Objective: Identify financing opportunities
Possible Strategies:
- Review traditional sources of funding and assess the potential to mobilize more funds from these sources (Which ones are underused?).
- Understand the different sources of finance that may be available to your country.
- Identify barriers to greater private-sector
 participation and low-cost ways to overcome them.
Appropriate use of the private sector can effectively increase the amount of resources for immunization. Resources may not be in the form of cash. For example, by supporting private providers such as doctors who provide immunizations, the programme can expand its ability to deliver immunization services. Private sector participation might be encouraged through provision of cold chain equipment or vaccine supplies.
Tip! This strategy is highly dependent on government policy and, most likely, would be very difficult to influence.
Objective: Increase political commitment
Possible Strategies:
- Promote allocation of resources on the basis of cost effectiveness and public finance principles.
- Promote public demand for immunization. Increased public demand can often lead to increased political commitment.
Objective: Access or increase in-country funds
Possible Strategies:
- Ensure immunization is a top health priority of the government.
- Develop line item in budget
- Foster political and/or legal mandate for baseline funding level. That is, encourage legislation or political promises to ensure that a minimum amount of in-country resources are allocated to the immunization programme.
- Negotiate increasing levels of funding (national and sub-national levels).
- Ensure immunization targets are incorporated in national financial and planning documents, such as Poverty Reduction Strategy Paper.
- Ensure immunization budgets and planning cycles are incorporated and synchronized with national financial and planning documents.
- Develop an immunization financial plan
- Ensure relevant sections are incorporated into national planning documents.
Objective: Access or increase external donor funds
Possible Strategies:
- Identify new donors, including NGOs and multilateral agencies.
- Develop targeted approach depending on programme component to be funded.
- Demonstrate government commitment to programme financing by adopting key policy and programmatic measures that can increase efficiency and assure consistent levels of domestic funding for immunization programs.
- Advocate for support of non-vaccine recurrent costs.
Comment: Donors often prefer to direct resources to capital items because they can see and monitor the use of their funds and they think leaving recurrent costs to the government improves sustainability. Also, these funds are often used to purchase from international suppliers which may support the development agency mission.
However, capital purchases nearly always increase the recurrent cost burden on countries. Investing in capital may reduce the incentive for governments to look for more cost effective solutions, such as outsourcing. Therefore, encourage donors to assist with recurrent costs rather than automatically funding capital costs.
Objective: Access alternative sources of finance
Possible Strategies:
- Seek private financing. For example, from philanthropic organizations or private business sponsorship.
- Debt relief
- Trust funds. That is, mobilize an amount of funds (capital) to be kept in a financial instituion, earning interest. Then use the interest (which will be ongoing) to fund operational costs of the programme.
- Development loans.
Objective: Identify alternative mechanisms for accessing funds
Possible Strategies:
- Identify new mechanisms, such as taxes, grant, seed money, matching allocations or a revolving fund, to access funds.
- Phase out external support by building up resources for a trust fund that can support recurrent costs
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Objective: Increase demand
Possible Strategies:
- Develop an active and well-targeted social mobilization programme. For example, increase public information and advertising on public radio.
More parents will bring their children to be immunized if they understand:
- the benefits of immunization,
- how to access immunization services (i.e., public information on clinics); and
- that the immunization service is free of charge.
A variety of different mechanisms can be used to improve social mobilization. For example:
- Use high profile and popular politicians and other public figures to advertise the immunization service to capture public attention.
- Work with schools to educate children about immunization.
- Work with local religious organizations to promote immunization.
- Manage public information in event of outbreaks, or fears about Adverse Events From Immunization (AEFI).
The provision of credible and timely information about outbreaks (and the governments reaction to them) or adverse events increases the public’s confidence in the immunization programme. Also by providing accurate information about the possibility of AEFI, you can minimize suspicions about immunization. This in turn will increase understanding of and support for the immunization programme. - Conduct research to identify barriers to demand.
Such barriers may be economic, social or geographic. By understanding what the barriers are, strategies can be developed to overcome them
- Economic barriers may include the cost of traveling to a clinic or the cost of taking time off work (either paid or unpaid) to take a child to a clinic or wait for the mobile team.
- Cultural barriers may include language when a health worker does not speak the language of the parent. This is common in countries with many ethnic monitories. If a parent does not understand the health worker and so doesn't receive information about the benefits and safety of immunization, he or she may be reluctant to have a child immunized.
- Geographic barriers may include difficult terrain, the distance to the nearest health clinic or a population's nomadic lifestyle.
Objective: Improve vaccine procurement
Possible Strategies:
Objective: Reduce wastage
Possible Strategies:
- Systematically assess sources and causes of waste
- Develop and implement targeted programme to reduce waste (with quantitative measures). For example:
- Vaccines: Implement a multidose vial policy and provide training in multi-dose vial policy; explore use of different vaccine presentations; improve stock management and logistics; improve cold chain equipment and maintenance
- Vehicles: undertake preventative maintenance, provide driver training
Objective: Improve efficiency of outreach services
Possible Strategies:
- Maximize number of children immunized at each session through improved social mobilization.
- Consider incentives to community workers or parents.
- Implement multi-dose vial policy as appropriate during outreach.
Objective: Improve efficiency of delivery services
Possible Strategies:
- Explore potential for outsourcing support functions
While an immunization programme is a public health programme and should be implemented by the government, in some circumstances, there are some support functions that can be contracted to the private sector. With the right kind of contract in place (such as a performance contract) it may be possible to both improve performance and reduce the overall cost of the activity. Examples of functions that can be outsourced include:
- Transport of vaccines
- Management of cold rooms
- Analyse number of sessions.
- Reduce number of drop-outs.
- Improved planning and budgeting.
Good planning and budgeting lead to funds allocated to the right place at the right time. This reduces missed opportunities and wastage, ensuring resources are used effectively. Planning and budgeting can be improved through:
- Improved information systems including financial information systems.
- Introduction of micro planning.
- Provision of training in financial management.
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Objective: Improve national government funding flows
Possible Strategies:
- Explore alternative financing mechanisms.
- Negotiate with the Ministry of Finance (MOF) on disbursement processes.
- Improve financial management capacity at all levels.
- Incorporate immunization budgeting processes into broader government planning and allocation frameworks (e.g., a Medium Term Expenditure Framework).
Objective: Improve national level donor funding flows
Possible Strategies:
- Advocate for multi-year commitments from donors
Objective: Improve resource flows to the service delivery area
Possible Strategies:
- Identify internal (programme or Ministry of Health) processes that impede resource flows, and can be influenced
- Improve coordination mechanisms between funding bodies (government, donors, NGOs)
- Negotiate early donor payments in exchange for government funding commitments
- Negotiate relationship between expenditure reporting and funding (at least for a part of the year) if delays prevent outreach for significant period of time
- Establish an internal 'revolving fund' that allows sub-national government to borrow for immunization against delayed disbursements
- Negotiate core programme funding (allowing discretionary use of funds) rather than activity specific funding
- Create complete and accurate sub-national plans - microplanning
- Develop line item in sub-national budgets; promote transparency in resource flows
- Establish performance targets for sub-national entities (and independent monitoring of result)
- Negotiate with Ministry of Finance about disbursement processes
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