Task Team NIFT Presentation to the ED of NPHCDA Tuesday May 30 2017 Outline Chairmans report NIFT overview and membership Problem statement Funding options Sub committee reports Evidence generation ID: 787743
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Slide1
National Immunization Financing
Task Team (NIFT)
Presentation to the ED of NPHCDA
Tuesday, May 30, 2017
Slide2Outline
Chairman’s reportNIFT overview and membershipProblem statement
Funding optionsSub committee reports
Evidence generationAdvocacyFund raising/Immunization fundLocal vaccine productionKey asks
Slide3NIFT was set up by the NPHCDA Board in 2015 to improve coordination on immunization financing and
vaccine security,
among govt., partners, CSOs and the private sector.
NIFT has over 20 member institutions
OverviewRationale
Huge financing gaps for the Nigeria immunization program had received little attention among relevant stakeholders
A rallying point was necessary to focus attention and coordinate a broad-based response to the immunization funding crisis
Composition
Institutional membership: MDAs, legislature, development partners, media, private & public sector
Task team is chaired by
Dr.
Ben
Anyene
NPHCDA and IVAC
are responsible for the secretariat.
HERFON
WAVACHRVNDCACOMIN
HFN
DCL
M&B
Preston
NMA
Media
Slide4NIFT’s mandate is delivered through the work if it’s four subcommittees
Overview contd.
NIFT’s goal is to assure sustainable immunization financing by 2021 and long term vaccine security in NigeriaMandate upon inauguration:
Develop a sustainable immunization financing (SIF) advocacy strategy and roll out planDevelop a structure for an immunization fund & a strategy to grow the fundDevelop a road map for achieving local vaccine production in Nigeria
The four subcommittees serve as technical units to achieve NIFT’s goals:
Slide5Overview contd. The GON leads 3 of the 4 NIFT sub committees
Evidence generation
NPHCDA finance
dept, CHAI, IVACw/ input from Mckinsey, WHO, UNICEF
Fund Raising/
ITF
NPHCDA advocacy
dept
,
CSJ, FMOJ, Fidelity and First Bank, NASS, W/ input from-
Mckinsey
, WHO, UNICEF
Advocacy
IVAC, CHR
, NPHCDA, Save the
Ch
,
PACFaH
, WAVA,
Gavi
CSOs, Preston,
Pfizer, DCL,
Business day, Vision FM
Local Vaccine ProductionFMOH, HFN, Unicef, FMST, NABDA, M&B
Chairman:
Dr. Ben
Anyene
.
Secretariat:
NPHCDA and IVAC/DCL
Slide6Overview
contd.
NIFT’s operational principles promote national ownership to achieve SIF
Slide7Funding challenge for vaccine program needs urgent action
Slide8Possible solutions to sustainable immunization funding
Short and Intermediate term
Short and Intermediate term
Intermediate and Long term
Slide9Presentation outlineReason for rising costs
Federal government of Nigeria’s past commitmentQuestionsEvidence generation Presented by Mr Ganiyu
Salau (NPHCDA Finance)
Sub committee report
Subcommittee’s TOR
Responsible for reviewing financial needs based on identified data sources (
cMYP
,
Mckinsey
analysis)
Other evidence sources as needed for advocacy
Worked with
Mckinsey
, WHO and
Unicef
to reconcile immunization funding figures
Slide10Reason for rising RI costs
New and expensive vaccines6 new vx planned btw 2014 and 2018PCV (2
nd/3rd stages), IPV, Rota, Men A, HPV.
Malaria Vx.GDP Rebasing=Graduation from GAVI financing GAVI graduation calculated linear increase in co-financing obligation between 2018 co-financing price and the 2021 vaccine price. In 2021, the full market price occurs, and the GoN pays the full cost of vaccines and devices, and average freight; for new vaccines, the ramp-up is from the time of introduction to 5 years after introduction.
Slide11Historical appropriation figures: GON commitments to RI.
