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The effect of performance-based financing on child vaccinations in northern Nigeria | Vaccine.

[Pay to View Full Text] [Received 27 August 2019, Revised 8 November 2019, Accepted 9 January 2020, Available online 23 January 2020] [In Press, Corrected Proof]


* We evaluate the effect of Performance-Based Financing (PBF).

* The main outcome is the quantity of vaccinations carried out in northern Nigeria.

* Difference-in-Differences (DiD) and ANCOVA are used to evaluate the effect of PBF.

* PBF intervention increased the quantity of full vaccination cases.

* Providing unconditional financial & technical assistance might be more cost-effective strategy.


Vaccination is known to be one of the most cost-effective ways to avert child deaths. However, in Nigeria, the vaccination completion rate among children is extremely low and the child mortality rate is one of the highest in the world. National immunization coverage survey shows that the low vaccination rate in Nigeria is partly attributed to service delivery issues. This paper evaluates the effect of Performance-Based Financing (PBF), an incentive scheme where health facilities are funded based on their performance, on the quantity of vaccinations carried out in Adamawa state. Under the Nigeria State Health Investment Project (NSHIP), half of the Local Government Areas (LGAs) in Adamawa State were randomly assigned to receive PBF intervention between 2015 and 2018. The Difference-in-Differences (DiD) technique as well as ANCOVA analysis are used to evaluate the effect of PBF on vaccination service delivery indicators. We find that the PBF intervention significantly increased the quantity of full vaccination cases as compared to the comparison group, although the effect size was small. On the other hand, if health facilities receive intensified PEI (Polio Eradication Initiative) concurrently, the effectiveness of PBF in increasing the number of full vaccination cases do not differ significantly from health facilities that are not under PBF. Rather than providing conditional financial incentives such as PBF to health facilities, simply providing unconditional financial and technical assistance to strengthen routine immunization programs might be sufficient to increase the quantity of vaccination service provision. The positive effect of PBF on vaccination provision was not sustainable, either. Future work should explore how we can strengthen the health system in a cost-effective and sustainable way.

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Pakistan: Over 200,000 Children To Be Immunized Against Polio | UrdoPoint.

[Tue 28th January 2020 | 06:41 PM] Mohammad Ali writes:

KOHAT, (UrduPoint / Pakistan Point News - 28th Jan, 2020 ) : As many as 206820 children under the age of five would be given polio vaccination drops during a five-day vacation campaign launched here on Tuesday.

Commissioner Syed Abdul Jabbar while administering polio drops to a child here at his office inaugurated the drive and directed all polio teams to ensure vaccination of each and every target child to make the district polio free.

On the occasion Deputy Commissioner Abdur Rehman, Additional Deputy Commissioner Shah Nawaz, DHO Dr Musharraf and officials of polio program were present.

The commissioner was informed that 939 mobile, fixed, transit and roaming teams would administer polio drops to target population.

The Commissioner expressed his pleasure to know that after 2014 no case of polio was reported from district Kohat and appreciated the efforts of all polio officials, workers and departments.

He directed foolproof security of polio vaccination teams and said it was our joint responsibility to vaccinate our children against polio virus and protect them from prevailing threat of physical disability due to the crippling disease.

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Philippines: Sarangani optimistic to hit target for polio vaccination | Big News Network.

[28th January 2020, 19:38 GMT+11] [Philippine Information Agency]

ALABEL, Sarangani (January 28) - Sarangani has immunized 60,525 children or 85% against its target of 70,816 children under five years old for the first week since it resumed vaccination on January 22.

"It is a good start for all of us," Razel Bustria, Sarangani Province's National Immunization Program coordinator, told Sarangani Provincial Information Office in an update regarding the continuing anti-polio vaccination which they hope to hit again more than 95% accomplishment.

This is the third round synchronized mass immunization for other regions but for Sarangani, it is providing its second dose for monovalent oral poliovirus vaccine or MOPV.

But Sarangani is set to conduct another vaccination in April for the bivalent oral poliovirus or BOPV which protects kids from types one and two viruses that mainly caused the outbreak in the Philippines according to Getnet Abie Abtew, World Health Organization (WHO) Philippines Country Office consultant.

Sarangani was leading among provinces in Region 12 during the first round of the mass immunization dubbed as "Sabayang Patak Kontra Polio" last year obtaining 99.71% or 70,612 children that Dr. Arvin Alejandro, Sarangani Provincial Health Officer, reported to have been "protected" from the disease.

