the nigeria immunization trust fund

Anglophone African Peer Exchange Workshop on

Immunization Trust Fund and Legislation |Sheraton Hotel, Abuja, Nigeria|

April 19-21, 2016

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CONCEPT NOTE FOR THE 3-DAY WORKSHOP FOR SUSTAINABLE

IMMUNIZATION FINANCING FOR ANGLOPHONE AFRICAN

COUNTRIES

DATE: 19th to 21st April, 2016

VENUE: Sheraton Hotels and Towers, Abuja, Nigeria

THE NIGERIA

IMMUNIZATION TRUST

FUND



April 19-21, 2016

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Contents

Introduction ............................................................................................................................................ 4

Vaccine Financing in Nigeria and GAVI Graduation .............................................................................. 4

Problem statement ................................................................................................................................ 5

The Nigerian Immunization Trust Fund ................................................................................................. 5

Defining the Nigeria Immunization Trust Fund (NITF) .......................................................................... 5

Rationale for the NITF ............................................................................................................................ 6

Objectives of the NITF ............................................................................................................................ 6

Legal Frame Work for the Establishment of a Trust Fund in Nigeria .................................................... 6

The 3-day Workshop .............................................................................................................................. 7

Proposed Date and Venue ..................................................................................................................... 8

Programme of Event................................................................................. Error! Bookmark not defined.

Objective……………………………………………………………………………………………………..……………………5

Expected Outcome…………………………………………………………………………………………………………….5



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Introduction

The Nigerian immunization program is facing a large funding gap due to rising birth cohort, the

country’s graduation from Gavi support for new vaccine procurement and dwindling government

revenues/shortfall in annual budgetary allocation, among other factors. Consequently, program

costs to the government will increase progressively and significantly through the stipulated Gavi

graduation years (2016 – 2020). This has placed the country’s immunization program at a critical

juncture where urgent action is needed to ensure sustainable financing for vaccines, devices and

related cold chain infrastructure. The government of Nigeria (GoN), through the National Primary

Health Care Development Agency (NPHCDA), has made significant progress in Routine

Immunization (RI) coverage in recent years. However, without adequate funding for vaccines, the RI

system will experience setbacks like stock outs of vaccines which could ultimately lead to increased

deaths from vaccine preventable diseases. Consequently, a call for action led to the suggestions of a

Nigeria Immunization Trust Fund (NITF) that will serve as an independent structure to mobilize

funds for routine and supplemental immunizations in the country in 2016 and beyond.

The Sabin Vaccine Institute, through its Sustainable Immunization Financing program has been

working with a growing number of countries on a range of advocacy activities which includes

briefings on immunization financing and legislation, peer exchanges between countries and support

to the key public institutions as they develop particular innovations, among other things. One of

these activities is the Anglophone Africa Peer Exchange Workshop on Sustainable Immunization

Financing (SIF) and Legislation.

The funding gap for immunization must be bridged to ensure Sustainable Immunization Financing in

Nigeria and as a result, Nigeria volunteered, at the Anglopnone African countries peer review

meeting in Nairobi, Kenya in October 2015, to host a meeting on finalizing on a framework for

setting up an Immunization Trust Fund with the support of Sabin Vaccine Institute. The offer was

approved by the government and National Immunization Financing Task team (NIFT) has

established regular contact with the representative of Sabin Vaccine Institute, Dr. Clifford Kamara.

It was then planned to hold in the 2nd quarter of 2016. The outcome of this workshop is expected to

be a huge step towards advocating for the need and establishing the Immunization Trust Fund.

Vaccine Financing in Nigeria and GAVI Graduation

Vaccine procurement is centralized at the national level to ensure quality and security. The Federal

Government pays fully for traditional vaccines and co-pays for new vaccines with support from Gavi.