Appropriations for:2010: N2.2 billion2011: N5 billion
2012: N6 billion2013: N4.15 billion2014: N2.156 billion
2015: N2.615 billion 2016: N1.095 billionAugmentation from loan and grants:2008: US$50.0million – World bank buy down grant - BMGF2010: US$ 60million – World bank buy down grant - BMGF
2013: US$95million – World bank buy down grant - BMGF2015: JPY8.285billion – JICA loan
2015: US$200million – World bank loan
2017: US$125million – World bank loan
Slide12Current sources of fund for immunization
There are two main sources available to the Government of Nigeria for funding total vaccine requirements as follows:The annual appropriations
Foreign grants/Loans World Bank IDA Facility
GAVI Alliance Bill & Melinda Gates Foundation UNICEF Rotary International Government of Germany (
kfw)
Government of Japan (JICA)
DFID
Slide13Total
25
KANO
1.8
KADUNA
1.1
OYO
1.1
BAUCHI
0.9
KATSINA
1.0
LAGOS
1.7
OGUN
0.7
ANAMBRA
0.7
BENUE
0.8
ZAMFARA
0.6
JIGAWA
0.8
ENUGU
0.6
BORNO
0.8
NIGER
0.8
SOKOTO
0.7
IMO
0.7
OSUN
0.6
KEBBI
0.6
PLATEAU
0.6
KOGI
0.6
GOMBE
0.4
ADAMAWA
0.6
CROSS RIVER
0.5
EKITI
0.4
ABIA
0.5
KWARA
0.4
EDO
0.6
EBONYI
0.4
ONDO
0.6
YOBE
0.4
TARABA
0.4
NASARAWA
0.3
RIVERS
1.0
DELTA
0.8
AKWA IBOM
0.7
BAYELSA
0.3
SOURCE: Population Commission, Budget Office, Office of the Accountant General, Vaccine investment case, NOTE: Revenue progressed as per
MTEF
; 2013 ratios assumed constant to 2020, total pop. and growth rate by state as per census, target pop. 4%
Total cost
(2020, NGN
bn
)
Total cost as % of each state’s Federal revenue
( 2020)
2014
Mckinsey
Analysis: Each state to pay according
to their need, which is their target population
Average 0.44
Cost per child
was calculated
by taking the total cost of vaccines and dividing it by the total number of children in Nigeria
With co-financing, ALL states pay
2,975NGN
/child; without Federal support, they ALL pay 6,147NGN
Cost per state was calculated by multiplying the
number of children
in each state by this cost per child
This means that states with
larger populations
(relative to their Federal revenues) pay a much greater proportion of their revenue
>30% below average
>30% above average
Slide14Principles of the adjustment of the federal revenue formula
No state should pay more than they would without co-financing
States with large revenues compared to their populations should help to ensure immunization in other states
No state should pay a proportion of their revenue which is much greater than the weighted average of 0.44% (Total vaccines cost as percentage of each state’s federal revenue).
Slide15AdvocacyPresented by Dr. Chizoba Wonodi (IVAC) and Dr.
Aminu Magashi (CHR)Sub committee report
Subcommittee’s TOR
Develop advocacy strategy
To support and strengthen platforms for non-state actors (including identified champions, CSOs etc.) that will hold the government accountable to its commitment on RI
Build capacity of relevant stakeholders and team members on advocacy approaches.
