Sabin SIF Anglophone African peer review workshop, Abuja, Nigeria, 19-21 April 2016

Anglophone Africa Peer
Review Workshop
on Sustainable Immunization
Financing
Abuja, Nigeria | 19-21 April 2016
Prepared by Diana Mugenzi, Dana Silver, Clifford Kamara, Andrew Carlson, Mike McQuestion

Contents
Executive Summary ............................................................................................. 2
Acknowledgements ............................................................................................. 2
Introduction ........................................................................................................ 2
Proceedings......................................................................................................... 3
Day One ............................................................................................................. 3
Theme I: Domestic Financing Arrangements.................................................... 5
Day 2 ............................................................................................................... 12
Theme II: Legislative Provisions and Implementation................................... 12
Theme III: Budgeting, Resource Tracking, and Domestic Advocacy............... 16
Day Three ........................................................................................................ 18
Peer Review Exercise..................................................................................... 19
ANNEXES ........................................................................................................... 26
Annex A: Concept Note .................................................................................... 26
Annex B: Participant List ................................................................................. 30
Annex C: Agenda ............................................................................................. 35
Annex D: Small group results .......................................................................... 38
Annex E: Welcome Address, Dr. Ado Muhammad............................................. 41
Annex F: Opening Remarks, Hon. Minister of Health........................................ 43
Annex G: Keynote Address, Managing Director, Fidelity Bank.......................... 45
Annex H: Peer Review Raters’ Comments ........................................................ 52
Annex I: Country Action Points........................................................................ 56

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Sabin Vaccine Institute
Executive Summary
On 19-21 April 2016, 156 delegates, local participants, and partners convened in Abuja,
Nigeria for the second Anglophone Africa Peer Review Workshop on Sustainable
Immunization Financing (SIF), hosted by Nigeria Immunization Financing Task Team
(NIFT) on behalf of the Nigerian Federal Ministry of Health and National Primary Health
Care Development Agency and organized in partnership with the Sabin Vaccine Institute.
The delegates represented Ministries of finance, Ministries of health, and other
government and subnational ministries in Sierra Leone, Liberia, Nigeria, Uganda and
Kenya. Delegates evaluated each other’s past, ongoing and current solutions promoting
sustainable immunization financing for their countries. Joining them were counterparts
from global immunization partner agencies including WHO, UNICEF, the GAVI Alliance, the
Bill & Melinda Gates Foundation, Clinton Health Access Initiative, IVAC, and the Sabin
Vaccine Institute, among others. Participants spent two and a half days in small groups
and plenary sessions, examining their countries’ immunization budgets, legislation, and
advocacy strategies. The workshop culminated in a poster session where delegates
assessed each other’s immunization financing innovations. Each country delegation
drafted action points that will help them achieve sustainable immunization financing.
Assessment of the peer review results and country action points show that all five
countries have made progress and since the previous Anglophone Africa Peer Review
Workshop, which took place in Nairobi in October 2015. Uganda had the largest increase
in innovativeness during this period, as rated by the other countries. A summary of
Colloquium proceedings and results follows.
Acknowledgements
This report was compiled with the valuable assistance of the following individuals: Dr.
Shola Molemodile (IVAC), Dr. Obinna Ebirim (IVAC), Ms. Funmilayo Adewumi (IVAC), Dr.
Obi Emelife (NPHCDA), Mrs. Fadal Girei (NPHCDA), Dr. Ekene Osakwe (NABDA), Mr.
Chimaobi Chukwu (NABDA), Mr. Aloysius Ugwu (HERFON), Mrs. Fumilayo Ojo (Federal
Ministry of Health), Ms. Saira Zaidi (CHAI), Ms. Oluseyi Abejide (Save the Children), Mr.
Kenneth Oshiobugie (Vaccine Network), Ms. Ndidi Chukwu (CHR), Ms. Celestina Obiekea
(SLNI), and Dr. Ben Anyene (HERFON/NIFT).
Introduction
The Nigerian Federal Ministry of Health and National Primary Health Care Development
Agency (NPHCDA) with intersectoral collaboration from Federal Ministry of Science and
Technology hosted the peer review workshop. Much of the NPHCDA planning and support
to the workshop came through its Nigeria Immunization Financing Task Team (NIFT). The
NIFT Concept Note for the workshop is shown in Annex A.

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On 12 April, the NIFT organized a press conference to preview the workshop and share
information on Nigeria’s strategies for achieving sustainable immunization financing.
In addition to Sabin, thirteen collaborating organizations were represented in the
workshop, including: Clinton Health Access Initiative (CHAI), Community Health and
Research Initiative (CHR/Nigeria), Healthcare Federation of Nigeria (HFN),
GlaxoSmithKline, Health Reform Foundation of Nigeria (HERFON), International Vaccine
Access Center (IVAC), May & Baker, Nigerian Medical Association (NMA), Paediatric
Association of Nigeria (PAN), Pfizer, Save the Children, UNICEF, Vaccine Network for
Disease Control, Gavi, the Vaccine Alliance, and WHO.
The five participating countries were represented by 16 delegates. In addition, 140 local
participants, partner agency counterparts and high officials attended. The list of
participants is shown in Annex B.
The workshop agenda (Annex C) departed from those of previous workshops in that time
was evenly divided between the peer review itself and sessions managed by the host
country counterparts. Sustainable immunization financing was the common theme.
Proceedings were transcribed and periodically posted to Facebook (#NIFTNIG) and twitter
(@niftnig) throughout the workshop.
The workshop objectives were the following:
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
Proceedings
Day One
Professor Ben Anyene, Chairman, National immunization Task team (NIFT), called the
workshop to order. Following a round of introductions, Sabin SIF Program Director Mike
McQuestion reviewed the Sabin portion of the workshop agenda. Professor Anyene then
described the Nigerian inputs to the agenda and the workshop arrangements which had
been meticulously prepared by the NIFT planning committee headed by Dr. Adamu
Nuhu. Among the participating Nigerian institutions were the Ministry of Health (and

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within it the NPHCDA), the Ministry of Finance, Ministry of Science and Technology and
Commissioners for Health and Financing from six of Nigeria’s 37 states. Also attending
were six NPHCDA zonal coordinators.
Mike McQuestion set the stage for the technical sessions with an introductory PowerPoint
presentation (Immunization as a public good). It described the four topical areas in which
the SIF Program works (financing arrangements, budget and resource tracking, domestic
advocacy, legislation) and presented indicators for each area which the Program uses to
measure a country’s progress toward the SIF objective. Additional topics he covered
included immunization as a collective or public good and institutional change processes
which are seen as the unit of analysis for any health transition.
In the next session (Collective update), one delegate from each country summarized
progress made toward sustainable immunization financing since the October, 2015 Nairobi
workshop.
 Liberia has concentrated mainly on advancing new immunization legislation,
reported Hon. Senator Dr. Peter Coleman. After the Nairobi meeting, Liberian
delegates agreed they needed to insert an explicit financing provision into their draft
law. The revised bill is now under review by the Ministry of Finance. It will then go
back to the Senate Health committee, then on to the joint (Senate and House)
Budget Committee.
 Speaking for Kenya, Dr. Dominic Mutie, deputy director national immunization
program, described ongoing advocacy work the federal immunization team is doing
with the 47 counties, which now control all immunization financing for the country.
Another round of advocacy workshops is planned with support from Gavi, the
Vaccine Alliance.
 Mr. Ishmael Magona (Ministry of Finance, Planning and Economic Development)
described Uganda’s December 2015 passage and March 2016 enactment of its new
Immunization Law. The Ministries of Health and Finance are currently writing
detailed regulations to implement the law.
 Hon. ABD Sesay (National Assembly) provided an update on Sierra Leone’s vaccine
legislative project. Stakeholder meetings have taken place since Nairobi. The draft
bill now sits with the National Assembly’s Law Department. He expects the bill to be
passed by the end of CY2016.
 Dr. Lekan Olubajo (NPHCDA) summarized Nigeria’s advances on several fronts. A
new public-private partnership trust fund to finance vaccines is in the works. Past
JRF financial reports are being reviewed and corrected as needed. The National
Health Act was recently gazetted, moving it closer to full implementation. There is a
broad base of stakeholders coming together for sustainable immunization financing,
thanks to the efforts of the NIFT. Nigeria is intent on developing local vaccine
production as part of its sustainable immunization financing solution. A consultant
has been engaged to write a policy document and a business investment case is
being prepared.
Prof. Ben Anyene then described Nigeria’s new Primary Health Care Under One Roof
(PHCUOR) strategy, which aims to improve accountability and reduce fragmentation in the
system’s governance- to bring all governance under one roof. It has been approved by the
National Health Council. A scorecard with 9 pillar indicators has been developed to show

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the level of PHC program performance in each state. Elsewhere, committees continue to
work on the implementation of the National Health Act. At the moment, the 2016 budget
has not yet been signed so financial flows to immunization services and external vaccine
payments are in suspense.
Theme I: Domestic Financing Arrangements
Following coffee, Prof. Abdulsalam Nasidi, CEO of the National Center for Disease
Control, assumed the chair and opened the first technical theme (Domestic financing
arrangements). In his remarks, Prof. Nasidi noted that countries and partners are in
agreement that, in the long run, Africa needs to be self-sufficient in vaccine
manufacturing and procurement.
Mike McQuestion then set the stage for the financing theme with a slide set presenting
recent vaccine and immunization program delivery costs, a summary of reported (JRF)
government expenditures for the five participating countries and an outline of sources and
mechanisms of domestic immunization financing. Various domestic financing
arrangements, existing and in preparation in other SIF countries, were described.
The presentation prompted a series of questions.
Dr. Chizoba Wonodi (IVAC) asked for more details on how federal and state financing is
being managed in other SIF countries. She asked how shared health system (delivery)
costs be distinguished from pure immunization costs. She also wanted to hear more about
how trust funds are organized. In response, McQuestion commented on the importance of
co-financing by federal and subnational governments in larger countries. At operational
levels, identifying just immunization expenditures is usually impossible because all health
system costs at that level are shared, as they must be. The share attributable to
immunization can be estimated at best. But even such estimates can be used for
advocacy purposes. Among the SIF countries, financial information is rarely shared across
the two levels. An exception is Vietnam. Vaccine procurement, however, must be
centralized for a host of reasons. In one region, the Americas, countries jointly procure
their vaccines. A trust fund is a legal term for assets in a fund that are no longer
controlled by the benefactor. It may be a passive fund (assets are regularly deposited and
used at approximately the same rate) or a working fund (assets are invested and only the
proceeds are spent). The money in any trust fund must be used for a pre-determined
purpose. A trust fund is controlled by trustees/board of directors who are personally liable
for its use.
Professor Alex Akpa, Director of Medical Biotechnology at the National Biotechnology
Development Agency (NABDA), asked why routine immunization delivery costs varied so
widely. Perhaps the main reason is the cost of health staff. In the most expensive
programs, vaccinations can only be administered by physicians, replied McQuestion.
The agenda then moved to Theme I (Domestic financing arrangements). Each delegation
presented one or more new practices, under development or already implemented, which
are helping their countries achieve sustainable immunization financing.

