]

Key Issues and Challenges for Initiative with Funding Implications Lower incidence of measles may lead to declining financial support Increasing costs for SIAs (staff, transport, vaccines, surveillance)?? Sustaining and expanding surveillance – increase costs Increasing country budget support – decrease costs Addressing 2 nd routine dose (potential GAVI/IFFIm funds) – decrease costs Coordination of integration activities and identification of cost savings: increase cost sharing for add-ons to SIAs will decrease cost; with polio will increase costs Defining, piloting integrated M&E methods including routine immunizations, ITN use – increase or decrease costs (who pays?)

Routine Immunization Strengthening Support by Measles Initiative [global increase from 71 to 77% between 1999 and 2005; in Africa, increase from 50 to 65%] Cold chain equipment (carriers, ice packs) EPI staff training (national to local) Injection safety (assessment, AD syringe introduction) Waste management (incinerators) Surveillance (staff, data managers) Laboratory network (equipment, kits) Swaziland example: funds used to improve injection safety skills of EPI staff; printing of tools to initiate RED in all districts for monitoring coverage; supervisor training to prepare for implementation of RED strategy in 2007

Ro utine Immunization Strengthening Measles Initiative Contribution Since 2004, 10% of Measles Initiative funds to WHO AFRO for SIA operational costs are made available to countries to strengthen routine immunization systems during year of SIAs To access these funds, countries submit plans to AFRO for review & approval; funds used primarily for RED (Reaching Every District) activities UNICEF contributes remaining SIA funds for purchase of bundled vaccines, cold chain, social mobilization – amount varies with country and is affected by wastage rate, accuracy of target population, etc In 2006, WHO sent $810,000 to 7 countries Zimbabwe ($40,000), Swaziland ($10,000), Burundi ($25,000), Angola ($75,000), Rwanda ($30,000), DRC ($230,670), Nigeria ($400,000) What about countries who have completed SIAs in previous years? Should MI funds also support these routine systems each year?

Measles Initiative Funding for Case- Based Surveillance in AFRO 2006 Total 35 countries under CB surveillance $824,710 total 2006 contribution $762,710 sent to 26 countries [range $9, ,000] $62,000 additional sent for lab operational costs in 25 countries [$2-3,000/country]

Child Health Interventions Beyond Measles Vaccinations Opportunities Vitamin A (CIDA) Routine immunization strengthening (MP, GAVI, others) OPV (PEI) ITNs – approximately18 million ITNs distributed with measles campaigns Deworming medication (mebendazole from Johnson & Johnson) Others Child Health Days as vehicle – cIMCI Note: Funds for ITNs to distribute during measles campaigns from Global Fund, IFRC, PMI, WB, ExxonMobil, Izumi Fdn, Vodafone Fdn, Mark Gordon, Rotary, UNF’s Nothing But Nets Note: funding is primarily parallel to MP process

Strategy Needed to Close the Funding Gap Goals: GIVS goal of 90% mortality reduction by 2010 Elimination goals of each WHO region with latest date set at 2012 Goals for SEARO and AFRO? What is reasonable to expect from country support? By when? Changes: Implementing at increased speed with increase in funding Preparation process in countries improved with draft POA largely available at start of 2007 Funding disbursed more rapidly – this week almost $100 million is at UN agency HQs and will be sent to regions/countries next week Annual reports received on time this year Increase in country support for operational costs of follow-up campaigns Management:: We have always managed with what we have available – can this continue? What lessons can we use to help with resources (ex: wastage rate) IDEAS ARE WELCOME