The federal government is also responsible for the cost of distributing bundled vaccines for a birth

cohort of 7.4 million children to all States and the Federal Capital Territory (FCT). The States in turn

distributes to the Local Government Areas (LGAs) within their respective jurisdictions.



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Since 2000, Nigeria has received tremendous support from Gavi through various financing windows

towards ensuring effective immunization service delivery in the country. Following the rebasing of

the economy, Nigeria’s GNI rose to US$ 2690, thus surpassing the eligibility threshold of US$ 1580

for Gavi support. Nigeria has now entered a transition period spanning from 2015 to 2020, during

which Gavi support will diminish by 20% every year for five years and subsequently, Nigeria is

expected to bear the full cost of vaccines.

Funding for vaccines/devices and other aspects of the immunization programme is precarious and

will become even more uncertain with the phasing out of Gavi support in the country. The financial

resource requirement for immunization from the GoN, to cover traditional and new vaccines, from

2015 through 2020 is estimated at 16, 29, 34, 44, 45 and 53 billion1 naira. Although funding for 2015

has already been secured with a facility from the World Bank, financing for 2016 and beyond is

uncertain.

Against the backdrop of the rising funding requirement, historic appropriations for vaccines have

always fallen short of need and even declined in recent years. From 2010 through 2015, the

following amounts were appropriated for vaccines annually - 2.2, 5.0, 6.0, 4.15, 2.156 and 2.615

billion naira1. The implication is that the average annual appropriation for vaccines in the last 6

years is 3.68 billion naira; this is just 23% of what is needed in 2015 and 7% of the funding need for

2020.

Besides the precarious funding situation facing the country, there are other significant cash flow

problems. Delays in budget passage and release of appropriated cash are common experience.

Efforts to address funding gaps should also include considering strategies to ensure that funding is

more predictable and timely available.

Problem statement

Nigeria faces an enormous funding gap for its immunization programme due to the cost of

additional vaccines, expanding birth cohort, loss of funding following Gavi graduation and

insufficient budgetary allocation to vaccines and immunization given the dwindling government

revenues profile. To fill the gap, Nigeria needs to secure progressively more money for the vaccine

program starting from 29 billion naira in 2016 and rising to 63 billion by 20202.

The Nigerian Immunization Trust Fund

Defining the Nigeria Immunization Trust Fund (NITF)

The Nigeria Immunization Trust Fund (NITF) will serve as an independent body that will advocate,

coordinate and mobilize funds for routine and supplemental immunizations in the country for 2016

and beyond.

1Collated from the department of Accounts and Finance NPHCDA 2015

2Culled from the NIFT concept note



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This trust fund shall be managed by an independent governing body comprising of Nigerians of

proven integrity, necessary financial clout and administrative prowess needed to propel the entity

(NITF) towards attaining the desired goals of efficient and sustainable immunization financing in

Nigeria. The Fund shall be subject to direction and control of the independent board in matters

connected with receipt, custody and disbursement of monies accruing to the Trust Fund from all

sources.

Rationale for the NITF

The funding gap for immunization in Nigeria requires sustainable financing solution as only

government cannot bear the cost of sustaining the procurement of both traditional vaccines and

the new vaccines in addition to the costs of other essential immunization components. It has

become paramount for the country to look inwards for immunization financing.

Leveraging on the passage of the Nigeria National Health Act 2014, a robust but sustainable source

of financing for immunization needs to be adopted to uphold and consolidate the gains already

recorded in immunization like the interruption of wild polio virus in 2015.

The elimination of vaccine preventable diseases has health and economic benefits nationally and

globally. Such benefits include cost-effectiveness in healthcare service delivery as immunization

serves to prevent the outbreak of many contagious diseases which otherwise would cost

government colossal amount of financial, human and material resources to contain. Also,

immunization seeks to ensure a healthy and productive population among other advantages.

Objectives of the NITF

The objectives of the NITF are:

1. To source for funds that will bridge the gap in immunization financing for 2016 and beyond.

2. To ensure that every child gets the appropriate doses of RI vaccine in the country.

3. To ensure that benefits of immunization is extended to every eligible persons living within

Nigeria.