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Nigeria
Dr. Adamu Nuhu summarized the work of Nigeria’s NIFT. Itself an institutional
innovation, the NIFT was created by the NPHCDA in 2015 to address the huge funding gap
in the national immunization value chain. New vaccines, added cold chain needs, rising
infrastructure operational costs and growing birth cohort sizes and the imminent (2021)
exit of Gavi, the Vaccine Alliance are all contributing to the gap. By the year 2020, Nigeria
will be facing an annual vaccine bill of around US$426.3m. There has been recent
progress toward sustainable immunization financing. The 2016 National Health Act was an
important milestone, however, it is not expected to be fully operational until 2018 and
even then will not provide all the funding needed. (The proportion set aside for vaccines is
insufficient.)
The NIFT brings together multiple government and non-government agencies, community
service organizations and the domestic private sector. Its present work focuses on
creating and financing a new national trust fund for immunization. The fund will receive
both public and private funds and will be directed by a board of fifteen individuals. Social
media (eg, bulk SMS messages) will be used to generate individual donations.
Beneficiaries will be all vaccine-eligible Nigerians.
Q&A
Dr. Nuhu’s presentation stimulated a series of questions and comments. Prof. Alex Akpa
asked if Nigeria’s proposed trust fund will finance research and development of vaccines.
No, those funds will come from the Federal Ministry of Science and Technology, responded
Prof. Anyene. The latter institution will be offered a seat on the board of trustees of the
national immunization trust fund.
Dr. Daniel Iya, Commissioner for Health, Nasarawa State, Nigeria, commented that the
focus should be on legislation. Nigeria’s National Health Accounts show that the
percentage given to provide a minimum health care package to Nigerians is far below the
Abuja Declaration target of 15% budget to health. Advocacy to the national assembly is
needed in order to increase the percentage stipulated in the National Health Act. Prof.
Anyene responded that the NHA was never designed to solve all the health problems of
the country. The fund examines expenditures; it does not affect government health
appropriations. To get the needed increases, government can only create an enabling
environment. It cannot drive the advocacy process or it dies. Countries need to think
outside the box to achieve sustainable financing. Solutions will not emanate from the
Ministry of Finance or Ministry of Health. They will come from the immunization fund
board and from all sectors contributing to the fund.
Dr.Lawal Bakare (NEPAD) asked if there will be just one fund with philanthropic
donations or will public revenues go into it? If so, under what kind of arrangements? Will
federal and state revenues both be allocated to the fund? Related to this, what will
happen to existing basket funding arrangements? Will the trust fund be supported by a
law or just an act? How will the Ministry of Finance participate in the fund? Will it be truly

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independently managed? How will it raise its funds? New legislation will be needed,
responded Dr. Nuhu, to ensure public revenues also flow into the fund.
Dr.Halima Mukaddas, Commissioner for Health, Bauchi State, Nigeria, asked whether
the national immunization trust fund will be duplicated at the state level. If so, what will
happen to the Basket Fund that is available in select states? The plan is to have a single
national trust fund, responded Dr. Nuhu. Individuals from subnational jurisdictions will be
invited to serve on the board of trustees.
Representing Uganda, Hon. Huda Oleru asked whether the proposed board of trustees
has been established by law. When raising funds, she continued, will it be managed
independently? How will Nigeria source the funding? Is there a mandate to go outside the
country or will fundraising be limited to domestic sources? She then described how her
country is setting up its trust fund so as to avoid potential conflicts of interest among its
board members. In response, Dr. Felicia Imohimi, NPHCDA, stated that the Private
Trust Fund is independent of government, so there will be no conflict of interest. The
proposed trust fund legislation incorporates a wider provision for contributions to come
from State, LGAs and organizations. While the will be represented on the board, it will not
manage or control the fund. Some organizations would otherwise be reluctant to
contribute.
Speaking for Gavi, the Vaccine Alliance, Dr. Karan Sagan described how Indian
corporations must allocate 2% of their profits, by law, to social projects like immunization.
Such an arrangement might work in Nigeria, he added.
Responding further, Prof. Anyene explained how Nigeria’s trust fund would be supported
by a law providing for both public and private contributions. NIFT is actively fundraising.
Government will have limited control over its operations. Specific fund regulations have
not yet been written by the Ministry of Health. When the fund is operating, NIFT will
generally oversee its work. Fund reports will link immunization program outputs (eg,
number of children fully immunized) to financial inputs, thereby monitoring value for
money. The trust fund, he added, needs to be operating before Gavi exits in 2021.
Chairman Nasidi reassured the participants that mechanisms will be put in place to build
confidence in the trust fund and that it is a great idea. The board and executive arm of
government will meet to develop the needed arrangements. In Nigeria, raising money is
not the problem, he added; it‘s governance.
Liberia
Representing the Liberian Congress House Committee for Health, Hon. William Dakel
presented that country’s newest practices for immunization financing. A structured study
was carried out by the Ministry of Health (Research Unit, Health Financing Unit, Office of
Financial Management Unit) and county health teams to assess ways to develop increased
capacity to track health sector resource flows. USAID and WHO provided technical
support. Costing routine immunization services is another need. Finding alternative
domestic financing sources is a third. A technical working group is carrying this work

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forward, co-chaired by Research and Health Financing Units. Members of the House of
Representatives Health Committee are also participating.
Developing these new practices is hindered by the lack of information about actual
expenditures. Fragmented external partner support further complicates financial
management for the immunization program. Another block is the ongoing reconstruction
of the post-Ebola health system, which the MoH is undertaking. All of these factors work
against the development of a domestic investment case for routine immunization. Perhaps
the most visible new practices since the October 2015 Nairobi workshop are the activation
of a parliamentary forum on immunization and regular meetings between the
immunization team and the House Health Committee.
Dakel noted that the parliamentary forum succeeded in getting the government to
increase its annual immunization spending from US$50k to $500k. Parliament also
prevailed on the government to catch up with its delayed Gavi co-financing payments, but
much more will be needed. Potential private sector donors and new revenue sources must
be identified for a proposed new “ring fenced” immunization fund.
Sierra Leone
Dr. Dennis Marke, National Immunization Program Manager, Ministry of Health and
Sanitation (MoHS), described recent immunization financing developments in Sierra
Leone. The most pressing need he sees is to establish an immunization budget line item
and his presentation focused on this proposed innovation. Currently, government
immunization funds are comingled with funds for other child health programs so
immunization-specific costs are unknown. Budget disbursement is a problem and the
country is chronically behind in its Gavi co-financing payments. The Director of Financial
Resources in the MoHS and counterparts in the Ministry of Finance and Economic
Development are working together to ameliorate this cash hoarding problem.
Within its scope, the immunization program carefully proposes and manages its budget
based on an annual plan of action (cMYP). Expenditures are reported quarterly. There has
been increased attention to the annual JRF financial reports and this has raised awareness
of the financing challenges the country faces. If the budget line item can be created, these
reporting needs can be better met. To make further progress, the budget line item would
be used to regularly track government immunization expenditures. This was one of Sierra
Leone’s action points stemming from the last (May 2015) Sabin-organized peer exchange
meeting in Freetown. Other institutions, particularly Parliament and local government,
must be brought into the process to provide oversight. In 2013-14, such an inter-
institutional network did briefly materialize, however, it became inactive due to frequent
staff turnover, elections and the Ebola epidemic. If the network could be revived, Dr.
Marke believes, the proposed new practices could be established and they would be
sustained.
The second new practice, described in Theme II below, is to update the 1960 Public
Health Act.

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Uganda
Mr. Ishmael Magona gave a concise analysis of immunization financing trends in
Uganda. According to a recent (EPIC) costing study, fully immunizing a Ugandan child
with the full complement of WHO-recommended vaccines now costs around US$62.
[EDITOR’S NOTE: With an annual birth cohort of 1.7m that works out to a theoretical cost
of around $105m. WHO/UNICEF (JRF) estimate the 2014 measles vaccine coverage level
to be around 82%. Adjusting for coverage, expenditures would have therefore been
around $86m.] In 2015-16, the government approved $16.4m for the immunization
program, of which it reported spending (to JRF) $16.2m on routine immunization. Of this
amount, $2.7m was for traditional vaccines and supplies (more than covering the $2.4m
Gavi co-financing obligations that year). Partner contributions for 2015-16 totaled
$61.7m. [EDITOR’S NOTE: By deduction, government health system spending and
decentralized external contributions must have covered the remaining roughly $8m in R.I.
expenditures.] The Government’s investment per infant rose from $3 in 2006 (13% of
total JRF-reported R.I. expenditures) to $11 in 2014 (49%).
With its heavy dependency on external funding, Uganda is still far from its sustainable
immunization financing solution, acknowledged Mr. Magona. He then described two new
practices that are helping move Uganda toward that solution. In October 2013, the
Ministry of Finance, Planning and Economic Development (MoFPED), the Ministry of Health
and Parliament combined multiple health budget line items affecting immunization (eg,
preventive, curative, administrative) into one. The single immunization vote function has
already improved resource tracking capacities. The Ministry of Health directs
expenditures, MoFPED oversees budget formulation, implementation and tracking and
Parliament provides high-level oversight, advocacy and support during budget
appropriation. Reports on immunization expenditures are produced quarterly. Local
governments, CSOs, Sabin and other external partners all played supporting roles. There
are now much better working relationships between MoFPED, Parliament and the Ministry
of Health, added Magona.
The second practice- a new National Immunization Act- is described in Theme II below.
Kenya
The Kenya case study was presented by Dr. Dominic Mutie. A new public immunization
fund has been established. It corrects the previous removal of all central–level program
funding caused by the 2013-14 devolution of Kenya’s governance structure. In that
process, failure of counties to purchase vaccines led to stockouts. Intervention by Gavi
and the federal government prevented expected epidemics from occurring. A second fund,
for centralized, federal vaccine procurement, has also been established. Other innovations
incubating include two new laws and a parliamentary advocacy network for immunization.
Facilitating these innovations was an EAC/ GAVI rapid assessment of immunization
services covering all East African partner states. In Kenya, the plan is to extend the study
to all 47 counties. Results will be presented to a governors’ forum, hopefully in June. The
hope is the governors will then agree on a way forward to remedy the severe

