Financial independence for Nepal's immunization program is now within reach for the first time in history. On January 26, 2016, President Bidya Devi Bhandari of Nepal signed into law a long-awaited immunization bill. This law will improve oversight of immunization services, set tighter standards for vaccine testing and use, and perhaps most importantly, change the way Nepal finances its immunization program.
Transitioning From Gavi Support
Like many nations, Nepal currently depends on financial support from Gavi, the Vaccine Alliance, to fund 60-70 percent of its vaccine purchases. Nepal's Finance Minister has stated that the country is expected to graduate from low-income to middle-income status by 2022, at which point it will no longer be eligible for Gavi support. This gives the government only a few years to establish reliable, domestic financing for immunization.
Nepal's immunization law establishes two methods for financing its immunization program. First, it mandates that the government allocate adequate funding for immunization to the National Immunization Fund, which will be collected through general taxation. To determine the amount, immunization advocates will bring evidence to the Ministry of Finance demonstrating how much money the immunization program needs to sustain current vaccine coverage and associated program operations, and purchase new vaccines. So far, the government has allocated 60 million Nepalese rupees (approximately US $550,000) to the National Immunization Fund. The law ensures that the government will maintain this immunization funding.
To supplement government funding, the immunization law includes a provision enabling domestic private partners to contribute to a separate Sustainable Immunization Support Fund, created by the Rotary Club in Nepal. However, private partners are unlikely to contribute unless they have some incentive, such as a tax credit or tax exemption. The new law is silent on this issue, but government decision makers are currently working on a separate legislative solution.
Developing The Immunization Law
Developing the new immunization law was a five year process. In 2010, Nepali parliamentarians crafted and signed the "Kathmandu Declaration," in which they expressed their commitment to help the country achieve sustainable immunization financing. From that point on, the Ministry of Health (led by the Child Health Division), the Ministry of Finance, parliament, and development partners, including the Sabin Vaccine Institute (Sabin), the World Health Organization, and UNICEF, worked together to make the immunization law a reality.
Nepal applied lessons from other countries' approaches to establishing long-term, domestic financing for immunization. Nepali decision makers attended peer exchanges arranged by Sabin's Sustainable Immunization Financing (SIF) Program to exchange best practices with their counterparts from other countries. During these peer exchanges, the Nepalese peers learned about innovative financing arrangements such as the Pan American Health Organization Revolving Fund, a secondary fund outside the government that supports immunization in Latin American countries.
At one point, Nepal's Ministry of Finance expressed doubts about creating a National Immunization Fund. The Ministry of Finance worried that if the fund were in place, the government would be less motivated to dedicate finances to the immunization budget itself. The Ministry's thinking changed after the Chief of the Budget and Program Division, Mr. Lokdarshan Regmi, participated in a SIF peer exchange with counterparts from Sri Lanka and Cambodia. A champion of the Fund, former health minister of Nepal, Hon Vidyadhar Mallik, played an important role in steering the Fund through the complex governmental approval process.
Other countries stand to learn from Nepal's experience in developing and passing the law. Every step—from drafting and vetting the bill with the public to garnering political support in parliament—was carried out through collective action by national institutions. This type of collective action between the parliament and Ministries of Health and Finance is something all countries can learn from.
The Next Step: Implementation
The long and arduous approval process is now complete, but the work is not finished yet. The government has less than three months to prepare the necessary regulations to implement the law. It must then find ways to adequately finance the new immunization fund in addition to taxation. The actual budget amounts requested must be justified to the Ministry of Finance.
Oversight is another critical component of the law, to ensure that funds are properly allocated. A newly formed Parliamentary Caucus on Sustainable Immunization Program will take that role. Parliamentary oversight will extend to the private National Immunization Support Fund as well.
The law ultimately makes the immunization program and its partners accountable for keeping the children of Nepal immunized. Chairperson of the Parliamentary Committee on Women, Children, Senior Citizen, and Social Welfare, Hon. Ranju Kumari Jha, calls the law, "a milestone to protect child rights of getting quality immunization service, increase country ownership and sustain the national immunization program by securing adequate funding."
With the passage of this law, Nepal has demonstrated its commitment to immunization as a priority and has made significant progress toward long-term, sustainable funding for immunization. This brings the country that much closer to achieving the ambitious goals of the Global Vaccine Action Plan. Through the effective implementation of this law, Nepal is setting a course toward full country ownership of its immunization program.
from Health Affairs Blog http://ift.tt/1OXEVvQ
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