National Immunization Financing - PowerPoint Presentation

Slide1

National Immunization Financing

Task

Team (NIFT)

Presentation to the ED of NPHCDA

Tuesday, May 30, 2017

1Slide2

Outline

Chairman’s reportNIFT overview and membershipProblem statement

Funding options

Sub committee reportsEvidence generationAdvocacyFund raising/Immunization fundLocal vaccine productionKey

asks

2Slide3

NIFT 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

3

Overview

Rationale

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 AnyeneNPHCDA and IVAC are responsible for the secretariat.

HERFONWAVACHRVNDCACOMIN

HFN

DCL

M&B

Preston

NMA

MediaSlide4

NIFT’s mandate is delivered through the work if it’s four subcommittees

4Overview

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:Slide5

Overview contd. The GON leads 3 of the 4 NIFT sub committees

Evidence generation

NPHCDA finance

dept, CHAI, IVACw/ input from Mckinsey, WHO, UNICEFFund 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 FMLocal Vaccine Production

FMOH, HFN,

Unicef

, FMST,

NABDA,

M&B

Chairman:

Dr. Ben

Anyene

.

Secretariat:

NPHCDA and IVAC/DCLSlide6

Overview

contd.

NIFT’s operational principles promote national ownership to achieve SIFSlide7

Funding challenge for vaccine program needs urgent action

7Slide8

Possible solutions to sustainable immunization funding

Short and Intermediate term

Short and Intermediate term

Intermediate and Long term Slide9

Presentation outlineReason for rising costs

Federal government of Nigeria’s past commitmentQuestions9

Evidence 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 figuresSlide10

Reason 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.Slide11

Historical 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 - BMGF2013: US$95million – World bank buy down grant - BMGF

2015: JPY8.285billion – JICA loan2015: US$200million – World bank loan2017: US$125million – World bank loanSlide12

Current 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 Slide13

Total

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 averageSlide14

Principles 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).Slide15

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AdvocacyPresented 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

NigeriaSlide16

Advocacy 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

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An example of evidence-based advocacy:

Rational

for asking for biennial

appropriation for vaccine procurementVaccine 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

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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 Slide18

NIFT 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, 2016Subcommittee meetings and workshops in Abuja, Kaduna and Lagos

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NIFT Advocacy Subcommittee activities 2017

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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

Presentation at NIFT Meeting, 17/05/2017Slide20

Key Advocacy

Asks

20Slide21

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Fundraising / 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.Slide22

Background

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: Slide23

Financing 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 instrumentSlide24

Nigeria 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 UNICEFNigeria Bar Association (NBA)

Representative Private Sector – Finance InstitutionChairman NIFT

Secretariat: CSO

representative

The Committee has the power to co-opt other members based on technical

needsSlide25

M

ilestones for ITF

Milestone for the Nigeria Immunization Trust Fund

End 20162020Beyond 2020

2018Consultation

Stakeholder Engagement

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26

Local Vaccine ProductionPresented 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 mapSlide27

Local

vaccine

production is a longer term

sustainable solutionNIFT 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

27Slide28

Situational 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 commitmentSlide29

History 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 productionSlide30

Stakeholders 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)

30

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 caseSlide31

LVP 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 EFFORTSSlide32

Questions 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 implementedSlide33

Key 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 periodNPHCDA 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 releases33Slide34

Key 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 vaccinesGoN should consider drawing up an agreement with States to pay for the States o-funding through the BHCPF or SOML fundFunding support for NIFT activities

Presentation by NIFT to ICC, Core Group, Immunization Working Group, NGI-TAG, Governors’ Forum

34Slide35

Thank youfor the audienceSlide36

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