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immunization financing disruptions. Dr. Mutie expects that the 2016-17 federal health
budget will cover vaccines and Gavi co-financing.
Q & A
Following the presentations, participants asked a series of questions. Speaking for
UNICEF, Dr. John Agbor commended Liberia for having increased government
immunization spending tenfold. He went on to ask, what would the immunization
investment case for all of Africa look like? Fifty years post-independence, African leaders
do not seem concerned with providing this valuable public good. Much advocacy, he
observed, involved powerful people- CEOs talking to presidents- but the best advocacy
comes from bottom up, when citizens demand that their governments provide
immunization.
Kenyan delegate Mr. David Kiuluku, Director, Health Planning and Administration,
Makeuni County, described how Kenyan counties are carrying out an eight-pillar
development strategy. One pillar is health and immunization rests within it. The problem
is competing interests. Overall, two years in, there is a more equitable distribution of
resources in the country. Performance improvements in the health sector have been
documented. Sustainability, however, is a concern. New ways of working between federal
and county governments must still be developed.
Dr. Oluseyi Abejide (Save the Children) noted the problem of global donor fatigue. He
then asked all delegates to reflect on how the alternative financing arrangements they are
developing are helping to make immunization financing more sustainable. How have they
worked and what percentage of the budgets do they cover? What new accountability,
tracking and reporting practices are promoting sustainable financing? Noting the case of
Uganda, he asked what happened after 2013 to improve immunization financing.
Responding for Liberia, Hon. Dakel said that the new financing scheme is still in the early
stage and reiterated that financial strains are limiting the process.
Dr. Clifford Kamara, Senior Program Officer, Sabin Institute, asked what it will take to
bring about the changes needed to get public money to the right places. Currently, efforts
to push governments from the outside prevail. His approach is to use advocacy and
communication to create demand for the services in the communities. They in turn will
decide to take charge and will demand that their children are fully immunized. This is the
endogenous approach.
Dr. Damaris Onwuka, National Primary Healthcare Development Agency, asked the
Sierra Leonean and Liberian delegates to describe the effects of the Ebola outbreak on
immunization. Ebola caused a collapse of the health system and immunization was
seriously affected, responded Dr. Dennis Marke (Sierra Leone). Measles re-emerged
after years of absence. The outbreak collapsed not just health services but the entire
economy. One benefit has been an increased disease surveillance capacity. Health
workers had to learn new ways to educate and communicate with the public. The previous
one-way style of communication failed. The crisis induced more community involvement
and this helped change the terms of engagement with the health system. Religious

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leaders and civil society groups played important roles in controlling the epidemic. Gavi is
now trying to redirect those efforts to strengthen routine immunization.
Hon. Dr. Peter Coleman described how Ebola led to the total collapse of the Liberian
health care delivery system. Immunization was greatly affected with drop in immunization
coverage from 85% to about 50%. As in Sierra Leone, that led to the re-emergence of
vaccine-preventable diseases like measles. There is currently an outbreak of measles in
Liberia. Economic growth fell from 5-7% to -1%. The fragility of the health system
revealed the country’s high dependency on external funding and technical support.
Liberians now realize they need to do things differently.
Session Chairman Professor Nasidi added his own impressions, having led a team of
Nigerian public health workers to assist both countries during the outbreak. He then
summarized the session. By 2050 the African population is projected to outgrow China’s
population. The cost of vaccine and volume of vaccine per child will increase. Africa needs
to achieve self-sufficiency for vaccines. The main financing must come from
governments. In Nigeria’s case, US$756m will be needed annually by 2020 for
immunization. The country is now hard pressed to provide $80m. Can the country
reposition its immunization financing arrangements or will it remain externally dependent?
Only Rwanda and South Africa are allocating 15% of their budgets for health, he noted.
All African countries must do so if they are to build robust systems – cold chain, local
vaccine production. The countries need to take a collective, integrated approach and find
complementarities. He closed by thanking the participants for the privilege of chairing the
session.
Small groups
Following lunch, participants were randomly assigned to six small groups. The theme:
Developing and applying innovative financing arrangements. Partner agency counterparts
facilitated the groups, using the nominal group technique. Results were reported by
rapporteurs from each group. They are summarized in Annex D.
Nigerian roundtable
The small group work was followed by a roundtable discussion on immunization financing
by Nigerian institutional counterparts (Prospects for federal- state co-financing of routine
immunization). Prof. Anyene began the session with a presentation summarizing the
illness burden attributable to vaccine-preventable diseases in Nigeria. He then outlined
various advocacy strategies the NIFT is using to increase the domestic immunization
budget. The basic health fund, as set out in the new National Health Act, is not enough.
As stated in an NPHCDA Discussion Paper provided to participants before the workshop,
Nigeria’s government immunization budget needs to increase from its current 29b Naira
(US$145m) to 63b Naira ($315m) in 2020. For vaccine alone in 2020, the government
must raise 53b N ($265m). The only way this can be accomplished, argued Prof. Anyene,
is with co-financing by the federal, state and LGA governments. He presented a plan
whereby the federal government will pay 52% of the vaccine bill with states progressively
paying into the trust fund until reaching their full population- and income-weighted shares
in 2021. If the states concur, a law must be passed formalizing the arrangement.

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The Commissioners for Health of Nigeria’s Nasarawa, Bauchi and Kebbi States all
commented on Prof. Anyene’s co-financing proposal. Dr. Daniel Iya (Nasarawa)
expressed admiration for all the NIFT is doing. The formula appears feasible. Vaccines will
represent just 0.44% of all state revenues. However, in the long run, he felt,
immunization must be financed through a community-based insurance scheme. Moving
forward, the next step is to involve the state governors. Dr. Halima Mukaddas (Bauchi)
suggested that health indices be integrated into the state contribution matrix. In Kebbi, a
prior concern is to assure there is at least one primary health care center for every 225
political wards so that immunization services can reach all of the population.
Additional participants commented favorably on the proposed arrangement. Mike
McQuestion (Sabin) observed that the states must already be paying around half the
immunization costs because they are financing their PHC delivery systems. To this Prof.
Anyene responded that state immunization spending levels are not generally known.
Costing and resource tracking are additional tasks to be faced with the states.
Summarizing, Prof. Anyene stated that all Nigerian states must accept that they ultimately
will need to fully finance immunization and that these immunization funds should not
consist solely of federal transfers to the states but should also come from locally
generated revenues.
Day One ended at 6PM.
Day 2
Theme II: Legislative Provisions and Implementation
Day Two began with announcements and a recap of Day One by the NPHCDA rapporteurs.
The agenda then turned to Theme II: Legislative Provisions and Implementation. Dr.
Mike McQuestion set the scene with a presentation describing the institutional work that
must happen to pass any law. Both government ministries and legislatures must
collaborate to draft and ultimately enact immunization-related laws. Many projects begin
but fail to reach fruition. In this regard, African countries are following the same
trajectories followed earlier by Latin American countries, most of which ultimately did pass
immunization laws. Ms. Dana Silver (Sabin) then presented the provisions of a synthetic
“model” immunization law derived from the Latin American experience.
With the arrival of Nigeria’s senior officials and dignitaries, the formal opening ceremony
began. Joining the meeting were:
 Chairman, Senate Committee on Primary Health Care and Communicable Diseases,
Senator Mao Ohabunwa
 Acting Director, Department of Public Health, FMOH, Dr. Sunday Aboje
(representing the Honourable Minister of Health, Prof. Isaac Adewole)
 Director, Physical and Life Sciences FMST, Dr. Manasseh Gwaza (representing the
Honourable Minister of Science and Technology Dr. Ogbonnaya Onu)

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 Mr. Ibikunle Adams (representing the Honourable Minister of Industry, Trade and
Investment Dr. Okechukwu Enelamah)
 Executive Director, National Primary Health Care Development Agency (NPHCDA),
Dr. Ado Muhammed
 GM/ Regional Bank Head, Fidelity Bank Plc. Mr. Obaro Odeghe (representing MD
Fidelity Bank Plc. Mr. Nnamdi Okonkwo)
 Representatives of the Governors of Bauchi, Kano, Nassarawa and Kebbi States
 Members of the press.
Welcome Address
In his welcome address (Annex E), the Executive Director, NPHCDA, Dr. Ado
Muhammad, expressed his satisfaction with the participation of the private sector in the
workshop, noting that the Managing Director of Fidelity Bank Plc. Mr. Nnamdi Okonkwo,
would be giving the keynote address. The workshop agenda, he said, showed a high level
of commitment to the task ahead and clearly placed Nigeria as a front runner on issues of
vaccine financing. Dr. Muhammed recalled that the NIFT was inaugurated on March 25,
2015 as part of Government’s efforts to secure sustainable immunization financing for the
country. Whereas Nigeria paid US$85m for vaccines last year, the bill will be $355m by
2021. He expressed his belief that the workshop will play a vital role in shaping current
strategies and the vision for sustainable Immunization financing in Nigeria as well as in
the other participating countries.
Dr. Mohammad’s welcome address was followed by a round of good will messages.
 The Chairman of the newly constituted Senate Committee on Primary Health Care
expressed his satisfaction with the workshop. He assured the participants of his
commitment and promised to pass legislation that will further improve Primary
health care services
 The Nasarawa State Governor assured the participants of his commitment to the
health of women and children in Nasarawa State
 GAVI re-iterated its commitment to supporting vaccine financing in main countries
of interest, especially with regards to new vaccines
 HERFON urged the Federal Government to fund the National Health ACT
 IVAC called on all relevant organizations to support the government as the task is
enormous and cannot be borne by the Government alone
 CHAI enjoined the Federal Government to do more, stating that it would be
appropriate for the Legislature to champion the vaccine financing effort
 On behalf of visiting Country delegates, Uganda observed that Africa was mostly
reliant on donor funds for financing national immunization programs
 The Honourable Minister of FMST said the National Research Innovation Fund will
help to make funds available for research and new technologies in local vaccine
production
 The NIFT Chairman encouraged all participants to reflect on the objectives of the
meeting and look at opportunities within Nigeria and Africa that can move the
countries from financial uncertainty to a more predictable and sustainable means of
immunization financing.

