In September, the global community launched the Sustainable Development Goals (SDGs) to replace the Millennium Development Goals (MDGs). The idea was to galvanise efforts towards improving the lives of people across the world. Countries are expected to set national priorities, and pursue set targets, which would lead to the realisation of these broad goals. Goal Number 3 of the 17 SDGs is “good health and well-being.” It is the goal around which the health sector would necessarily articulate its targets for service delivery to millions of Nigerians.
For Nigeria, a country where the challenge of governance severely constraints the capacity of the health sector to deliver proper service to the people, ceaseless advocacy is needed to keep important issues relating to health and well-being in the front burner of the policy conversation. Also, at a time when the effects of the current economic recession is stretching what gets prioritised in the allocation of national resources, campaigners for the goal of good health and well-being must be very quick to spotlight important deliverables in the area of health, and advocate that even in these lean times, such priorities cannot be sacrificed for any reason whatsoever. This approach, involves active citizens taking the conversation, and the people’s demands to those who control state resources.
It is this proactive citizen-driven strategy that is currently shaping the nationwide campaign for sustainable vaccines and immunisation financing, which was launched recently by the Women Advocates for Vaccines Access (WAVA). With the recent resurgence of the wild polio virus, after what had been assumed to be a decisive victory, the place of robust immunisation to counter the spread of preventable diseases, cannot be treated with levity.
WAVA, which is leading this important conversation, is a coalition of women led civic organisations working in various states, across the six-geo-political zones of Nigeria. When it was founded in 2011, the coalition’s initial objective was to mobilize female politicians and wives of influential government functionaries to help increase uptake of immunization in Nigeria. That first step has now metamorphosed into a broader engagement of stakeholders in the vaccine delivery chain. WAVA envisions a world where individuals irrespective of their gender, creed, value or physical attributes have unhindered access to the vaccines required for their well-being.
In the course of a recent parley with CSOs on the goal of sustainable vaccines financing, the Convener of the coalition, Dr. Chizoba Wonodi sought to strike a positive note in the advocacy for sustainable vaccine financing and immunisation. She basically avoided the traditional scaremongering in which development advocates talk in morbid terms of deaths and suffering. Her message was powerful and positive because it highlighted the fact that immunisation, and its attendant cost should not be seen as mere expenditure. This world class public health expert, stressed the point that advocates, governments and policy makers should rather see spending on the vaccine, and the immunisation process as investments which would yield fantastic benefits, not just for individual beneficiaries, but also for society at large. She specifically pointed drew attention to the fact that when countries spend $1 for vaccination, they get back $16 in economic gain.
The power of positive messaging in this kind of narrative is likely to resonate well in Nigeria, where funding gaps exist in the vaccines delivery chain. Instead of putting audiences off by reeling out tiresome statistics of deaths, there is the alternative strategy of placing emphasis on the economic benefits in terms of health and well-being of citizens.
These benefits in the long run create positive outcomes for society in areas like productivity and well-being. In line with the need to reinforce this positive approach, members of the WAVA coalition are being trained on how to engage with federal, sub-national governments, communities and other interest groups to advocate for better funding, and delivery of vaccines.
In places like the North East, where the Boko Haram conflict has disrupted health governance systems, the intervention would be even more significant. WAVA members are also being made to understand the nexus between budget cycles and immunisation funding needs. The trainings are providing a platform for members to network, and immerse themselves in information about vaccines, what specific diseases they help prevent, and the myths that have to be dispelled, especially in local communities. Best practices in dialogue and persuasion when cases of cultural resistance or misconceptions that act as barriers to smooth uptake of immunisation, are encountered, have been integral aspects of the preparation of the advocates.
As always, financing would be a critical part of any such deliberation. The scale of funding for immunisation would be gleaned from the fact that in the 2016 budget, a total sum of N12.879b was earmarked for expenditure on traditional vaccines devices, the clearing and distribution process, polio eradication initiative, Hajj vaccines and non-polio immunisation. For functionaries, like legislators who may want to bristle about the quantum of money being spent vaccines, part of the advocacy is to help them understand the importance. The story is for instance told of how during the appropriation process, some lawmakers decided to yank off a huge chunk of the vaccines budget in 2016. Their argument was that polio had been eradicated, so there was no need to budget for polio vaccines.
They lawmakers did not know that the vaccines needs of the nation go beyond polio. They had to be informed that there are several other diseases, which vaccination keep away. That list includes; hepatitis, pneumonia, measles, meningitis, whooping cough, yellow fever, diphtheria, speticamia, ear infection and tetanus. Even in a recession, keeping citizens free of these ailments is a national priority that cannot be contested by any other consideration. Similarly, advocates are being empowered to understand and stress the point that what is at stake is the well-being of children and women, who are actually the vulnerable ones in society. It is only logical that society spends to protect them, even in these lean times.
The monies budgeted for immunisation are used for the procurement, storage, and transportation of vaccines to state Central Medical Stores (CMS). Similarly, a cold chain has to be maintained because vaccines are preserved at specified temperatures to be effective. Cost is also incurred in activities such as immunization outreach to hard-to-reach areas, program management, as well as advocacy, communications and social mobilization.
WAVA is empowering a multiplex of voices across the country to amplify the need for increased budgetary allocation and appropriation for immunizations, co-funding for the immunization by Federal, State Governments and the private sector. There are also advocacy points around the need to set up a National Trust Fund for Primary Health Care (including Immunization), as well as local vaccine production.
Back to the question of funding, the need for timely release of budgeted funds for immunization is a significant advocacy point, given the fact that health is about human lives, and they well-being of citizens, which should not be constrained by undue delays. All of these advocacy points become even more important with the realisation of the funding gaps that exist. For 2017 and 2018, a funding gap of $140 million has already been identified. WAVA has burnished the skills of advocates to begin to raise these issues and insist they become a vital part of the national conversation. Interestingly, the discourse did not only focus on how to generate the financial resources for vaccines and immunisation. WAVA members have also been also taken through the mill of the planning, appropriation, expenditure, and monitoring processes.
At the heart of the matter is the need for civic agencies to follow the money, with a view to ensuring that it is being used for what it is meant. In the end, whether Nigeria is able to attain Goal 3 of the SDGs will partly depend on the successes recorded through interventions like the advocacy being spearheaded by the committed advocates on the WAVA platform.
Ajanaku is Media and Communications Manager at the Resource Centre for Human Rights and Civic Education (CHRICED), a member of the WAVA coalition.