Authors: Grace Chee, Elizabeth Ohadi, and Leah Ewald
Fourteen member countries gathered for the third Networkwide Meeting of the Learning Network for Countries in Transition (LNCT) in Tangerang, Indonesia. This year’s meeting followed the theme of “Resource Mobilization: Moving Beyond Vaccines.” Countries spent three days in focused and energized discussion around common budget gaps for immunization programs, strategies for resource mobilization at the national and sub-national levels, and the development of immunization resource mobilization strategies. LNCT welcomed new members Cote d’Ivoire and Pakistan to their first LNCT event, along with 12 continuing LNCT countries: Armenia, Republic of Congo, Georgia, Ghana, Indonesia, Lao PDR, Nigeria, Sao Tome and Principe, Sudan, Timor-Leste, Uzbekistan, and Vietnam. Member countries were supported by a strong team of experts from UNICEF, WHO, CHAI, Solina, Gavi, BMGF, and LNCT.
We are so grateful to the Indonesian government for hosting us this year. Indonesia provided an excellent backdrop for discussions around Gavi transition, allowing members to glimpse the country’s wealth of experience engaging non-traditional stakeholders in immunization, confronting challenges related to vaccine hesitancy, and building a strong national health insurance system. Participants had the opportunity to take part in enriching field visits to Badan Penyelenggara Jaminan Sosial (BPJS, Indonesia’s social insurance administrator), the Banten Provincial Health Office and South Tangerang District Health Office, a private hospital providing immunization services, and a public community health center (puskesmas). Additionally, seven countries participated in a pre-meeting workshop on managing immunization programs in countries with national health insurance systems.
As always, we are grateful to our country teams for their willingness to share their transition experiences with frankness and insight. A few key takeaways that came out of the discussions were that:
- Successful Gavi transition requires resource mobilization beyond vaccines and supplies. Countries also need to find reliable sources of funding for key components of immunization service delivery, such as personnel, cold chain equipment and maintenance, training and supervision, data and surveillance, demand generation, and waste management.
- Many transitioning countries have increasingly decentralized health systems and are interested in developing strategies to support subnational entities to identify immunization needs, mobilize resources and track expenditures. Countries recognize the need to involve these subnational governments in transition discussions and planning.
- Countries recognize the importance of working closely with other agencies, ministries, and sectors to integrate Gavi transition planning into broader budgeting and planning processes to ensure the long-term sustainability of immunization programs. To this end, countries are working to integrate the resource mobilization strategies they developed in Tangerang into existing immunization and health plans.
- Many LNCT countries have successfully engaged a wide variety of non-government stakeholders to strengthen their immunization programs, including for-profit organizations, faith-based organizations, community groups, and professional associations. Besides playing an important role in service delivery, these organizations can provide critical support to a wide variety of immunization functions, including advocacy, demand generation, management of vaccine hesitancy, workforce training, and logistics.
- Countries are facing a wide variety of challenges related to vaccine hesitancy and are seeking communications resources and other tools from global partners to help address them. These challenges include managing rumors spread via social media, communications strategies for changes in immunization programs or the elimination of vaccine preventable diseases, addressing hesitancy in conflict areas, and addressing religious concerns about vaccines containing haram ingredients.
- While there are pros and cons to including immunization in the health insurance benefits package, agreement on roles and responsibilities between the MOH and the insurance agency is critical to ensure that immunization functions do not fall through the cracks. It was also agreed that risks of integrating immunization into health insurance schemes with funding solvency issues and low population coverage may outweigh potential benefits.
We were thrilled to see the large number of side conversations taking place between countries during coffee breaks and our poster gallery walk. Here are just a few examples of country experiences that we heard participants would like to hear more about in the future:
- Cote d’Ivoire employed Gavi’s new Theory of Change tool during their Gavi transition planning process to help think through their transition activities and goals.
- Indonesia uses national health insurance funds and provincial and district funds to cover maintenance, cold chain, staff incentives, clinical training, monitoring, cold chain, and cold room costs not included in the national budget. This mix of funding helps cover important service delivery costs post-transition.
- Lao PDR engages local communities in outbreak response to encourage local ownership. Local leaders are involved in outbreak-related communications and campaign mobilization.
- Nigeria uses innovative models of immunization financing, such as Memoranda of Understandings between States and donors and Results Based Financing, to Managing the Gavi transition process.
- Pakistan engages traditional leaders to speak on TV about concerns around vaccine safety and whether vaccines are halal.
- Sao Tome and Principe strengthened its Gavi transition planning process by improving the availability of coverage and financial data through the implementation of DHIS2 and a new accounting software.
- Vietnam conducts immunization safety trainings with health workers and journalists to help address vaccine hesitancy issues.
- Georgia, Armenia, and Uzbekistan spoke about a variety of lessons learned and lessons learned around vaccine procurement in small countries that they discussed during a sub-regional procurement workshop earlier this year – see our Tbilisi Takeaways blog for more information!
The LNCT team is back in Washington and hard at work following up on these experiences and many other planned activities. Keep an eye out for news about upcoming webinars on private sector engagement, immunization & national health insurance, Gavi’s Theory of Change tool for transition planning, country-to-country twinning arrangements; and more. Country Core Groups (CCGs) will also be hearing from us soon for a check-in call – we are looking forward to hearing about how participants are putting their resource mobilization plans into action!
For those of you unable to attend the meeting, the presentations can be found here on our website (you will need to log in to view them). We will also be posting recordings of several sessions as well as interviews with attendees over the next few weeks. And finally, we would like to encourage you to continue engaging with your fellow network members, experts, and partners on the LNCT website’s discussion forum.
Has your country already started implementing something you learned or plans you developed in Tangerang? Tell us about it in the comments below!