14
Opening Remarks
The Honourable Minister of Health stated that the workshop was in line with the vision
of the change agenda of the current administration which is focused on the reactivation of
basic Primary Health Care as proposed in the current Strategic Implementation Plan for
the 2016 Budget. He recounted the recent success of the Federal Government in delisting
Nigeria from WHO’s list of polio endemic countries and attributed the achievement of this
feat to increased Government commitment and support from donor partners. He also
enjoined all delegates at the Workshop comprising of representatives of the Ministries of
Finance, Economic Planning and the Parliaments to ensure that funds allocated to health
programmes are disbursed promptly and in full. His full remarks are found in Annex F.
Keynote Address
The MD of Fidelity Bank emphasized the need for high-level political and legislative
support for the passage of laws defining how immunization is to be financed perpetually.
He encouraged sub-national governments to explore the possibility of contributing more
significantly to the programme rather than depending solely on the central government.
In any future arrangement, it will be essential to show clearly how immunization funds are
being used. Budget discipline must also be demonstrated. He also re-iterated the
commitment of Fidelity Bank Plc in the development of a sustainable partnership with the
National Immunization Financing Task Team to find new immunization financing sources.
The full keynote address is found in Annex G.
Special Guest of Honour
The Executive Governor of Bauchi State re-iterated his commitment to routine
immunization, exemplified by the signing of an MOU with the BMGF. The new agreement
has already had an enormous impact on the state primary health care system. He also
said that the state was committed to sustaining this progress by ensuring timely delivery
of vaccines to all the children of Bauchi State.
The dignitaries stayed on to hear more about the workshop. Chairmanship of the session
was passed to the representative of the Executive Governor of Bauchi State. At Professor
Anyene’s suggestion, Dr. Mike McQuestion again presented the introductory Sabin
presentation, which included a discussion of the criteria the SIF Program uses to judge
when countries have reached the sustainable immunization financing goal. Work on
Theme II then resumed. Four delegations gave updates on the status of immunization
legislation in their respective countries.
Liberia
Senator Peter Coleman described how work on Liberia’s immunization bill began in
2013. The emergence of a parliamentary forum for immunization that year facilitated the
work. An initial draft law was prepared by the MPs. It was reviewed by the Ministry of
Health and later revised to include a financing provision. With the Ebola outbreak,
fourteen months were lost but momentum has since been regained. At present, four MPs

15
are recognized as immunization champions. They are passionate and committed to
passing their Bill before parliamentary recess in September 2016.
Sierra Leone
There is currently no legislation for vaccine financing in the country, stated Hon. ABD
Sesay, who has emerged as the leading champion for the cause. However, a bill is being
developed and will conform to a newly revamped National Immunization Policy Cabinet
Paper. Among the institutions working together on the bill are the Ministries of Health and
Sanitation and Finance and Economic Development, the Law Officer’s Department and the
Parliamentary Health and Sanitation Committee.
Uganda
Hon. Huda Oleru, who most recently led Uganda’s legislative project, outlined the
history of that country’s new National Immunization Act. The work began more than five
years ago when an MP introduced it as a private member’s bill. Backing him were over
forty MPs who had just formed Uganda’s parliamentary forum on immunization, which
would eventually be led by the Speaker of the Parliament. Early technical support came
from the Parliamentary Research Office and from Sabin. A key step in the project was
winning the approval of the Ministry of Finance, Planning and Economic Development. At
one point, 170 MPs signed a letter to the President calling for the Act to be approved.
Important advocacy support came from Uganda’s national immunization technical
advisory committee (NITAG) and from local media. The Act was passed in December
2015. With the President’s signature, it was enacted in March 2016, timed to coincide with
the launch of the new Gavi-supplied pneumococcal vaccine.
The Ministry of Health is currently preparing regulations to implement the Act. The
Immunization Act provides for the creation of a national trust fund, to be run by an
independent board of trustees. Efforts are now focused on creating the fund. One risk is
that MPs engaged in the past are now replaced by newly elected successors. The
Parliamentary Forum on Immunization will hopefully provide the institutional memory to
keep the legislative work going.
At that point, Dr. Nuhu (NPHCDA) thanked the dignitaries for their commitment to
Sustainable Immunization Financing and all proceeded to lunch. Following lunch, Professor
Anyene presented Nigeria’s legislative project and summarized Theme II.
Nigeria
Prof. Ben Anyene recalled how work on the National Health Act began in 2004, a time
when there was little or no Government commitment to health. The National Assembly
consistently led the project. Finally passed in October 2014, the Act provides dedicated
funding for health care delivery, including vaccines. One percent of the total budget is to
go to a new National Health Fund to provide a basic package of PHC services. Of this,
20% is earmarked for basic drugs and vaccines. Now gazetted, 2016 will be the first
budget (not yet passed) to implement the provisions of this law. (See roundtable
discussion, Day One, for more on Nigeria’s immunization financing.) A set of technical

16
working groups has been charged with implementing the Act. Rollout is expected to be
piecemeal. There is a pressing need to clarify roles and responsibilities at all levels of
government. In Nigeria, the 37 states finance 60-70% of all health spending. Senator
Mao Ohabunwa described his efforts to shepherd through the needed new financing
legislation, noting the fact there are a number of health-related bills before his
Committee.
Q&A
Prof. Alex Akpa asked whether Sabin can help Nigeria develop an investment case for
local vaccine production. Negative, replied Dr. Mike McQuestion. That would be beyond
the scope of the SIF Program. However, Sabin will soon be implementing the ProVac
Program, which Nigeria could use to study the cost effectiveness of particular vaccines.
Counterparts from the countries themselves carry out the ProVac studies. Sabin would
organize technical support if Nigeria requests it.
Sabin indirectly helps countries increase financing, commented Dr. Clifford Kamara, by
encouraging greater budget transparency and reporting across sectors. He described how
counterparts have analyzed their routine immunization budgets and used that financial
information to strengthen their investment cases. Impressed and informed by this budget
transparency, parliamentarians often use the results to argue for increased immunization
budget appropriations.
Theme III: Budgeting, Resource Tracking, and Domestic Advocacy
The agenda turned next to Theme III: Budgeting, Resource Tracking, and Domestic
Advocacy. Mike McQuestion began with a slide set outlining the main concepts of
transparency and accountability and the kinds of innovations observed in the countries in
this domain. Using the case of DRC, McQuestion illustrated how MoH counterparts used
the Sabin budget flow analysis tool to improve budget execution. When asked whether
anyone in the audience had ever used the tool, only one hand was raised. This was an
indication of how difficult it is for managers and others to access financial data in the
countries.
The countries then presented their recent work in this area.
Liberia
Mr. Adolphus Clarke (Ministry of Health) began by stating that the annual immunization
program work plan now explicitly incorporates advocacy (itself a new practice). Advocacy
is needed to convince the government to invest more in immunization. The most effective
new practice are regular in-year meetings between the immunization team and the
National Assembly Health Committee. During budget negotiations, the team presents the
indicative immunization budget to the MPs. This information sharing and advocacy has led
to a tenfold increase in the government’s immunization budget (from $50k to $500k)
since the practice started in 2013, reported Clarke. The Liberians decided to adopt the
practice after observing it through Sabin-organized peer exchanges with other countries.

17
The Liberian immunization team is now incorporating economic arguments into their
investment cases and communication and social mobilization messages. Media and CSOs
are increasingly carrying and amplifying those messages. But there is a long way to go.
The government is funding just 25% of its vaccine bill.
Sierra Leone
Mr. Peter Sam-Kpakra (MoFED) described how Sierra Leone has been developing better
resource tracking capacity for its immunization program. A locally adapted version of the
Sabin budget flow analysis tool was developed by the MoHS immunization team in 2012.
Complementing this is a simpler Excel spreadsheet developed for use by district health
management teams to cross analyze programmatic and financial data. These reports
would be presented to the local development councils which oversee all government
spending and services. MoFED and the Ministry of Local Government and Rural
Development have collaborated with MoHS on the project. The system has yet to be
implemented because the requisite financial data are not available at central level. The
government uses an Internal Financial Management Information System which produces
quarterly expenditure reports but the data are not down to program level. This structural
problem also causes severe under-reporting of the government’s annual JRF immunization
expenditures.
Kenya
A county-level annual work planning tool was the practice presented by Kenya’s David
Kiuluku (Makneni County Health Commissioner). Kiuluku and his team began developing
the practice in 2015. At that time there was no line item for immunization in the county
budget. Making the annual plans requires county and sub-county health counterparts to
carefully estimate projected costs activity by activity across 101 facilities offering
immunization, then to identify financing sources (government or external partners) to
meet them. Fifty percent of the annual routine immunization budget is now financed by
the county. The budget is currently around US$675k- 40% more than the immunization
budgets in other counties. About half the budget is executed by the county health
management team and the other half is executed by the sub-county health management
teams. A county public health nurse, Ms. Roseline Kavata, has emerged as the
champion for the new county budgeting practices.
The county resource tracking work is being assisted by CHAI, reported Ms. Jennifer
Foth. The annual work plan model is now being introduced in five additional countries.
Engagement with the counties is improving, commented Mr. Dominic Mutie (MoH).
There are now immunization focal points in each. More work is needed to identify focal
points at sub-county levels. There are also new resource tracking practices germinating at
central level, he added. An online tool is being used to track movement of vaccines and
supplies.
Uganda

18
Dr. Sylvester Mubiru (MoH) described how Uganda uses an output-based budgeting tool
for the health sector and how this tool performs the needed sector-level resource tracking
function. The system generates budget projections based on unit costs (logistics,
vaccines, supplies) and service coverage levels. It links resources to inputs, outputs and
outcomes. Once approved, budgets are disbursed quarterly. Expenditures are also
reported quarterly from the receiving entities. Workshops have been used to introduce the
system to local governments. It has been used to populate the National Health Accounts.
A newer version of the tool will be unveiled in 2017-2018. One problem is that it does not
capture off-budget external financing. Nor was unclear whether the tool generates
program-level information. If not, adapting it to do so would be an important resource
tracking innovation.
Nigeria
At present, there is no resource tracking practice specific to immunization. Periodic budget
performance reviews are performed at federal and state levels. Key contacts for
expenditure tracking are directors of finance and accounts (federal, state) and local
government treasurers (LGAs). Two key innovations, the use of a Single Treasury Account
(STA) and the new zero budgeting technique (ZBB), may now make resource tracking
possible for the immunization program. ZBB is a method of budgeting in which all
expenses must be justified for each new period. Budgets are built around what is needed
for the upcoming year regardless of whether it is higher or lower than the previous year.
A third possibility are the PHC scorecards, mentioned Professor Anyene, which are used to
monitor program performance at state level. Expenditure indicators could be added to the
scorecard or immunization expenditures could be cross analyzed with the current
programmatic data.
Q&A
The presentations for Theme III triggered a number of comments and queries.
Dr. Daniel Iya (Nasarawa State) observed that Nigeria and Uganda face the same
difficulties caused by external funds not being tracked by the government accounting
systems. With the possible exception of polio, all donor funds should be on-budget, he
remarked.
A participant from Niger State observed the general difficulty in accessing any financial
data. Another Nigerian participant asked about the Future Generations Fund.
Following the discussion, Theme III and Day Two came to a close.
Day Three
Minister of Health

