This story provides an illustration of:
- Advocating for immunisation financing
- The importance of advocacy skills
- Developing an advocacy strategy
- The power of multi-sectoral partnership
- Working at all levels of government and community
The political crisis that characterised Ivory Coast from 2002 to 2011 created a widespread increase in health needs across the country, particularly in the immunisation programme. Additionally, a new decentralisation policy has been implemented by the Ivorian government which increases demands for expanded and coordinated efforts at all levels of the health system.
Advocating for budget and funding allocations
Those involved in immunisation in Ivory Coast have had to become advocates to mobilise resources to finance immunisation. Advocacy efforts are needed in order to continue to raise awareness of the benefits of immunisation and to secure resources required to achieve the goals of the immunisation programme.
The process for developing the national budget of Ivory Coast includes an opportunity for representatives of every ministerial department to justify their budgets. However, the representatives of the Ministry of Finance were not familiar with health-related issues, so immunisation stakeholders – including Ministry of Health staff and Civil Society Organisations (CSOs) – developed arguments justifying the relevance of planned activities and the resulting budgetary implications. This exercise was conducted every year with mixed outcomes, which depended a lot on the quality of the documentation presented and the advocacy skills of the presenters.
At the international level, funding applications to donors are regulated by guidelines that guide stakeholders in their application process. For partners such as Gavi, the Vaccine Alliance, the national ministry staff have to advocate before the Comité de Coordination Inter Agence (CCIA or ICC) which validates the content of the application. Also, advocacy efforts are needed at the national level to mobilise the country’s share of the co-financing mechanism established by Gavi.
Even though these initiatives allowed the programme to mobilise some resources, they did not always reach the expected results and sometimes financial needs were not sufficient to achieve the goals. Furthermore mechanisms for the sustainability of these initiatives were not always in place.
The importance of strengthening advocacy skills for immunisation financing
The success, challenges and lessons learnt bolstered the will to develop a programme for strengthening advocacy skills in immunisation financing. The objective of the ADVIM (ADVocacy for IMmunisation financing) project – established by Agence de Médecine Préventive (AMP) – was to strengthen the advocacy skills of immunisation stakeholders at all levels of the health system. ADVIM’s goal was to transform immunisation stakeholders at all levels of the health system into immunisation and immunisation financing advocates, and to assist in the implementation of strategic advocacy within a collaborative, intersectoral framework.
Advocacy at all levels of government and community
At the national level, ADVIM focused on those decision-makers who were involved in the immunisation planning and financing processes. It was about setting up an immunisation intersectoral advocacy team comprising health, economics and planning stakeholders who would build a national-level coalition for immunisation financing. The coalition’s role was to advocate for routine immunisation financing, new vaccines introduction and immunisation campaigns. These advocacy efforts were directed to the national budget and to internal and external target audiences of donors and funders (e.g. Gavi, private foundations, bilateral cooperation, public and private sector, national media etc…).
At the regional level, ADVIM focused on the establishment of a team specialised in advocacy for financing immunisation. This team developed an advocacy strategy targeting local governments, NGOs and private companies and relied on local media to disseminate advocacy messages.
At the district level, the focus was on the establishment of a team specialised in advocacy for financing immunisation to develop an advocacy strategy targeting municipalities, NGOs and private companies. The team was mobilising the support of the community and the civil society and relied on local media to disseminate advocacy messages related to immunisation financing.
The mechanisms and the tools developed by the ADVIM project were shared as “Best Practices” with other Sub-Saharan African countries. By ensuring sustainable financing, ADVIM supported the sustainability of the immunisation programme, thus contributing towards the achievement of MDG4:
“Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate”.
Source: Initiatives de Plaidoyer pour le financement des vaccinations: cas de la Cote d’Ivoire – Etude de Cas (ADVIM – Amp) Oct 2011