As Gavi withdraws support, can Nigeria sustain immunization financing beyond 2017?
In the past two decades, Nigeria has made good progress in the routine immunization programme. With the introduction of new vaccines and expansion of the immunization coverage, child survival has improved as evidenced by a 31 percent reduction in infant mortality between 2003 and 2013 (NDHS 2003 & 2013). Since 2001, Gavi, Bill and Melinda Gates Foundation and other donors have been providing funding support towards vaccines procurement and strengthening of our health systems for effective delivery of immunization services. The Gavi funding is for countries whose Gross National Income per capita is below the eligibility benchmark of $1580; with the rebasing of its economy in 2014, Nigeria has exceeded this benchmark and therefore ineligible for the support. Consequently, we have begun a five-year accelerated exit transition phase of Gavi funding beginning from this year (2017).
According to the National Immunization Comprehensive Multi-Year Plan (cMYP 2016-2020), Gavi funding shall witness annual progressive decrease from $199 million in 2017 to $74 million in 2021 while funding from the Federal Government is expected to rise annually and progressively from $123 million in 2017 to $279 million in 2021. Although the rapid ramp down of Gavi funding begins this year, the rollover of excess vaccine stock and existing loans will cushion the impact of the transition on the 2017 budget, as only 21% of need was budgeted for. In 2018, the situation will be very different. Without additional loans or carry over vaccines, Nigeria must come up with $141 million (N43 billion) to meet its co-financing obligations. Given the prevalent tight fiscal space and uninspiring macroeconomic indices, the feasibility of raising a single budget line item by four and half times (from $25M to $I41M) is still an open question.
Since 2016, there has been an active and growing advocacy for increased health financing largely led by three advocacy coalitions – the National Immunization Financing Task Team (NIFT), Partnership for Advocacy in Child and Family Health (PACFaH) and the Women Advocates for Vaccine Access (WAVA). The rallying calls of the advocates have been revolving around; one – budgeting no less than 1% of the consolidated revenue fund for the Basic Health Care Provision Fund (as stipulated by Section 11 of the National Health Act, 2014), two – attaining Abuja Declaration of at least 15% of nation’s budget for health and three – increasing the immunization budget line to address the funding gap resulting from the Gavi transition. Despite the advocacy efforts made in the previous year, the 2017 budget proposal however does not capture the 1% of CRF for BHCPF, neither has the percent of the national budget for health risen significantly, at 4.17%. A major limitation is that the Ministry of Health must operate within the budget envelope provided by the Ministry of Budget and National Planning.
From 2018, very large budget increments for immunization will be needed per annum till 2021 and beyond. Can Nigeria afford this? I believe we can. As such, a solid government transition plan endorsed and accepted by all stakeholders, that includes measure to expand the fiscal space, will be necessary to guarantee sustainable funding. To achieve this, there is need for a continuous high level advocacy, prioritization of immunization financing along with polio end game, ramped up mobilization of grassroots support for immunization as well as regular public engagement through various media platforms.
In conclusion, the International Vaccine Access Centre (IVAC) advocates for the development and endorsement of the Sustainable Immunization Financing (SIF) Transition Plan by the federal government and will continue to provide evidence to support advocacy, strengthen the coordination of advocacy through the NIFT and WAVA, nurture key champions in the legislature and media and also cultivate champions in the Ministry of Budget and Planning and Ministry of Finance.