19
The day began with a summary of Day Two proceedings by the NPHCDA rapporteurs.
Country delegations then worked together to prepare for the peer review exercise. The
group returned to plenary when the Honourable Minister of Health, Prof. Isaac Adewole,
joined the meeting. In his remarks, the Minister declared that achieving local vaccine
production was a matter of national pride. He further commented that the health and
immunization budgets would be increased in 2017. It is high time we public health people
learn to speak the language of finance, he continued. He thanked the visiting delegates
for coming to Nigeria and for sharing their immunization financing work.
Peer Review Exercise
In this exercise peers reviewed each other’s efforts to achieve sustainable immunization
financing. Each country presented a case study. Participants were given four copies of a
standard evaluation form, one for each of the other countries. Five poster sessions were
set up around the perimeter of the room. The first three countries to present were Sierra
Leone, Liberia and Nigeria. Participants moved from one to the other. After 45 minutes,
Ugandan and Kenyan delegates began their presentations.
Forty-three participants completed at least one review form. Of these, 20 (47%) were
from ministries of health, 11 (26%) were from external partner agencies or CSOs, 5
(12%) were from ministries of finance, 3 (7%) were parliamentarians and 4 (9%) did not
state their institutional affiliations.
One hundred seven completed forms were collected. Of these, 104 were analyzed. Table
1 shows the numbers of peer ratings contributed and received by each country.
Raters were asked to classify the cases by domain. The most common classification was
“legislation” (48%), followed by “advocacy” (27%), “financing” (16%), “resource tracking”
(5%) and any “combination” of these (4%). By country, legislation dominated for Kenya,
Liberia and Nigeria. The other countries were perceived as active in two or more of the
other domains.
Raters were asked whether the activity is already happening or aspirational. Responses
are shown in Figure 1. Another item asked how long the innovative activity has been
going on. Responses were almost evenly divided between “this year”, “past 1-2 years”
Country No. ratings contributed No. ratings received
Kenya 14 25
Liberia 12 17
Nigeria 51 13
Sierra Leone 13 22
Uganda 14 27
Total 104 104
Table 1. Number of raters and ratings by country, Anglophone
Africa Peer Review Workshop, Abuja, Nigeria, April 2016

20
and “3+ years”. They were also asked to judge how advanced the activity is in terms of
implementation. Most commonly, the raters classified the cases as “becoming
institutionalized” (41%), followed by “just talking about it (aspirational)” (27%), “fully
institutionalized” (18%) and “now being tried (piloted)” (15%). Responses to this item are
shown by country in Figure 2.
Seventy-two percent of the raters described the activity as being launched “top-down”,
28% perceived it to be “bottom-up” and 2% felt the activity was introduced from the
outside, by a third party. Ratings on this item did not vary by country.
Looking at government involvement, 75% of raters saw the new activity as emanating
from national authorities- most commonly, a combination of ministry of health, ministry of
finance and elected officials. This was the modal response in all five cases. National and
subnational officials were seen as working together to develop the activity by 15% of
raters. Community service organizations were identified as part of the activity 49% of the
time. Thirty percent of the ratings identified CSOs teaming up with business to support
the activity. External partners were implicated in 17% of the ratings.
0
20
40
60
80
100
120
Kenya Liberia Nigeria Sierra Leone Uganda Total
Fig. 1. Perceived implementation status of
innovativeactivities (n=100 ratings)
Operational Aspirational

21
To finish their assessments, raters answered a battery of ten Likert-scaled items.
Responses to these items are shown in Table 2.
0
20
40
60
80
100
120
Kenya Liberia Nigeria Sierra Leone Uganda Total
Fig. 2. How advanced in the new practice?
Aspirational Piloting Spreading Institutionalized

22
On whether or not the activity was well conceptualized, raters were generally positive.
Only Kenya (2/14), Nigeria (6/48) and Uganda (1/14) received any ratings of “unsure” or
“unlikely” on this item.
The next item- whether a different approach to the problem would have been better-
garnered doubts (“likely” or “almost certain”) by a few raters. They expressed these for
the cases of Kenya (6/14), Nigeria (13/49), and Sierra Leone (1/13).
On whether the activity engages the proper mix of institutions, raters gave affirmative
responses 88% of the time. Each country received at least one, but no more than 11%,
“unlikely” or “unsure” responses.
Item Description of Item Obs. (n) Mean Std. Dev. Min Max rho 1
95% C.I.
concept
The innovation is well conceptualized.
Proposed solution matches the
problem/opportunity it addresses. 98 1.36 0.68 -1 2 ----- -----
approach
Another approach would have been
more suitable for solving the problem,
improving sustainability. 99 0.48 1.16 -2 2 0.32** (0.03, 0.70)
mix_inst
The right mix of institutions is or was
involved in developing the innovation. 97 1.28 0.86 -1 2 ----- -----
resist
There is or was a lot of resistance to this
innovation. 91 0.31 1.29 -2 2 0.44*** (0.08, 0.84)
no_costs
This innovation is or was carried out
without incurring significant new costs. 94 0.33 1.06 -2 2 0.39*** (0.06, 0.79)
sustain
This innovation will help country reach
sustainable immunization financing
sooner. 95 1.21 0.78 -1 2 0.43*** (0.09, 0.81)
inst_nation
The innovation will ultimately be
institutionalized nationwide. 96 1.35 0.79 -2 2 ----- -----
ownership
The innovation will increase country
ownership of the immunization program. 98 1.55 0.58 0 2 ----- -----
likely
Considering all the factors, how likely is
the innovation to succeed, to become
institutionalized? 99 1.2 0.71 -1 2 0.12 (-0.11, 0.53)
my_ctry
This innovation would likely succeed in
your own country. 95 1.1 0.88 -2 2 0.33** (0.04, 0.71)
Table 2. Descriptive statistics, Likert Scaled items, Anglophone Africa Peer Review Workshop, Abuja, Nigeria, April 2016
1
rho is the intra-class correlation
* 0.05<=p<0.10, ** 0.01<p<0.05, *** p<0.01

23
Raters perceived resistance to the new practice in all five cases. Responses to this item
are shown in Figure 3. Highest resistance was perceived in Kenya (5/14 responses),
Liberia (2/7), Nigeria (14/47) and Sierra Leone (3/13).
On whether the new activity entails new, additional costs to the institutions, raters were
divided. Twenty-six percent of the responses 24/94) were negative (“no chance”,
“unlikely”) while 46% (43/94) said “likely” or “almost certain”. Kenya, Nigeria and Sierra
Leone were judged most likely to induce new costs.
Will the new activity help the country reach sustainable immunization financing sooner?
Raters responded affirmatively 86% overall (82/95 “”likely” or “almost certain”). Only
Kenya (2/14) and Nigeria (2/46) received any “unlikely” responses.
Response to the next item- whether the new practice will ultimately spread nationwide-
were similarly optimistic (91%). Doubts were expressed only for Nigeria (2/46 “no
chance” or “unlikely”).
At 96% (94/98 responses), raters felt the new practices are advancing country ownership
of immunization programs. No countries received “unlikely” or “no chance” responses to
this item.
Weighing whether the new practice is likely to succeed, raters were more guarded.
Overall, the perceived probability of success was 85% (84/99 “likely” or “almost certain”).
There were no differences among the countries on this item.
The final item asked whether rater thought the innovative activity would succeed in his or
her own country. Eighty percent (76/95) felt yes. Responses by country are shown in
Figure 4.
0
10
20
30
40
50
60
70
80
Kenya Liberia Nigeria Sierra
Leone
Uganda Total
Fig. 3. Perceived resistance to new
activity
none/unlikely likely almost certain

24
The Likert-scaled items were used to construct an index of innovativeness. Of the ten
items, five were found suitable- their responses were normally distributed and the raters
showed consistency in their responses to those items (intra-class correlations significant).
Further analysis reduced the index to four items (approach, resist, sustain, my_cntry).
Table 3 shows the ranks of the five countries from most to least innovative.
Table 4 shows the ranks for each composite index item.
Reviewers were encouraged to write down comments, critiques and recommendations for
each delegation they interviewed. They are listed in Annex H.
Country Action Points
0
10
20
30
40
50
60
70
80
90
Kenya Liberia Nigeria Sierra
Leone
Uganda Total
Fig. 4. Would this innovation work in
my country?
no/unlikely likely almost certain
Rank Country
1 Uganda
2 Nigeria
3 Liberia
4 Kenya
5 Sierra Leone
Table 3. Countries ranked
on innovativeness index
Rank (high to low) approach resistance sustainable my_country
1 Sierra Leone Liberia Uganda Uganda
2 Kenya Sierra Leone Liberia Nigeria
3 Nigeria Uganda Nigeria Liberia
4 Uganda Kenya Kenya Sierra Leone
5 Liberia Nigeria Sierra Leone Kenya
Table 4. Countries ranked on innovative index items

25
In the last workshop session, delegates worked by country to review their past action
points and develop new ones for the coming months. The results are shown in Annex I.
Each delegation then presented its action points in plenary.
Workshop Evaluation
A standard workshop evaluation form was circulated to delegates. Thirteen completed
forms were collected, representing all five countries. Asked to state three personal
objectives coming into the workshop, 7/13 (54%) mentioned peer learning. The next most
frequent responses were to learn more about legislation, resource tracking and advocacy
(3/13, 24%). Asked whether the workshop completed those objectives, 83% (10/12)
responded affirmatively.
Only 63% (8/13) felt the workshop was well organized. There was not enough small group
work and too many speeches, several delegates commented. Seventy percent (9/13)
stated they would recommend that a colleague attend a similar Sabin SIF peer review
workshop. Recommendations for improvement included better time-keeping, more small
groups and open plenary sessions, trying to measure impacts of the innovations, more
policymaker involvement, a special session for financial decision makers and allowing the
focus of country presentations to be more flexible.
Overall, delegates felt the workshop would help them with their own work (92%, 11/12).
Detailed results are tabulated in Annex J.
Closing Comments
To close the workshop, each delegation nominated a spokesperson to share final words
about prospects for sustainable immunization financing. (Spokespersons: Professor Ben
Anyene, Nigeria; Senator Peter Coleman, Liberia; Mr. Peter Sam-Kpakra, Sierra
Leone; Dr. Dominic Mutie, Kenya; Hon. Huda Oleru, Uganda). A common theme was
legislation. The three countries without immunization legislation accepted the challenge of
getting new bills passed. A second theme was resource tracking. Delegations asked for
more training in this area, including the routine use of the Sabin budget flow analysis tool.
In a final vote of thanks, partner agency counterparts added their comments and
expressed admiration for the work the delegates are doing in their respective countries.
Certificates of attendance were distributed and the workshop came to a close at 13:00
hours.