4. To ensure national self-reliance and long term sustainability in immunization financing in the

country,

5. To engender confidence of stakeholders in the management of national immunization funds.

Legal Frame Work for the Establishment of a Trust Fund in Nigeria

The legality and viability of a trust fund depends on its establishment and management. A trust fund

can be legally established by statute (Act of parliament), by regulation or by registration as

incorporated trustees under the companies and allied matters act (CAMA).

Trust fund by statute: This is the preferred form of establishment and it is by an act of the National

Assembly. This process will further reinforce the confidence of all relevant stakeholders involved in

the trust fund as all shades of opinions would have been considered and wide stakeholder buy-in



April 19-21, 2016

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ensured, before the Act is approved. In addition, such enabling law makes adequate provisions for

the management and operation of the Trust Fund. An amount may be set aside in the annual

budget for the fund as the government contribution; there may be provisions for mandatory

contributions from some specified organizations/corporate entities in form of taxation or

levies/fines on some specific “harmful” consumer products e.g Tobacco, alcoholic beverages, luxury

consumables etc. These will guarantee continuous inflow of cash into the Fund. In addition,

legislation of the Fund assures voluntary donors, especially business corporations and the private

sector, that their funds are protected and will be used for the intended purpose(s). Example of such

trust funds are Education Trust Fund, Petroleum Trust Fund etc.

Trust fund by incorporation: This is a trust fund established by registration in which the

contributors to the fund apply to the Corporate Affairs Commission (CAC) under part C of CAMA to

be registered as incorporated trustees. The operating rules or provision for administering the trust

fund are set out in the trust deed and the incorporated trustees are appointed by the trust deed.

This can be amended or replaced at any time at a general meeting convened for that purpose when

considered necessary. The procedure of establishing a trust fund as incorporated trustee is set out

in section 679 of CAMA.

Trust Fund by regulation: The NPI and NPHCDA Act, have provisions under which an Immunization

Trust Fund could be established. Such power can be derived from sections 12 and 14 of the NPI Act

and section 7 and 8 of the NPHCDA Act. Through the Minister of Health’s directive or regulations,

the ITF can be set up in the interim, pending proceeding/passage of a bill by the National Assembly

or amending the National Health Act or the NPHCDA Act to establish the Nigeria Immunization Trust

Fund.

Alternatively, if the ITF is perceived as a Public Private Partnership (PPP) initiative, registering it as

an incorporated Trustee under the CAMA is recommended. In which case, the ITF will operate as a

Non-governmental organization (NGO) servicing immunization programmes.

The 3-day Workshop

This Anglophone Peer Exchange meeting shall have in attendance, country delegates from SIF Anglophone countries such as Liberia, Kenya, Nigeria, Sierra Leone and Uganda. Participants will be drawn from members of the NIFT, Government officials, development partners and the private sectors that are expected to play key roles in mobilizing resources and technical support for a sustainable vaccine program in Nigeria. Participants The meeting will have in attendance member countries of the Legislators and top health officials from Anglophone African countries; legislators from Nigerian National Assembly; State Governors; State Commissioners for Health and Finance; members of NIFT; development partners; staff of the NPHCDA, staff of ministry of Health, Finance and Science & Technology FMOH, FMOF, FMOST and other relevant ministries, the private sector, members of the press and other stakeholders.



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Objectives of the meeting

To identify, share, and cross-evaluate best domestic sustainable financing initiatives, budget tracking and advocacy mechanisms, and legislative practices for immunization in Nigeria vis-à-vis other participating countries.

To develop a set of recommendations for achieving Nigeria Immunization Trust Fund.

To develop a global template for implementing immunization trust funds, for adoption by participating Countries.

