This document discusses advocacy strategies for sustainable immunization financing programs in Anglophone African countries. It outlines the social contract between citizens and their government, where citizens elect the government to manage resources and budgets on their behalf. Advocacy can come from endogenous groups seeking to influence the social contract, like citizens asking their government to prioritize immunization issues. Different institutional actors, like government agencies and parliament, follow different logics in their decision making. The document provides examples of effective advocacy, like demonstrating a program's cost-effectiveness to avoid budget cuts. Overall it examines how to formulate advocacy messages that fit the different logics of institutions to effectively make the case for increased immunization budgets.

1. Financing and budget advocacy
Dr. Michael McQuestion
Dr. Cliff Kamara
Ms. Dana Silver
Sustainable Immunization Financing Program
Anglophone African Peer review workshop
Nairobi, Kenya
26 October 2015

2. Social contract
• Citizens elect, empower government to
manage patrimony, create and execute
budgets on their behalf
• Citizens elect, endow parliament with
independent powers
– Government oversight
• budget creation
• budget execution
– Legislation
– Representation

3. Social contract
• Citizens surrender individual freedom,
agree to follow laws, participate in
governance, hold government, parliament
accountable
• Changing conditions, popular expectations
make social contract dynamic
• The more participation, the richer the
social contract

4. Advocacy
• Endogenous: Citizens, parliament or
government seek to renegotiate social
contract
– Elections
– Advocacy
• Exogenous: External groups, agents not
party to the social contract yet seek to
influence it (example: Sabin)

5. SIF endogenous
advocacy examples
• Citizens, community organizations,
professional groups, firms ask MPs,
government to act on immunization issues
• Parliament pressures government to
increase immunization budget
• One government agency exhorts another
to increase, improve the immunization
budget

6. Institutional logics
• The public institutions directly concerned
with providing immunization- government
and parliament- must work together
• But these institutional actors follow
different logics
• For those who follow a welfare logic, the
argument is that immunization is a basic
human right

7. Institutional logics
• According to the logic of medicine and
public health, no one should be left
unvaccinated
• Economic logic holds that immunizations
are a justifiable investment provided they
are cost effective or cost savings

8. Institutional logics
• According to the logic of public finance,
the EPI program deserves a bigger budget
provided there is unmet need, adequate
revenues and the program meets three
criteria: absorptive capacity, allocative
efficiency and value for money

9. Institutional logics
• Political logic maintains that
inmunizations are part of the social
contract, something the state should
provide as a public good
• In addition, to assure a well functioning
EPI program is to deserve more votes!

10. Case studies
• The art of advocacy is knowing how to
formulate messages that fit into each
particular institution’s logic and deliver
them effectively
• Some examples:
– EPI manager makes investment case to MPs
– Finance officer convinces health director to
cross analyze data, report expenditure per
fully immunized child

11. Case studies
• Advocacy examples, continued
– Rotary and Lions clubs convince Government
of Nepal to create an immunization trust fund
– MPs from National Assembly convince
provincial MPs to join national MP
immunization network
– EPI team analyzes provincial immunization
expenditures, demonstrates program
efficiency, avoids mandated budget cut

12. Thank You!!!

13. PEFA standards
• Credibility of the budget - The budget is realistic and is implemented as
intended
• 2. Comprehensiveness and transparency - The budget and the fiscal risk
oversight are comprehensive, and fiscal and budget information is
accessible to the public.
• 3. Policy-based budgeting - The budget is prepared with due regard to
government policy.
• 4. Predictability and control in budget execution - The budget is
implemented in an orderly and predictable manner and there are
arrangements for the exercise of control and stewardship in the use of
public funds.
• 5. Accounting, recording and reporting – Adequate records and information
are produced, maintained and disseminated to meet decision-making
control, management and reporting purposes.
• 6. External scrutiny and audit - Arrangements for scrutiny of public finances
and follow up by executive are operating