26
ANNEXES
Annex A: Concept Note
CONCEPT NOTE ON A 2-DAY MEETING FOR SUSTAINABLE IMMUNIZATION FINANCING FOR
ANGLOPHONE AFRICAN COUNTRIES
DATE: March 2016
VENUE: …………… Hotel, TBD, Nigeria
Introduction
The Nigerian immunization program is facing a large funding gap arising from the country’s graduation from GAVI
support and dwindling government revenues/shortfall in annual budgetary allocation, among other factors.
Consequently, Program costs to the government will increase progressively and significantly too 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 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 by way of stock outs that will ultimately lead to increased deaths from vaccine preventable
diseases. Therefore calls for action led to the suggestions to come up with a Nigeria Immunization Trust Fund
(NITF) that will serve as an independent body to advocate and mobilize funds for routine and supplemental
immunizations in the country in 2016 and beyond.
In line with the TOR for the Anglophone Africa Peer Review Workshop on Sustainable Immunization Financing
(SIF), the Sabin Vaccine Institute’s 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
It is in line with bridging the gap in Sustainable Immunization Financing that Nigeria volunteered at the Anglophone
countries peer review meeting in Nairobi, Kenya in October 2015 to host a meeting in Nigeria on finalizing on a
framework necessary for setting up an Immunization Trust Fund with the support of SIF SABINVACCINE
INSTITUTE. The offer was approved and NIFT has established regular contact with Dr. Clifford Kamara through
whom SABINVACCINE INSTITUTE accepted to support and hold the Anglophone peer exchange meeting in
Nigeria. It is planned for the first quarter of 2016. The outcome is expected to be a huge step towards advocating for
the need and establishment of 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 Global Alliance for Vaccines and Immunization
(GAVI) support. The federal government is also responsible for the cost distribution of bundled vaccines for a birth
cohort of 7.4 million children to all States and the states in turn distributes to the local governments within their
respective jurisdictions.
Since year 2000, Nigeria has received tremendous support from GAVI Alliance through various financing windows
(i.e. cash and kind) towards ensuring effective immunization service delivery in the country. Following the rebasing
of the economy, however, Nigeria’s GNI rose to US$ 2690, thus surpassing the eligibility threshold of US$ 1580 for
GAVI support. Nigeria has now entered a graduation period spanning 2015 to 2020, during which GAVI subsidies
will diminish by 20% every year for five years, after which Nigeria is expected to bear the full cost for vaccines.
Having entered graduation, 2015 is the last year Nigeria can apply for new vaccine support.
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 for 2015 to 2020 is estimated at 16, 29, 34, 44, 45 and 53 billion1 naira respectively to
1
Collated from the department of Accounts and Finance NPHCDA 2015

27
cover traditional and new vaccines. Although funding for 2015 has already been secured with a facility from the
World Bank, financing for 2016 and beyond is yet uncertain.
Against the backdrop of the rising funding requirement, historic appropriations for vaccines have always fallen short
and even declined in recent years. Since 2010 the following amounts were appropriated for vaccines annually - 2.2,
5.0, 6.0, 4.15, 2.156 and 2.615 billion naira2, thus bringing the average annual appropriation for vaccines in the last
6 years to 3.68 billion naira; 23% of what is needed in 2015 and 7% of funding needed for 2020.
Besides the precarious funding situation facing the country, there are other significant cash flow problems as well.
Delays in budget passage and delays in release of actual cash are common experience. Efforts to address funding
gaps should also include considering action/s on how to make funding more predictable and available as planned.
Problem statement
Nigeria faces an enormous funding gap for the 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
20203.
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.
This trust fund shall be managed by an independent governing body comprising men and women of proven
integrity and necessary financial clout and administrative prowess needed to propel the entity (NITF) towards
attaining the desired goals efficient and sustainable immunization financing in the country. 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
Considering the graduation of Nigeria from the GAVI eligibility criteria, it has become paramount for the country to
look inwards for immunization financing as government alone cannot bear the cost of sustaining the procurement
of both traditional vaccines and the new, expensive vaccines in addition to the costs of other essential immunization
components.
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. The elimination of
vaccine preventable diseases has health and economic benefits 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 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 manner of 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.
2
Collated from the department of Accounts and Finance NPHCDA 2015
3
Culled from the NIFT concept note

28
Legal Frame Work for the Establishment of a Trust Fund in Nigeria
The legality and viability of a trust depends on its establishment and management. A trust fund can be legally s
established by statute (Act of parliament), by registration as incorporated trustees under the companies and allied
matters act (CAMA) or by regulation.
 Trust fund by statute: for the NITF, the preferred form of establishment is by an Act of the National
Assembly. This process will further reinforce the confidence of all relevant stakeholders in the trust fund as
all shades of opinions would have been taken into consideration before such an Act is approved. In
addition, such enabling law will make adequate provisions for the management and operation of the Trust
Fund. 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. Tobaco,
Sugar, Energy Drinks, electronic wastes – used computers, Dry Gins or even luxury consumables like
expensive Wines, etc; all these will guarantee continuous inflow of cash into the Fund. In addition,
voluntary donors, especially business corporations and private individuals would feel assured 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: in a trust fund by registration, the contributors to the fund apply to 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 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, as 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 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 an NGO
servicing immunization programmes.
THE TWO- DAY MEETING
This Anglophone Peer Exchange meeting shall have in attendance country delegates from SIF Anglophone
countries such as Liberia, Kenya, Nigeria, Sierra Leone and Uganda also in attendance will be members of the
NIFT, Government officials, development partners and the private sectors that will organize and work to mobilize
resources and technical support for a sustainable vaccine program in Nigeria.
Participants
The meeting will have in attendance member countries of the SIF Anglophone, Members of the National
Immunization Finance Task Team, Government official, Development Partners, Staff of the NPHCDA, FMOH,
other relevant ministries, National Assembly, States, the private sector, media and other stakeholders.
Objectives of the meeting
The meeting shall seek to achieve the following:
 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 main recommendations for achieving the ideals of Nigeria NIFT

29
 To develop a global template for adoption by participating Countries.
Expected Outcome of the Meeting
 It is expected that at the end of the 2-day meeting that:
 Best domestic sustainable financing, budget tracking, advocacy, and legislative practices for immunization in
Nigeria would have been developed.
 Set of recommendations for the Nigeria NIFT to pursue would have been developed
 Acceptable template for participating Countries.
It is important to have a session to brief the meeting on the progress made by Nigeria on Local Vaccine Production
(LVP) as part of the decision at the Nairobi was for Nigeria to produce a credible platform for LVP that can serve
the need of sub-Saharan Africa rather than all countries engaging the process

30
Annex B: Participant List
ATTENDANCE LIST FOR ANGLOPHONE AFRICA PEER EXCHANGE WORKSHOP ON SUSTAINABLE IMMUNISATION
FINANCING-NIGERIA
S/N NAME DESIGNATION STATE ORGANISATION E-MAIL ADDRESS
1 CLIFFORD KAMARA SPO SABIN cliff.kamara@sabin.org
2 MIKE McQUESTION DIRECTOR USA SABIN mike.mcquestion@sabin.o
rg
3 DANA SILVER PO USA SABIN dana.silver@sabin.org
4 SAIRA ZAIDI NIGERIA CHAI szaidi@clintonhealthacces
s.org
5 DIANA KIZZA SPO UGANDA SABIN diana.kizza@sabin.org
6 CHIMAOBI CHUKWU SO IMO NABDA chukwuchimaobi@yahoo.c
om
7 DR. EKENE OSAKWE ACSO NIGERIA NABDA ekeneosakwe@yahoo.co
m
8 ADOLPHUS T
CLARKE
EPI, Dep LIB MOH adolphusclarke@gmail.co
m
9 WILLIAM V DAKEL MP LIB HOR wvdakel@yahoo.com
10 HON.ABD SESAY MP SIERRA
LEONE
PARLIAMENT abdsesay64@gmail.com
11 FAITH MUTUKU PO CHA fmutuku@clintonhealthacc
ess.org
12 DR. KARAN SAGAR SCM GAVI ksagar@gavi.org
13 DR. NAMADI M
LAWAL
MO NPHCDA namadih@yahoo.com
14 MAJIDAH
ABDULWAHAB
A. O FCT NPHCDA majidahabdulwahab@gma
il.com
15 OYEYEMI BANKE PEO II FCT NPHCDA oyeyemibanke50@yahoo.
com
16 DR. ADAMU NUHU DAC FCT NPHCDA adamunuhu2001@yahoo.
co.uk
17 JOY OSHINOWO SO FCT NPHCDA joyawu88@yahoo.com
18 DR. HALIMA B
TAFIDA
SMO FCT NPHCDA drhalimatafida@gmail.com
19 FIONA BRAKA EPI TL WHO brakaf@who.int
20 ALOYSIUS
CHIDIEBERE UGWU
PA/TA FCT HERFON ugwualoysius@gmail.com
21 EMMANUEL
ABANIDA
ES FCT HERFON drabanida@gmail.com
22 SABO M ADAMU CAO FCT NPHCDA
23 JUSTICE IGBOKWE AO I FCT NPHCDA lytlejustice@gmail.com
24 ALIYU ABDULKADIR HEO FCT NPHCDA aliyujalaluddeenabdulkadir
@gmail.com
25 THERESA ABBA PSO FCT NPHCDA tessyabah@yahoo.com
26 ADAMU GAMAWA EC BAUCHI BSPHCDA adamugamawa@gmail.co
m
27 JOSEPHINE OBANDE AO I FCT NPHCDA obandeori@yahoo.com
28 KENNETH OSHIOBUGIE FCT VACCINE NETWORK kenneth.oshiobugie@gmai
l.com
29 SYLVESTER MUBIRU AG. PRO UGANDA MOH sylvestermuibiru@yahoo.c
om
30 OLERU HUDA MP UGANDA PARLIAMENT holeru@parliamentgo.ug
31 M. ISHMAEL
MAGONA
COMMISSIONER UGANDA MFPED ishmael.magona@finance.
go.ug