Expected Outcome of the Meeting

Best strategy for domestic sustainable financing, budget tracking, advocacy, and legislative

practices for immunization in Nigeria would have been developed.

Set of recommendations for the implementation of Nigeria immunization trust fund (NITF)

would have been developed

Acceptable template for adoption by participating Countries would also have been

developed

Proposed Date and Venue

The Anglophone African Peer Exchange Workshop has been scheduled to hold from the 19th to 21st

of April, 2016 at Sheraton Hotels and Towers, Abuja, Nigeria.

Theme and Subtheme

The theme of the workshop is Sustainable Immunization Financing and the subtheme is

Immunization Trust Fund and Legislation.

Agenda

Day One

Time Content Presenters Location/Notes

Opening Ceremony

8:30-8:40 Introduction of Participants and Dignitaries Sabin and Master of Ceremony

Plenary, Moderator: Sabin Vaccine Institute & Master of Ceremony

8:40-8:50 Welcome & Workshop Objectives Sabin

8:50-9:00 Welcome Address Dr. Ado Muhammad, Executive Director, NPHCDA

9:00-9:15 Opening Remarks by Co-hosts

Prof Isaac Adewole, Hon. Minister of Health & Mrs. Kemi Adeosun, Hon. Minister of Finance

9:15-9:40 Goodwill Messages Partners and Private Sector: BMGF, Gavi, IVAC, Pharma industry, others

9:40-9:55 Keynote Address and declaring the Mr Nnamdi Okonkwo, MD



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Workshop Open Fidelity Bank PLC.

9:55-10:00 Workshop Declared Open Alhaji Mohammad Abubakar, Governor of Bauchi State.

Collective Update

10:00-10:30

Panel Discussion: Progress since the

October 2015 Anglophone Africa Peer

Review Workshop & Implementing the

Parliamentary Statement, Ministerial

Conference on Immunization in Africa,

Addis Ababa

Partners and country delegates (One per country)

Plenary, Moderator: Sabin Vaccine Institute

10:30-10:45 Coffee Break

Theme I: Domestic Financing Arrangements

10:45-11:00 Overview of domestic immunization financing arrangements

Sabin Plenary, Moderator: Nigeria Senate Committee Chairman on Health

11:00-11:30 New financing practices: Nigeria NIFT and Nigerian delegates

11:30-12:30 Case Study Presentations: New financing practices, visiting countries

Country Delegations: Liberia Sierra Leone Uganda Kenya

Plenary, Moderator: Nigeria Senate Committee Chairman on Appropriation

12:30-12:45 Discussion and small group work instructions (first round)

Sabin and delegates

12:45-13:45 Lunch Break

13:45-14:45 First Round Small Groups: Developing and applying innovative financing arrangements

Randomized small groups Separate rooms

14:45-15:45 Group Presentations: Innovative financing arrangements

Panel of rapporteurs Plenary


16:00-17:00 Nigerian Roundtable: Prospects for federal- state co-financing of routine immunization

NPHCDA, state commissioners

Plenary

17:00 End of Day One

18:00-20:00 Reception

Day Two


Theme II: Legislative Provisions & Implementation

8:30-8:45 Summary of Day One Rapporteur/NIFT Secretariat Plenary, Moderator: Nigeria Senate Committee Chairman on Ethics and Governance

8:45-9:00 Overview of legislative provisions and

legislative project implementation Sabin

9:00-10:00 Vaccine legislative project implementation

updates

Country Delegations: Liberia Nigeria Sierra Leone Uganda Kenya



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10:00-10:15 Legislative Text Comparison Sabin


10:30-11:30 Second Round Small Groups: Comparing legislative projects

Randomized small groups Separate Rooms

11:30-12:30 Group Presentations: Legislative projects Panel of rapporteurs Plenary

12:30-13:30 Lunch Break

Theme III: Budgeting, resource tracking and domestic advocacy

13:30-13:45 Immunization budgeting, resource tracking and domestic advocacy: best practices