Alejandro said mobilizing key stakeholders to support the campaign had raised their accomplishment during the vaccination last November 25 to December 17.

Abtew said Sarangani's accomplishment for the first round mass vaccination "is very interesting, very high coverage."

He then accounted "13 positive cases" in the Philippines. "We have four positive cases in Region 12, one from Cotabato City, one from North Cotabato and two from Sultan Kudarat" and other nine cases from BARMM region."

"Increment is gradual but it is not going down" Abtew said as he accounted that one case from Sultan Kudarat and two cases from BARMM region out of the 13 cases he reported were just discovered this January.

"That means BARMM and Region 12 are highly affected by this outbreak," he said.

The Philippines was free of polio around 20 years but an outbreak was declared again last September.

Polio is a contagious disease caused by poliovirus that in its most severe form causes nerve injury leading to paralysis, difficulty in breathing, and sometimes death.

Glan Mayor Vivien Yap, a physician, explained polio as preventable disease "but once the child is affected with polio especially with paralysis, you cannot bring back or cure paralysis anymore. Henceforth it is but necessary for us to do polio vaccination in all children of each barangay, each municipality and each province."

In Sarangani, the first round mass immunization kicked-off in Glan.

In the previous Local Health Board meeting, Mayor Yap urged support for sanitation as a preventive aspect also to hold the transmission of the polio virus.

Similar to the previous immunization, administration of anti-polio vaccines until February 2 will be done in straight two weeks including weekends, Alejandro said, as he continuously urged barangay officials in Sarangani, the local chief executives and other partners to support the campaign.

"We need to sustain the more than 95% herd immunity so that we will really be able to hold the transmission of the disease. That is the only way to prevent the transmission of the disease," Alejandro said.

Polio immunization for dose 3 in Sarangani in the past, according to Alejandro, was calculated at only 74% due to lack of vaccines.

Alejandro said children should have been immunized with three doses of polio vaccine before reaching one year old. "But for Sarangani province basically because of lack of logistics before, nasa 74% lang" which he accounted to only 50,000 to 55,000 immunized children.

All vaccines for polio came from WHO and are administered for free.

Alejandro said polio vaccines are unavailable in private facilities hence the president of the Pediatric Association in the Philippine has called on all the pediatricians to subject their clients to any health facility where the vaccines will be given for free. (Beverly C. Paoyon/SARANGANI COMMUNICATIONS SERVICE)

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Somalia Weekly Polio Update: Week 3, 2020 | World Health Organization, UN Children's Fund via ReliefWeb.

Published on 28 Jan 2020 —View Original

Situation Update.

  • Three new circulating vaccine-derived poliovirus type 2 (cVDPV2) - positive sewage samples have been identified this week from three environmental surveillance (ES) sites in Mogadishu, collected on the 22 December. All virus is genetically linked to the two environmental positives identified from 10 November 2019, from two of four ES sites in the city. These new results confirm that there is currently active circulation of this type of poliovirus in the Banadir region.

  • No new cases of children with cVDPV2 were reported this week. The date of onset of the most recent case of cVDPV2 in a child with acute flaccid paralysis (AFP) was 8 May 2019. A total of three cVDPV2 cases were reported in Somalia in 2019.

  • No circulating vaccine-derived poliovirus type 3 (cVDPV3) - positive cases or environmental samples were identified in 2019. The onset of the most recent case of cVDPV3 in a child with AFP was 7 September 2018.

  • In total, 15 children with polio infection have been identified across Somalia since the initial detection of the ongoing cVDPV2 and cVDPV3 outbreaks in late 2017.

Operations and Outbreak Coordination.

_ The cVDPV2-positive environmental samples collected in November and December reflect undetected virus transmission, indicating gaps in surveillance and population immunity likely stemming from areas where the polio programme cannot access populations with surveillance and immunization activities.

  • A targeted mOPV2 response is currently being designed in response to these recent virus isolations. mOPV2 has not been used since late 2018 across south and central regions, and there are a number of susceptible children born since the last case response activities who are unvaccinated. The polio programme aims to implement the first round of mOPV2 in selected areas in early February depending on arrival of vaccine into the country.

  • Priorities for outbreak response in view of the new epidemiology include further strengthening surveillance and conducting active case search, including in hard-to-access areas, identifying population groups susceptible to harbouring the virus, monitoring population movement and continuing efforts to gain access to security compromised areas with vaccines.


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Gavi And The EU: A Partnership For The Future | Save the Children International.

