Advocacy for Financial Sustainability

In this presentation, Dana Faulkner and Rebecca Fields from the Academy for Educational Development (AED)'s CHANGE Project provide guidance to health professionals on how to make advocacy for financial sustainability in the area of vaccination more constructive, realistic, and actionable.

They begin by detailing a process that began in the second half of 2002: the requirement that Financial Sustainability Plans (FSPs) be submitted to The Global Alliance for Vaccines and Immunization (GAVI)'s board for grant reporting. GAVI's definition of financial sustainability is "the ability of a country to mobilize and efficiently use domestic and supplementary external resources on a reliable basis to achieve current and future target levels of immunization performance." FSPs are prepared by countries, often with external assistance. They must conform to guidelines from GAVI's Financing Task Force (FTF), which manages the submission and review process. They consist of situation assessment, estimates of current and projected costs and likely funding, and strategies for financial sustainability. Twelve countries (Round 1) submitted their plans in autumn 2002; these plans were reviewed by an FTF panel. In early 2003, the FTF arranged a series of case studies, detailing the experience of Round 1 countries in their FSPs.

Reflecting on the first round of proposals, Faulkner and Fields reported on the FTF's observation that many financing strategies lacked depth and clarity (detailed steps were rarely outlined). Strategies were not prioritised according to feasibility or impact, for example. Furthermore, advocacy with donors and government decision-makers was seen as a "magic bullet" for resource mobilisation. In response, members of GAVI's Advocacy & Communication Task Force (ACTF) and FTF met in Geneva in April 2003. FSP advocacy sessions were then developed and presented at regional FSP workshops in Kampala, Douala, and Moscow (May-August 2003). The CHANGE Project and the Children's Vaccine Program provided technical assistance on advocacy to Cambodia during a visit in July 2003. Based on this experience and interviews with individuals who had helped prepare FSPs, an interactive advocacy tool was developed and posted on the FTF website for pilot testing in late 2003.

The presenters cull from this background a few key challenges for financial sustainability:

1. The money doesn't reach where it's needed: funds get "stuck" at higher levels or do not reach the local level in a timely manner
2. The programme doesn't do as much as it could with the money: for instance, money is wasted unnecessarily
3. There is not enough money to meet programme objectives: there is a gap between anticipated funding and anticipated needs.

Faulkner and Fields explain that efforts to build awareness about the value of immunisation are insufficient to address these challenges; a realistic, disciplined, and strategic approach to advocacy must be developed. This approach does not require the production of new lengthy guidelines or manuals (high-quality materials already exist). Rather, it is rooted in the following concepts:

• Advocacy activities should be driven by, and directly support, the financing strategies themselves
• The critical first step is to identify the specific actions that need to be taken and by whom, exactly
• This information serves as a basis for determining messages, materials, channels, and the like.

As an illustration of this approach, the presenters lay out a framework designed to help countries think through the specific steps that need to be taken, and by whom, to achieve financing goals. This framework is meant to be used to identify persuasive (advocacy) actions that convince people to take particular steps on behalf of a vaccination programme). The framework begins with the finance-related strategic objectives already selected by the country, then poses a series of questions to clarify the specific actions that are needed to achieve the goal. It defines the specific actors who can carry out the needed action, clarifying secondary actions and actors if necessary. Faulkner and Fields stress that this framework can be modified to meet specific ends and aims; it is a flexible strategy. This framework for analysis and advocacy action has been articulated in an advocacy tool, taking the form of an interactive CD-ROM, that helps users work through a strategy development process. It includes a series of short problem statements that link to frameworks for analysis and planning, existing manuals, country examples, and resource materials. Fifty such CD-ROMs have been sent to FTF for field testing by consultants working on FSP development. In addition, the contents of the CD-ROM are posted on the GAVI FTF website.

The presenters conclude by sharing a few issues for consideration. In their words:

• "Advocacy is highly culture-bound and situational: Outsiders can only pose good questions - the answers require insider savvy
• Advocacy activities targeted at specific, politically sensitive issues (like budget allocations) can be a risky activity for EPI program managers
• Country health officials tell us they need more than messages that say "immunization is good" - if they are to successfully advocate for immunization programs relative to other priorities
• Successful advocacy for immunization by country programs has the potential to affect the power dynamic between and among country managers and external funders - Funders may feel that their priorities are challenged."

Click here to access this presentation in PDF format.