Sabin Plenary, Moderator: House of Reps, Chairman committee on Appropriations

13:45-14:05 Case Study Presentations: Budgeting, resource tracking and domestic advocacy case studies

Country Delegations: Liberia Nigeria Sierra Leone Uganda Kenya

14:05-15:00 Role play scenario instructions Sabin Plenary


15:15-16:00 Role Play Preparation: Budgeting, resource tracking and domestic advocacy practices

Country Delegations Separate rooms

16:00-16:45 Role Play Exercise: Resource tracking and domestic advocacy practices

Country Delegations: Kenya Liberia Sierra Leone Nigeria Uganda

Plenary, Moderator: Sabin Vaccine Institute

16:45-17:15 Optional: Country delegates meet to prepare peer review case study presentations

Country Delegations Plenary

17:15 End of Day Two

Day Three


Peer Review: Innovations in Sustainable Immunization Financing

8:30-9:00 Country delegates meet to prepare peer review case study presentations

Country Delegations Plenary (note: use Peer Reviewer Packet)

9:00-9:30 Peer review instructions and demonstration Sabin

9:30-10:15 Peer review, part I: (Group A) Country delegates

10:15-11:00 Peer review, part II: (Group B) Country delegates


11:15-12:00 Special Panel: Achieving country ownership in Nigeria

Nigerian delegation

Way Forward

12:00-12:45 Discussion of next steps Country delegates Plenary

12:45-13:00 Closing words & workshop evaluations Sabin, Country delegates

13:00 End of workshop

15:00 Visit to Tourist site and Health Facility.



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Terms of Reference

Context

Experience shows that sustainable financing for national immunization programs can be secured

through the coordinated action of key national institutions. Ministries of health must show strong

investment cases for their immunization programs. These cases may include demonstrating the cost-

effectiveness of particular vaccines, documenting child mortality reductions due to vaccination,

showing efficient program management and meeting other tests any public investment must meet.

Ministries of finance must assure that funds allocated to the programs are disbursed in full and on

time and that sources of public financing are adequate and dependable. Parliaments have important

roles to play in promoting vaccination and public health in general. They do this by participating in

selected field activities in their jurisdictions. Parliamentarians also scrutinize annual ministry of

health budgets, and often craft immunization-related legislation. In some cases, non-governmental

organizations play a catalytic role. These and other key public institutions must work together to

accomplish the sustainable immunization financing objective.

Since 2008, the Sabin Vaccine Institute’s Sustainable Immunization Financing (SIF) Program has

been supporting this kind of institutional work in countries through a range of advocacy activities.

These activities include briefings on immunization financing and legislation, peer exchanges between

countries and support to the key public institutions as they develop particular innovations- new ways

of doing things- that lead to increased domestic immunization financing and more efficient

immunization programs. Examples of such innovations include: new ways to track and report

immunization program expenditures; new laws or amendments to existing laws to guarantee public

financing for immunization; use of media and social interactions to share immunization program

information with new stakeholder groups; new financing mechanisms such as public-private trust

funds.

The Decade of Vaccines (2011-2020) envisions a world where all individuals and communities are

free from vaccine-preventable diseases. To achieve this ambitious goal, the 65th World Health

Assembly endorsed the “Global Vaccine Action Plan (GVAP)”. The SIF Program focuses its work

on GVAP Strategic Objective 1 (all countries commit to immunization as a priority), Objective 3 (the

benefits of immunization are equitably extended to all people) and Objective 5 (immunization

programmes have sustainable access to predictable funding, quality supply and innovative

technologies).

The SIF Program is currently engaged in five Anglophone African countries: Sierra Leone, Liberia,

Nigeria, Uganda, and Kenya. Each country has developed, or is developing, institutional innovations

to achieve the sustainable immunization financing objective. The innovations may be in government

institutions or parliament; they may be at national or subnational levels; they may be fully

implemented, under field testing or still in the conceptual phase.