[27 JANUARY 2020]

Gavi and Europe

On the 3rd and 4th of June 2020, the UK will host the next replenishment of Gavi, the Vaccine Alliance, providing an opportunity for the EU, and the international community, to realign with the ambitious Agenda 2030 by scaling up immunisation efforts and “reaching those left furthest behind”. At a time when the world is off track to reach the Sustainable Development Goals (SDGs) by 20301, immunisation is not only a chance to achieve SDG3’s aspiration of healthy lives and the promotion of well-being for all, it is also essential to reach most of the SDGs. Having recently hosted the first Global Vaccine Summit in Brussels, the EU has shown itself to be a supporter of immunisation worldwide. Now is the time for the EU to turn words into actions and maintain immunisation gains by continuing its support for the Vaccine Alliance. This initiative aligns fully with forthcoming European priorities, such as the European Green Deal and a meaningful partnership with Africa.

In the next investment cycle, the Alliance intends to reach 300 million more children, saving an additional 7-8 million lives2. Global Health Advocates France, ONE and Save the Children, a group of child and global health advocates and implementers, are calling on the EU to support this life saving initiative by making a robust, increased, and unearmarked commitment, through grant funding, to the Vaccine Alliance of €300 million for the years 2021-2025.



As a strong supporter of Gavi since 2003, the investment made by the EU has had a deep and lasting impact on millions of children living in low-income countries. Increasing access to vaccines changes lives; protecting children from infectious diseases which may prevent them from attending school, result in life-long injury or illness, or even fatality.

Gavi’s progress has been impressive. Since its inception in 2000, Gavi has supported countries to protect 760 million

children, thereby reducing vaccine-preventable deaths by as much as 70%3. Gavi is among the best performing global health initiatives, due to its high societal return on investment, and it receives top scores in multilateral reviews with regards to transparency of internal processes, and fiduciary and operational risk management.

For every US$ 1 invested into immunisation, we see a return of US$ 54 in broader societal benefits4.

In its upcoming strategic period (from 2021 to 2025), Gavi has laid out a comprehensive strategy, vowing to reach the last unvaccinated child, and reaffirming a foundational dedication to equity.

Furthermore, Gavi’s partnership model complements the importance placed on sustainable, equal partnerships by the new European Commission. Gavi takes a strategic approach to sustainability, and encourages countries to transition towards self-financing through domestic investment. Over the 2021-2025 period, Gavi will help the transition of 10 countries into self-financing, and continue to engage with the 18 other countries that have already transitioned.

The eradication of poverty depends on healthy populations. Communities or individuals that face health setbacks can easily fall back into the poverty from which they struggled to escape. Gavi’s renewed emphasis on gender is exemplified by the Alliance’s plans to accelerate the roll out of the new human papillomavirus (HPV) vaccine, which serves to protect women and girls from cervical cancer. These targeted equity initiatives allow Gavi’s impact to go beyond SDG3, affecting a plethora of the Sustainable Development Goals. Additionally, the EU is increasingly recognising the role that climate change will play in the future of health including for vulnerable communities. Immunisation strengthens the health systems of communities most at risk from the climate crisis.


Even with the number of countries transitioning from Gavi support, the reality is that Gavi’s 2021-2025 strategy will be more ambitious, due to the inclusion of inactivated polio vaccine (IPV) within the co-financing of Gavi and the increased docket of vaccines and focus on equity. As a result, Gavi will need at least US$ 7.4 billion in additional resources.

There are a number of reasons why the EU should increase its investment in Gavi:

  1. Partnership with Africa: If the EU is serious about a genuine and equal partnership with Africa, one that creates opportunities for local populations, it should prioritize investments in immunization and public health, as the foundation for healthy societies. Gavi’s 2021-2025 strategy allocates 69% of support for vaccine programmes to Africa, supporting the EU’s commitment to a renewed partnership that empowers the continent’s children and youth.
  2. Reaching under vaccinated and unvaccinated children is harder and more expensive: In order to reach the increasing number of underimmunized children in low-income urban communities and the most remote rural areas, Gavi will need to implement new tools and approaches that adapt to local challenges.
  3. Increasing coverage means doing more: Gavi is continuing to expand its portfolio of vaccines, and during the next period will provide protection against 18 diseases, compared with just 6 in 2000. This includes taking on polio eradication through implementing routine inactivated polio vaccine (IPV) programmes across Gavi countries. We must also keep in mind that Gavi’s hard-earned gains are increasingly threatened by the combined impacts of climate change, population growth and displacement, and vaccine hesitancy so increasing coverage in places that face these issues will be more challenging.
  4. Universal Health Coverage/ Health System Strengthening: Gavi delivers more than vaccines. By helping countries extend their capacity to deliver immunisation where most health services are also unavailable, it strengthens local health systems and supports the primary health platform through which other essential health services can be delivered. The EU has been a long time supporter of health system strengthening (HSS) and if they want Gavi to do more in this area, it is essential to ensure that Gavi can deliver in the area of HSS programming.
  5. Preventing tomorrow’s emergencies: The Gavi funded stockpile has already been instrumental in battling health emergencies and will be increasingly crucial in ending ebola and tackling the rise of climate sensitive-diseases ie dengue fever, cholera etc.
  6. Market-shaping innovations: With every investment cycle, Gavi’s market shaping tools increase the impact of donor investments by improving the availability and pricing of vaccines. Gavi’s market shaping model will result in savings of over US $900 million between 2021-2025.



