Bill & Melinda Gates Foundation

The Key to Sustainability

August 20, 2013

As Ciro de Quadros stated, "We’re at a pivotal moment in history, where we have the opportunity to create change like never before.” Earlier this month over 100 leaders from 17 countries, including, Ministers of Finance, Ministers of Health, and members of Parliament convened in Dakar, Senegal to discuss Sustainable Immunization Financing (SIF). What brought these leaders together last week was a shared common goal, better health for their citizens and children.

The Colloquium provided a unique opportunity, for leaders to spend two days in peer-to-peer workshops examining their countries’ immunization budgets and expenditures, and discussing shared obstacles that transcend country borders. By the conclusion of the Colloquium, delegates from each country had drafted their own action plan.

What differentiates the SIF program is its focus to empower countries to budget for and effectively strengthen their immunization program. The program isn’t about providing financial aid, but supporting countries in their efforts to better manage immunization budgets through peer reviews and exchanges, budgeting, and information sharing.  The Colloquium brought together groups within governments that are often fragmented and don’t meet regularly, for example, Parliamentarians, Ministries of Finance and Ministries of Health.

So why does this matter? What’s different? As the meeting concluded, it became clear to me that if we provide aid without countries taking ownership, the change will be short-lived. In a conversation with Mike McQuestion, Director of the SIF program at the Sabin Vaccine Institute, he explained the importance of country ownership of programs through this metaphor, “It’s like renting a home versus owning a home. When you rent a home, and something breaks, you expect your landlord to come and fix it for you. When you own a home, and something breaks, you take it as your responsibility to repair.” We need a shift in this paradigm if we are to achieve long-lasting results.

The results of the SIF program have proven to be promising so far, since the program’s inception in 2007, a majority of the participating countries have reported increases in immunization budgets.   

Democratic Republic of Congo (DRC) is one country that has participated in the SIF program which has made significant achievements. DRC significantly increased its budget for routine immunization in 2012, and has started on the path of expenditure tracking in the provinces. Parliament has also been a leading actor in drafting and finalizing an immunization law that guarantees a line item for vaccine procurement.

What’s become clear to me is that we should be thinking about aid in a holistic way, not just financially, and support countries to develop a sustainable system, where they are the homeowners. We need to encourage and provide our aid concurrent with the resources and support to help our identified countries manage their systems independently. Sustainability is rooted in ownership, and our efforts and investments can empower countries to take ownership and control of their programs with well-functioning systems.  

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