Develop advocacy materials and key messages
Catalyze the engagement of the media in discussions around sustainable vaccine financing in Nigeria
Slide16Advocacy strategic objectives
To build consensus at national and subnational levels on sustainable immunization financing in Nigeria
To ensure adequate budgetary appropriation, timely release of appropriated funds and efficient utilization of funds for immunization at national and subnational levels in Nigeria
To ensure coordinated advocacy for sustainable immunization financing in Nigeria To ensure evidence based advocacy for immunization financing in Nigeria
Slide17An example of evidence-based advocacy:
Rational
for asking for biennial appropriation for vaccine procurement
Vaccine procurement requires a long lead time, with Nigeria’s large birth cohort, yearly appropriation gives little time for planning Predictable demand from a large country like Nigeria reduces global supply instability and maintains favorable pricing
Timely cash-backed vaccine orders ensures uninterrupted procurement and distribution of vaccines to states
Predictable distribution prevents vaccine stock-out and maintains public confidence in the immunization program and the health system
Securing vaccines for two years gives more time to work out sustainable funding solutions
Slide18NIFT Advocacy Subcommittee activities 2015-16
NIFT participated in October 2015 at Nairobi Anglophone Peer review on SIF
Co-hosted with Sabin Institute the Anglophone Peer review workshop in Abuja on SIF in April 2016 as follow up – broad participation included NASS and private sector
Participated in Sabin Institute SIF colloquium in July at Nepal 2016Hosted Uyo Legislative retreat on health financing, NHAct, and immunization in October, 2016Hosted Advocacy Subcommittee workshop on Sustainable Immunization Financing (SIF) Transition Plan in February, 2016
Subcommittee meetings and workshops in Abuja, Kaduna and Lagos
Slide19NIFT Advocacy Subcommittee activities 2017 – 1/2
Q1 2017 Meeting, 02/02/2017
Q2 2017 Meeting, 09/05/2017
SIF Transition Plan Workshop, 13/02/2017
NASS Public Hearing,
13-15/02/2017
PHCSG/WAVA meets HMH, 15/05/2017
DPG Meeting, 17/05/2017
ADI Consultation, 18/05/2017
NIFT Meeting Presentation, 17/05/2017
Slide20NIFT Advocacy Subcommittee activities 2017 – 2/2
Kebbi
Grassroots Sensitization on Vaccine Demand, 11/08/2017Sensitization of WoGs on Vaccine Demand & Funding, 02/08/2017
Policy Dialogue on Immunization Budget Tracking, 26/07/2017
Policy Dialogue on Immunization Budget Tracking, 26/07/2017
Sensitization of
WoGs
on Vaccine Demand & Funding, 02/08/2017
Kebbi
Grassroots Sensitization on Vaccine Demand, 11/08/2017
NIFT Meeting Presentation, 15/08/2017
NIFT Meeting Presentation, 15/08/2017
Slide21Key Advocacy Asks
Slide22Fundraising / Immunization Trust Fund Presented by Dr. Eugene
Ivase (NPHCDA)Sub committee report
Subcommittee’s TOR
Coordinate with NPHCDA to develop the National Immunization Trust Fund (NITF).
Develop the fundraising strategy for the NITF.
Implement, monitor and evaluate the fundraising strategy for the NITF once it is adopted.
Slide23Background
The NITF is a concept to bridge the Gap in Vaccine Value Chain Financing for Nigeria 2016 and beyond
It will serve as an independent body that will advocate and mobilize for funds towards routine and supplemental immunizations in Nigeria
The NITF will ride on two principles:
Slide24Financing subcommittee
a
ctivities
In consultation with government and partners, have constituted a membership list for a Legislation Drafting Committee (LDC) for the immunization trust fund (ITF)Researching on success of trust funds and how they are implementedDeveloped a Concept Note for Immunization Trust FundLDC developed a draft NITF Legal instrument
Slide25Nigeria Immunization Trust Fund (NITF) Legislation drafting committee (LDC) members
Parliamentarians (Senate & House of Reps)
Representative of CSO – Centre for Social Justice (CSJ)
Federal Ministry of Health (FMoH - PRS)Federal Ministry of FinanceFederal Ministry of JusticeNPHCDA (PRS &Legal Unit)WHO and UNICEF
Nigeria Bar Association (NBA)Representative Private Sector –
Finance Institution
Chairman NIFT
Secretariat: CSO representative
The Committee has the power to co-opt other members based on technical
needs
Slide26Milestones for ITF
Milestone for the Nigeria Immunization Trust Fund
End 2016
2020Beyond 2020
2018Consultation
Stakeholder Engagement
Slide27Local Vaccine Production
Presented by Dr Benson Ayodele Coleman (HFN) Sub committee report
Subcommittee’s TOR
Conduct a situational analysis into current efforts in the area of local production of both vaccines and devices. Highlighting past and current efforts , challenges, strengths, weakness, opportunities and threats
Develop a road map for local production of vaccines
Work with the government to disseminate the determined road map
Slide28Local vaccine production
is a
longer term sustainable solution