31
32 DR. OBINNA EBIRIM SPO FCT DCL/IVAC obinna.ebirim@dclnigeria.
com
33 DR. HENRY
EWUNONU
Rep. President FCT NMA NATIONAL henryewunonu@gmail.co
m
34 ADEWUMI
FUNMILAYO
PA FCT DCL/IVAC funmilayo.adewunmi@dcln
igeria.com
35 CHIKA OFFOR COO FCC WAVA/VACCINE
NETWORK
vaccinenetwork@gmail.co
m
36 ABDULAZEEZ M.M SCDO FCT NPHCDA mahura2003@yahoo.com
37 DR. CHARLES
MAMMAN
ZC NEZ NPHCDA charlesmamman@yahoo.c
om
38 DAVID KIULUKU CDH KEN MOH dkikiko76@gmail.com
39 UMMAL-FADAL
BABAGIRE
I.O FCT NPHCDA fadalgirei@yahoo.com
40 DR. ALIYU YABAGI
SHEHU
EDSPHCDA NIGER SPHCDA ayshehu@yahoo.com
41 EUGENE IVASE HOD Comm FCT NPHCDA eugeneivase@yahoo.co.u
k
42 DR. MOH'D ATIKU
KENDE
PER SEC KEBBI SMOH matiku28@yahoo.com
43 DR. PETER S.
COLEMAN
Senator LIBERIA LIBERIA pscolemon2003@yahoo.c
om
44 PETER SAM-KPAKRA Deputy Financial
Secretary
SIERRA
LEONE
MIN OF FINANCE muyab@hotmail.com
45 DR. SHOLA
MOLEMEDDE
MANAGER FCT DCL/IVAC sholamole@gmail.com
46 ANIEMA OKON PCS11 FCT NPHCDA Tommyekong@yahoo.com
47 DANIEL IYA HOC NASARAWA MOH dan_iya_dr@yahoo.com
48 DANGANA MUSA
SAAD
ZC NCZ NIGER NPHCDA pharmdagana@yahoo.co
m
49 CELESTINA OBIEKEA NIFT FCT SLNI celestinalobiekea@gmail.c
om
50 DR. UDUALE OFFION PAEDIATRICIAN FCT PAN uroffiong@yahoo.com
51 SOJI TAIWO DD A&C NPHCDA NPHCDA sojitaiwo@yahoo.com
52 SHARON WANYEKI ICT KENYA MIN OF FINANCE sharon.wanyeki@gmail
com
53 GARBA SADEQ SSO NCDC NCDC FMOH sadiggarba720@gmail.co
m
54 DR DENNIS MARKE PRO. MGR S/ LEONE MOHS dmarke@gmail.com
55 NDIDI CHUKWU ADV.& COM FCT CHR ndidi.chukwu@chrnigeria.i
nfo
56 OJO FUNMILAYO SEO FMOH FMOH dhmarke@gmail.com
57 NOSA PRESTON IO FCT NPHCDA nosapreston@gmail.com
58 ABBA MUHAMMED I. PO FCT NPHCDA isawa99@hotminl.com
59 JOHN DANIEL NYSC FCT NPHCDA johndanny2014@yahoo.co
m
60 DR A.F. KOLAWOLE MO11 FCT NPHCDA dejokekolawole2gmail.com
61 MARYAM
MUHAMMED
AO1 FCT NPHCDA maryaham.habubakar@g
mail.com
62 HAJ KYAUTA
MUHAMMED
DD A&C FCT NPHCDA
63 MIKE ANYA FCT NPHCDA
64 AMINU MAGASHI D. DIRECTOR FCT CHR
65 DR. BEN ANYENE CHAIR NIFT HERFON benanyere@gmail.com
66 GANIYU SALAU NIFT ABUJA NPHCDA ganysal@yahoo.com

32
67 FELICIA B. UMOH
ESQ
L. A. ABUJA NPHCDA fumoh2000@yahoo.com
68 GARBA ABDUL DIRECTOR ABUJA CHAI Gbduaclintonhealthaccess
.org
69 DR. OGBU T.E. SHALFERKLUM ABUJA MD toradoc@yahoo.com
70 DR. KABIRU
MOHAMMED
ZCNWZ KANO NPHCDA kabirumd2003@yaho.CO.
UK
71 MUSA MOH NPHCDA NCZ NIGER CMO
72 DR. DAMARIS
ONWUKA
NPHCDA ABUJA DDCI
73 DR. OBI EMELIFE DD FCT NPHCDA kizobi@yahoo.com
74 M.M ABUBAKAR DD FCT NPHCDA mmusaabubakar@yahoo.c
om
75 EMMANUEL SOKPO MD ABUJA NPHD emmanuel.sokpo@gmail.c
om
76 SANNI ADENIYI O. A.
(MRS)
DD ABUJA FMOH sanni57@yahoo.com
77 IRECHUKWU
KELECHI
INTERN ABUJA DCL/IVAC ugireks@gmail.com
78 ABIODUN AJAYI FCT HEALTH
79 JOHN AGBOR IMM. MANAGER UNICEF jagbor@unicef.org
80 PETER ENALYWU EDITOR FCT LEODDWARD inap60@gmail.com
81 AISHA K. ABBA CCDO FCT NPHCDA drtukur@yahoo.com
82 PROF. ALEX AKPA DIRECTOR FCT NABDA akpaalex@yahoo.com
83 DR. A.O. ADESOPE ZCSWZ OYO NPHCDA funkeoyina@yahoo.com
84 OLUREMI OLUBAJO HEAD HF FCT NPHCDA leke_olu1@yahoo.co.uk
85 LAWAL BAKARE FOUNDER LAGOS EBOLA ALERT ibakare@abdladat.org
86 DR. HALIMA
MUKADDAS
HON.COMM BAUCHI SMOH halima.mukaddas@gmail.
com
87 REMI JOSEPH HEAD R. MOB. FCT NPHCDA
88 AKINYEMI
SAMSON.O
HEAD PROTOCO FCT NPHCDA kayodeakinyemi07@yaho
o.com
89 OKEFE ALICE
CECILIA
NYSC FCT NPHCDA elsie_okefe@yahoo.com
90 OLUSEYI ADEJIYE ADVOCACY
ADVISER
FCT SCI oluseyi.Abejide@savethec
hildren.org
91 FRANCIS MBA CDM FCT NPHCDA
92 NURU GARBA CDM ABUJA NPHCDA
93 JOSEPH AUDU CDM NPHCDA
94 DR. MANASSEH
GWAZA
DIRECTOR FMST FMST
95 AGNES JIMMY PCDO FCT NPHCDA jimmyagues362@yahoo.c
om
96 JAMILA ALIYU AO I FCT NPHCDA Jymindady@yahoo.com
97 H. K. MUSA AO1 FCT NPHCDA khidr127@yahoo.com
98 AGBOGU OKWUDIH
C.
AO1 FCT NPHCDA Ci_ment1@yahoo.com
99 KAFARU
OLUWAFEMI
FE FCT NPHCDA kafdefemi@yahoo.com
100 DR. AKIN
OYEMAKINDE
CLE FCT FMOH gbekelolwa2003@yahoo.c
om
101 DR. SALIFU M. S. PMO 11 FCT FMOH unenwa4@yahoo.com
102 PHARM LAMI A. N. PHCD FCT NPHCDA tonialamiamos@gmail.co
m

33
103 VICTOR EMGUINE Prog. Officer FCT Center for Social
Justina
victoremguine@gmail.com
104 A. NASIDI NC/CEO FCT NCDC a.nasidi@gmail.com
105 OLUWA JINADU PROTOCOL FCT NPHCDA esliomolakaba@yahoo.co
m
106 NANCY D. SEMION ADMIN ASST ABUJA CHR nannd.semion@gmail.com
107 BALOGUN A. A. PA FCT NPHCDA yemi_balogun@yahoo.co
m
108 DR. NGOZI NWOSU ZC SEZ ENUGU NPHCDA ngjpi@yahoo.com
109 DR. JOSEPH OTERI ZC SSZ BENIN NPHCDA josephoteri@gmail.com
110 ADEGBITE
OLUFUNMILOLA
AD SO FCT FMOH lolu4Jesus@gmail.com
111 UDEME PETER-IJEH Prog. Manager FCT CENTRE FOR THE
Right to health
UpeterIjeh@crhmigena.or
g
112 GOUDJO CEHZO ACSM Officer FCT CENTRE FOR THE
Right to health
Cgoudjo@crhnigeria.org
113 DR.D. NWODO CSG1 FCT NPHCDA dnowdo@gmail.com
114 DR. KAYODE
FASOMINU
CONSULTANT FCT SOLINA kayode.Fasminu@solinagr
oup.com
115 IWEALA-OSHISKE N. CDO FCT NPHCDA iwealanjideka@yahoo.com
116 DR. M. Z. MAHMUD DLHC FCT NPHCDA drmahmud@yahoo.com
117 DR. ONWU NNEKA CSG11/HSIAs FCT NPHCDA nnekaowun@yahoo.com
118 STEPHEN
SHAKARHO
Regional Manager FCT MAY & BAKER ushakarho@yahoo.com
119 MUSA ABDULLAHI CDM FCT NPHCDA
120 IBRAHIM I. IBRAHIM CDM FCT NPHCDA
121 DR. NNENNA
IHEBUZOR
D,PHCSD FCT NPHCDA nnennaihebuzor@yahoo.c
om
122 DR. EMMANUEL ODU D-CHS FCT NPHCDA emmanodu@gmail
123 SAADU SALAHU HPRU FCT NPHCDA bamssa@yahoo.com
124 REMI ADELEKE PCDO FCT NPHCDA adelekerm@gmail.com
125 PROF. KABIRU I.
DANDAGO
HC Finance KANO MOF kidandago@gmail.com
126 DR. KABIRU I.
GETSO
Hon. Commissioner
- Health
KANO SMOH kabirgetso@yahoo.com
127 NASIRU MOH'D Hon. Commissioner
- Finance
BAUCHI MOF Bhministoryoffinance@gm
ail.com
128 EZE ONYEKPERE Lead Director Centre for Social
Justice
censei@gmail.com
129 DR. CHIZOBA
WONODI
Country Lead FCT JOHN HOPKINS US
IVAC
cwonodit@jhu.edu
130 BONNY SUMAILI IMM SPECIAL UNICEF KSUMAILI@UNICEF.ORG
131 DOMINIC MUTIE NVIP DCP KENYA dmintie@pie.epi@gmail.co
m
132 DR. BASSEY
OKPOSEN
CMO/HEAD RI FCT NPHCDA basenokng@yahoo.com
133 ASHOGBON DANIEL DFA FCT NPHCDA billyduru@yahoo.com
134 HENRY OSAWE DIA FCT NPHCDA hosawee2@gmail.com
135 MOLOKWU NDIDI PO FCT NPHCDA ndidimolokwu@yahoo.com
136 H. D. GARNUWA HE FCT NPHCDA adgidave@gmail.com

34
137 ABIOLA OJUMU Snr Program
Manager
FCT CHAI AOJUMU@CLINTONHEA
LTHACCESS.ORG
138 KABIDIRI IBRAHIM MERIT FCT CHAI dmeritnews@gmail.com
139 L. B. HAMADU FCT NPHCDA
140 ONYEKWELU HENRY STATE CHAIRMAN ANAMBRA HERFON belonwunwankwo@yahoo.
com
141 ONWUMAH UCHE STATE CHAIRMAN DELTA HERFON cdcnigeria@gmail.com
142 IBIKUNLE ADAMS DD FMITI FMITI Kunleadams04@yahoo.co
m
143 BLESSING ADEBAYO OYO SABIN
144 JENNIFER FOTH C UGANDA CHAI jfoth@clintonhealthaccess.
org
145 YUSUF SULEIMAN FE FCT NPHCDA yusufjp22@gmail.com
146 DR. LAZ UDE EZE SMT FCT DCL/IVAC laz.eze@ddnigeria.com
147 DR. PETER
EDAFIOGHO
HPRM FCT HERFON Petereda2a1@yahoo.com
148 DR. H. H. ADAMU
(MRS)
PM FCT HERFON hh.adamu@gmail.com
149 DR. ABDUHRAHMAN
D
RM FCT RHS kafiu005@yahoo.com
150 DR. U. S. ADAMU STA-ED/CE FCT NPHCDA drusaida@yahoo.com
151 OBARD ODEGHE REP MD FIDELITY
BANK
LAGOS FIDELITY BANK obaro.odege@fidelitybank.
com
152 DR. RUI G. VAZ WR WHO WHO Ruivaz@who.int
153 DR. ADO J. G. MOH'D ED-NPHCDA FCT NPHCDA
154 KAFARU O. FB FCT NPHCDA kafahefemi@yahoo.com
155 SARAH AZUBIKE INFOR. OFFICER FCT NPHCDA azubikesarah@yahoo.com
156 ABOLA EMMA ROVA FCT DIOVA rova_healthmgt@yahoo.co
m