Peers from seventeen Sabin/SIF countries scrutinized each other’s institutional innovations in the

Second Colloquium on Sustainable Immunization Financing in Dakar, Senegal in August 2013.

Using a standard guide, participants scored each project. Results were analyzed and the countries

were ranked in terms of perceived innovativeness. A follow-up peer review workshop for the five

SIF Anglophone African countries was held in Nairobi, Kenya, in October 2015. In both these events,



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delegates from each country formulated short-term action points they would follow to help secure the

sustainable immunization financing objective.

A potentially “game-changing” event, the Ministerial Conference on Immunization in Africa,

subsequently took place, on 24-25 February 2016, in Addis Ababa, Ethiopia. During this event,

Members of Parliament from nine SIF African countries came together to sign a Parliamentary

Statement in Support of the Ministerial Declaration on Immunization, which was read aloud in the

final plenary session. The signatories committed to establish and strengthen national parliamentary

coalitions for immunization as well as to conduct necessary advocacy, lawmaking, and oversight

roles for immunization services. This parliamentary initiative greatly increases the likelihood African

countries will achieve country ownership and reach the ambitious 2020 GVAP objectives.

To continue this momentum, Sabin is inviting peers from each SIF Anglophone African country to

the Second Anglophone African Peer Review Workshop on Sustainable Immunization Financing, to

be held 12-14 April 2016 in Abuja, Nigeria. This workshop will give peers the opportunity to

evaluate progress on the action points their predecessors formulated in the October, 2015 Nairobi

workshop, take stock of new practices and developments (including the February, 2016 Addis

Parliamentary Statement) and set out new action points which will move their countries closer to the

sustainable immunization financing objective. In July, peers attending the Abuja workshop will come

together with peers from the other sixteen SIF countries in the third SIF Program Colloquium.

Objectives: The main objectives of this workshop are to:

1. Assess implementation of the country-specific action points developed at the previous

Sabin/SIF Anglophone Africa Peer Exchange Workshop (Nairobi, Kenya, October 2015)

2. Identify, share, and cross-evaluate innovations and best practices in immunization financing,

resource tracking, and domestic advocacy

3. Analyze and review the laws and regulations on vaccines and immunization that exist or are

under preparation in the participating countries, and document the status of ongoing

legislative projects in each country

4. Develop new country-specific, short-term action points for achieving sustainable

immunization financing

Methodology:

The workshop will cover three themes (Domestic financing arrangements, Legislation,

Budget/resource tracking/ advocacy) across two and a half working days. Following each brief

thematic introduction, peers from each country will form a panel and present their case studies

related to that theme. Case studies will focus on particular practices, whether new or already

institutionalized. Each delegation is expected to present at least one innovative practice in one of the

thematic areas. Peers will work in two rounds of randomly assigned small groups to further discuss

and document their cases. Nominal group techniques will be used. Rapporteurs from each group will

report the results in a series of plenary panels. The third theme will include a role play exercise, in

which peers simulate their resource tracking and domestic advocacy strategies. The workshop will

include a formal peer review exercise. Sabin staff members and external partner agency counterparts

will act as facilitators throughout the workshop.



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In preparation for the workshop, each country delegation will be given a guide to preparing their case

studies, as well as supplementary reference materials. Peers will evaluate the workshop using a

standard questionnaire.

Expected Results:

Each national delegation prepares and presents at least one innovative practice in the areas

of financing, budget/resource tracking or domestic advocacy, allowing innovative and

best practices to be documented and shared

Progress on vaccine-related legislative projects and associated best practices are shared

among the delegations

The peer review exercise generates innovativeness scores for each country case study

Delegations elaborate updated and new short-term action points moving their countries

closer to the sustainable immunization financing goal

Country immunization financing and legislation efforts become more effective as peers

learn from each other and develop new practices

the nigeria immunization trust fund

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