When making the commitment, we are asking the EU to fully leverage their donor role on the Gavi Board and seek the following promises from Gavi linked to the EU pledge:

1. Enhance transition preparedness and capacity support: There is a need to strengthen and deliver on comprehensive country transition plans early on, going beyond ability to pay and take into account programme readiness. These transition plans must be developed with full transparency and alignment with other Global Health Initiative transitionary frameworks to avoid burdening transitioning countries with overlapping or simultaneous transitions.

2. Sustainability and strong primary healthcare systems: Currently, a large portion of Gavi support is funnelled through UN programmes (such as UNICEF and the WHO). To help countries strengthen primary healthcare systems in the long term, Gavi support for health system strengthening should increasingly be provided to or in partnership with the government, moving beyond cash-based support, and should be extended to local NGOs that have strong ties to communities and access to remote areas.

3. Equity: We welcome the equity focus in the new investment case with a prioritisation of undervaccinated children and the implementation of a new gender policy. In order to reach the most marginalised, Gavi will need to continue to sharpen its focus, including on children affected by conflict. This can be done by developing an Equity Policy to provide an overarching strategic framework, give oversight to, and drive Gavi’s equity agenda.

4. Vaccine affordability: Market shaping is an important tool for ensuring vaccine affordability. Gavi has extensive market-shaping expertise and could use this expertise more strategically to influence markets, so that prices are affordable in the long term for all countries. Gavi should be encouraged to use all its tools to the fullest to expand supplier base, such as maximising the use of Advanced Market Commitments (AMC)5 to support new vaccine producers, including for the PCV vaccine (which is currently one of the most expensive vaccines in the Gavi Portfolio).

5. Accountability: While the move to simplify the funding models is commended, transparency and accountability mechanisms should be strengthened by creating a strong accountability framework for the Secretariat of the Alliance and its partners. CSO engagement is key to fostering accountability. Gavi should commit to further fostering meaningful civil society engagement in immunisation and Gavi planning and processes, through independent support to civil society.


During the last replenishment, the EU’s early pledge set the level of ambition for a successful replenishment. Gavi has a proven track record of delivering on its promise. Now, the partnership wants to run the last mile, to reach the communities who have been left out of the benefits reaped through immunisation. This last mile will be the hardest and most expensive, because the road needs to be built to the most marginalised and furthest behind - those in difficult to reach rural settings, the urban poor, people facing conflict, instability and displacement.

Additionally, Gavi has been asked to do more with less, while shouldering more responsibility in the fight to eradicate polio. As a vaccine champion, the EU can lead the way to a successful replenishment with an early pledge, catalyzing support from EU Member States. For these reasons, we call on the European Commission to live up to its reputation as a champion of vaccination and global health by making a robust, increased, and unearmarked commitment, through grant funding, to the Vaccine Alliance of €300 million for the years 2021-2025.

Notes to Editors

1 United Nations, 2018. The Sustainable Development Goals Report: 2018. Available here; See also SDG Tracker, 2019. Measuring progress towards the sustainable development goals. Available here.

2 GAVI, 2019. Prevent, Protect, Prosper: 2021-2025 Investment Case, page 4. Available here.

3 Ibid.

4 John Hopkins University - International Vaccine Access Center (IVAC), 2019. Methodology Report: Decade of Vaccines Economics (DOVE) Return on Investment Analysis. Available here.

5 An AMC is a legally-binding agreement for funds to subsidize the purchase, at a given price, of an as yet unavailable vaccine against a specific disease in developing countries. The establishment of AMCs encourages the development of future generations of vaccines and accelerate the development and availability of priority new vaccines to developing countries. 

Pamphlet available here

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