35
Annex C: Agenda
Agenda
Day One: 19th April 2016
Time Content Presenters Location/Notes
Opening Ceremony
8:30-8:40 Introduction of Participants and Dignitaries Sabin
Plenary,
Moderator: Sabin
Vaccine Institute
8:40-8:50 Welcome & Workshop Objectives Sabin
8:50-9:10 Goodwill Messages
Partners and Private Sector:
BMGF, Gavi, HERFON, IVAC,
CHR, Pharma industry, others
9:10-9:20 Remarks by NIFT Chairman Dr. Ben Anyene
Collective Update
9:20-10:00
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
10:00-10:15 Coffee Break
Theme I: Domestic Financing Arrangements
10:15-10:30
Overview of domestic immunization financing
arrangements
Sabin
Plenary,
Moderator: Nigeria
Senate Committee
Chairman on PHC
& Communicable
Diseases
10:30-11:00 New financing practices: Nigeria NIFT and Nigerian delegates
11:00-12:00
Case Study Presentations: New financing practices,
visiting countries
Country Delegations:
Liberia
Sierra Leone
Uganda
Kenya
Plenary,
Moderator: Nigeria
Senate Committee
Chairman on
Appropriation
12:00-12:15 Discussion and small group work instructions (first round) Sabin and delegates
12:45-13:45 Lunch Break
13:45-14:45
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

36
18:00-20:00 Reception
Day Two: 20th April 2016
8:45-9:00 Recap of Day One NPHCDA rapporteurs Plenary
Theme II: Legislative Provisions & Implementation
9:00-9:30
Overview of legislative provisions and legislative project
implementation Sabin
Plenary
Opening Ceremony
9:30-9:40 Introduction of Delegates and Dignitaries
Sabin and Master of
Ceremony
Plenary,
Moderator: Sabin
Vaccine Institute
& Master of
Ceremony
9:40-10:00 Welcome Address
Dr. Ado Muhammad,
Executive Director, NPHCDA
10:00-10:20 Opening Remarks by Co-hosts
Prof Isaac Adewole, Hon.
Minister of Health & Mrs.
Kemi Adeosun, Hon. Minister
of Finance
10:20-10:40 Keynote Address
Mr. Nnamdi Okonkwo,
MD Fidelity Bank Plc
10:40-11:00 Remarks by Special Guest of Honor
H.E. Barr Mohammed A
Abubakar, The Executive
Governor of Bauchi State
11:00-11:15 Welcome & Workshop Objectives (repeat) Sabin
Theme II: Legislative Provisions & Implementation, continued
11:15-12:15 Vaccine legislative project implementation updates
Liberia
Sierra Leone
Uganda
12:15-12:45 Discussion
12:45-14:00 Lunch Break
14:00-14:20 Health and vaccine legislation in Nigeria Prof. Ben Anyene Plenary,
Moderator: Sabin
Vaccine Institute
& Master of
Ceremony
14:20-14:50 Discussion, Summary of Theme II Sabin
Theme III: Budgeting, resource tracking and domestic advocacy
14:50-15:00
Immunization budgeting, resource tracking and
domestic advocacy: best practices
Sabin
Plenary,
Moderator: H. E.
Barr Mohammed
A Abubakar,
Executive
Governor of
Bauchi State
15:00-15:45
Case Study Presentations: Budgeting, resource tracking
and domestic advocacy case studies
Liberia
Sierra Leone
Kenya

37
16:00-17:00
Case Study Presentations, continued: Budgeting,
resource tracking and domestic advocacy case studies
Uganda
Nigeria Plenary
17:00-17:30 Discussion
17:30 End of Day Two
Day Three: 21st April 2016
Peer Review: Innovations in Sustainable Immunization Financing
8:45-9:00 Recap of Day One NPHCDA rapporteurs Plenary
9:00-9:30 Country delegates meet to prepare peer review case
study presentations Country Delegations Small groups
9:30-10:00
Remarks by Honorable Minister of Health of Nigeria Prof Isaac Adewole, Hon.
Minister of Health Plenary
10:00-10:15 Peer review instructions and demonstration Sabin
10:30-11:15 Peer review, part I: (Group A) Country delegates
Plenary
11:15-12:00 Peer review, part II: (Group B) Country delegates
12:00-12:20 Country action points: Next steps Nigerian delegation Small groups
Way Forward
12:20-12:45 Discussion of next steps
Country delegates
Kenya
Liberia
Nigeria
Sierra Leone
Uganda
Plenary
12:45-13:00 Closing words & workshop evaluations Sabin, Country delegates
13:00 End of workshop

38
Annex D: Small group results
Summary of small group results, Domestic Financing arrangements
Group/Rapporteur
Other members
Problems Solutions
1 (Jan-Feb) Eugene
Ivase
Dr. Ekene Osakwe, Nigeria
Dr. Mohammed Atiku K.,
Nigeria
Dr. Charles Mamman,
Nigeria
Mahmud Mustafa, Nigeria
Dr. Ngozi Nwosu, Nigeria
Dr. Peter S. Coleman,
Liberia
Ms. Sharon Wanyeki, Kenya
Dr. Mike McQuestion,
US/Sabin
Ms. Diana Mugenzi,
Uganda/Sabin
*insufficient government
financing for R.I.
*new public policies, legislation
*high-level advocacy
*low public awareness of need
for immunization
*mass sensitization, more
community engagement
*low or no private sector
involvement in immunization
financing and local vaccine
production
*more regional institutional
collaboration for fast-tracking
local vaccine production (African
Union, ECOWAS, SADC, IGAD,
AfDB)
2 (Mar-Apr)
Peter Sam-Kpakra
Dr. Adefunke Adesope,
NPHCDA
Hon. Ohesu Huda, Uganda
Dr.Henry Ewuonwu, NMA
Nigeria
Balogun Abubaka,
NPHCDA
Danguma M. Saadu,
NPHCDA
Mohammed Sabo Adamu,
NPHCDA
Kenneth Oshiobugie,
Vaccine Network Nigeria
Dr. Kayode Fasominu,
Solina Health Nigeria
* insufficient government
financing for R.I.
*make adequate resources
available
*trust funds
*create regional vaccine industry
*lack of political commitment *sustained advocacy at all levels
*social mobilization
*enactment of laws
*poor or no stakeholder
coordination
*constant stakeholder
engagement
*streamlined bureaucratic
processes, including procurement
*inadequate data collection *more monitoring & evaluation
*proper data dissemination
*regular updates, feedback
*more efficient reporting system
*little or no accountability *public financial mgt training
*timely submission of financial
reports
*new tracking tools
*regular audits
3 (May-Jun)
Adolphus Clarke
*limited budget *grassroots advocacy
*more effective advocacy with
key institutional actors (Treasury)

39
Faith Mutuku, CHAI
KENYA
Saira Zaidi, CHAI NIGERIA
Dr. Obinna Ebirim, SPO
DCL/IVAC Nigeria
Ndidi Chukwu,
Advocacy/Communication,
CHR Nigeria
Ojo Funmilayo, PO/FMOH
Nigeria
Dr. Onwuka, Director,
Disease Control &
Immunization, NPHCDA
*MoH budget line for advocacy
*poor advocacy, coordination,
legislative oversight
*increase advocacy work at all
levels
*include CSOs in budget process
*strengthen task teams for
coordinated advocacy
*poor demand creation *mass sensitization
*public information on VPD
epidemiology
*engage religious, traditional
leaders, CSOs
4 (Jul-Aug)
Dominic Mutie
Chika Offor, Vaccine
Network Nigeria
Shola Molemodile
DCL/IVAC Nigeria
Celestina Obiekea, SLNI
Nigeria
Dana Silver, SABIN USA
Ganiyu Salawu, NPHCDA
Nigeria
Dr Obi Emelife, NPHCDA
Nigeria
Felicia Umoh, NPHCDA
Nigeria
William V Dakel, MP
Liberia
Stephen Shakarho, May &
Baker,Nigeria
*inadequate financing *increase government revenues
*legislation
*engage domestic private sector
*reduce costs via local vaccine
production
*low country ownership *R.I. co-financing at all levels
*joint stakeholder advocacy
*investment (business) case for
private sector investors
*insufficient stakeholder
involvement
*co-financing at all levels of
government
*trust funds
*comprehensive accountability
framework
5 (Sept-Oct)
Dennis Marke
Clifford Kamara (SABIN)
Hon. Abdulkarin D. Sesay
Sierra Leone
Dr. Halima Mukaddas, Hon.
Commissioner for Health
Bauchi State
Aloysius Chidiebere UGWU,
HERFON Nigeria
Dr. Daniel Iya, Hon.
Commisioner Nasarawa
State
Irechukwu Kelechi, IVAC
M.M Abubakar, NPHCDA
Dr. Thomas Ogbu
*inadequate legislation *write new laws
*high-level advocacy
*high donor dependency,
inadequate government
funding
*new public-private partnerships
(fuel tax example)
*trust funds
*basket funds (increase gov’t
proportion)
*weak resource tracking *Strengthen monitoring &
evaluation
*Sabin budget flow analysis tool
*inadequate demand creation,
low awareness
*more sensitization (IEC, BCC)
*engage local leaders
*inadequate human capacity *train more health care
professionals, give them retention
incentives

40
6 (Nov-Dec)
Sylvester Mubiru
Adegbite Olufunmilola-
Nigeria, NPHCDA
Dr. Chizoba Wonodi-
Nigeria, JHU/IVAC
Prof Alex U. Akpa- Nigeria,
NABDA, FMST
Ismail Magona- Uganda,
MoF
Pharm Lami Nebechi-
Nigeria, NPHCDA
David Kiuluku- Kenya, MoH
Adewumi Funmilayo-
Nigeria, DCL/IVAC
*inadequate legislation *legislative provisions for
immunization financing
*low country ownership,
insufficient private sector
involvement
*immunization budget line item
at all levels
*adequate financing of advocacy
efforts
*weak financial arrangements
(inadequate budgets, high
donor dependency, curative
bias, high immunization
program costs)
*minimize campaigns
*public- private partnerships
*implement comprehensive,
universal health care (UHC)
*resource tracking, budget
analyses at all levels
*lack of political commitment,
corruption
*help officials use immunization
support to build political capital

Sabin SIF Anglophone African peer review workshop, Abuja, Nigeria, 19-21 April 2016

Sabin SIF Anglophone African peer review workshop, Abuja, Nigeria, 19-21 April 2016

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Sabin SIF Anglophone African peer review workshop, Abuja, Nigeria, 19-21 April 2016