NIFT mandate is to ensure vaccine security throughadvocating for a conducive policy environment for stakeholders within the local vaccine production space
Conducted SWOT and
situational analysis
LVP subcommittee of NIFT has pooled evidence that needs to be validated and followed through
Volumes of vaccines demanded in Nigeria are set to
increase from 169 million doses in 2016 to 210 million doses in 2020
Current
Vaccine prices are higher for new vaccines
with HPV costing as much as $4.61 per dose
Potential revenue from the sale of antigens for RI alone will increase from $215M in 2016 to $280M in 2020
Slide29Situational analysis for LVP results summarized below
Strengths
Access to Large Market
Interest of several private pharmaceutical Investors
Government Buy-in
Knowledge of Staff formerly at the
Yaba
production plant
Weaknesses
Run-down of
Yaba
plant, obsolete equipment
Poor technological capabilities
Inconsistent power supply
Poor regulatory and quality control systems
no LVP policy document
Opportunities
Land
Already existing partnership with private pharmaceutical companies
Technology sharing opportunities
availability of institutional and international investors
Threats
Fund availability
Patents and poor knowledge sharing
Long-term strategic commitment
Slide30History of Local Vaccine Production in Nigeria
1947
The Federal Vaccine Laboratories commenced with production of Smallpox vaccine
1960s - 1970s
Smallpox vaccine production continued with supplies to the West African Sub-region
1980s
Began production of the first batch of yellow fever vaccine to combat yellow fever outbreak
2005
Memorandum of understanding for the conversion of FVPL to private vaccine production and distribution company between May & Baker and the FG
1986
FMOH collaborates with Oswaldo
Crutz
foundation of Brazil to renovate and improve the skills of the HR to produce more stable Yellow F Vaccine
1991
Shutdown of the production plant for renovation
2007
Formalized partnership with May & Baker Signed
2014
First Round table discussion on Local vaccine production held
2015
Round II
Expanded stakeholder’s Round table meeting on Local vaccine production
Slide31Stakeholders were then engaged to discuss probabilities and future of LVP in Nigeria
National roundtable discussion with stakeholders on
Sustainable Immunization Financing as the theme and
Local Vaccine Production as the sub-theme held on 15th December, 2015 at Sheraton Hotel and Towers Abuja OutputResolutions to developa draft policy document to shape the sector.
a business plan to make a case for LVP to the private sector investors (potential income generation for Nigeria/ sub-Sahara Africa region)
UNICEF has offered to pay for an international consultant for the development of the policy document
The
HMoH
has offered to fund the consultant for development of needs assessment/business case
Slide32LVP Post Event
The committee engaged with UNICEF and she graciously committed to pay the bill for the international consultant that will develop the Draft of LVP policy document.
A
ToR
to guide the consultant’s work has been developed by the subcommittee and shared with relevant stakeholders.
CVs have been sent to UNICEF for their evaluation and contracting of the consultant.
ONGOING EFFORTS
Slide33Questions to be addressed
Is vaccine supply the responsibility of only the federal government?
How can other stakeholders fund vaccines?Budgetary releases at all levels; which model?What is the feasibility of local vaccine production?
Can the funding basket arrangement for Polio be replaced by that for Routine Immunization?Creation of an immunization fund financed by donations and private sector donationsRoles of NHIS contributions to immunization fundingWhen will BHCPF be implemented
Slide34Key asks 1/2
Complete resolution of Gavi Audit issue
GoN should ask GAVI to reconsider the graduation in the light of the fact that the rebased GDP has dropped from $578b (2014) to $290b (2016) and per capita income has dropped $3,100 to $1500 within the same period
NPHCDA should propose at least double 2017 appropriation for immunization in 2018 budget ought to begin now. NIFT willing to support NPHCDA on advocacy to presidency, NASS, FMOF and FMOBNP for adequate appropriation and timely releases for vaccinesGoN should consider signing up to the Vaccine Independence Initiative to prevent future stock out due to delayed fund releases
Slide35Key asks 2/2
NPHCDA should make available to: Core group, ICC, quarterly Vaccine Financing Outlook and lead in the development of a Gavi Transition Vaccine Funding plan. NIFT can support this.
Lead advocacy to States’ for joint co-funding for vaccines
GoN should consider drawing up an agreement with States to pay for the States o-funding through the BHCPF or SOML fundFunding support for NIFT activitiesPresentation by NIFT to ICC, Core Group, Immunization Working Group, NGI-TAG, Governors’ Forum
Slide36Thank youfor the audience
Slide37