LNCT Member Newsletter July/August 2019

LNCT Updates

Materials from 2019 LNCT Network-wide Meeting Now Available
Earlier this month, the Learning Network for Countries in Transition (LNCT), in partnership with the Indonesian Ministry of Health, Gavi, and the Bill and Melinda Gates Foundation, held its third network-wide meeting in Tangerang, Indonesia. The meeting brought together country delegates from 14 of the 17 sponsored LNCT member countries. Participants included key representatives from ministries of health, ministries of finance, health policy and planning agencies, and national health insurance agencies in Gavi transitioning countries, as well as global, regional, and country-level partners.  The Tangerang meeting was organized around the theme, “Resource Mobilization: Moving Beyond Vaccines.” Countries spent three days engaged in focused and energized discussions around common budget gaps for immunization programs, strategies for resource mobilization at the national and sub-national levels, and models and strategies for effectively engaging the private sector. Participants also worked within their country teams to develop resource mobilization plans to mobilize additional resources and improve the flow of funds for priority inputs. Following the meeting, the LNCT Steering Committee convened to discuss priorities for the network for 2020 and beyond.

Resources used and produced from the meeting can be found on the LNCT website:

*Note: You will need to log-in to view the meeting materials or respond to the discussion forum thread.  Additionally, some materials are still going through the translation process – keep checking back if you don’t see what you’re looking for.

Immunization and National Health Insurance Side Meeting
Delegates from countries with national health insurance programs (Georgia, Ghana, Indonesia, Lao PDR, Nigeria, Sudan, and Vietnam) participated in a one-day side meeting on immunization and national health insurance as part of LNCT’s 2019 Network-wide Meeting in Tangerang, Indonesia. Delegates from Ministries of Health worked closely with their colleagues from Ministries of Finance and National Health Insurance Agencies and with colleagues from other countries to consider the pros and cons of including immunization in the National Health Insurance benefit package. Participants also had a chance to learn about how immunization services are handled in the multiple insurance schemes in Mexico. On the whole, participants agreed that there is no perfect solution, and appreciated the importance of clear roles and responsibilities between the MOH and the insurance agency to ensure that critical immunization functions do not fall through the cracks. It was also agreed that risks of integrating immunization into health insurance schemes with funding solvency issues and low population coverage may outweigh potential benefits. Participants also discussed how to create strong incentives for providers and concluded there is no one best way to pay providers for immunization services, and that payment mechanisms may need to evolve over time. They also noted the importance of non-financial incentives, such as providers being well trained on the importance of immunization and receiving feedback on coverage. The presentations from the meeting can be found here.

LET’S DISCUSS: How does your Government Engage with Private Immunization Providers?
How does your government engage with private for-profit or non-profit immunization providers? Does the MOH distribute national immunization program vaccines to private providers at no charge? If so, what types of providers receive vaccines from the government and what populations do they serve? What requirements come with the vaccines, such as reporting to the MOH on doses administered and Adverse Events Following Immunization (AEFI), and restrictions on fees charged? How does the MOH handle distribution of vaccines to private providers? Is it distributed by the national government, subnational (e.g. provincial) government, or private distributors?
*Have examples to share or additional questions on this topic? Log into the LNCT discussion forum and post your response here!

More Improvements Launched on LNCT Website
Between June and July, LNCT launched several additional improvements to the lnct.global website, including:

  • Getting Started Guide – An electronic guide that can be used to help you navigate the LNCT platform.
  • New ways to look for ‘Updates’ – You can now filter between LNCT-specific updates and Global updates from partners. We’ve also made it easier to read LNCT blogs and added the ability to post a question or comment directly on each individual blog.
  • New design for our resource and discussion filters – Did you know that you can filter resources and discussion posts by topic, type, or country? We’ve updated the design of this filter feature so that it’s easier to use.

Country Spotlight

Georgia Shares Experience on Using Data to Support Increased Budgets for Immunization at 2019 iHEA Congress
LNCT moderated a panel at the Immunization Economics pre-congress session at International Health Economics Association (iHEA)’s biennial congress. During the panel, Using Data to Support Increased Budgets for Immunization in Georgia, Vladimer Getia of the Georgian National Center for Disease Control and Public Health and Natia Gulua of the Georgia Ministry of Finance discussed how the Ministries of Health and Finance work together closely in Georgia to ensure they gather high-quality information about the costs and benefits of potential changes to immunization programs in order to make informed decisions. Their collaborative working relationship and the high-quality data that the Ministry of Health has been able to provide has allowed the Ministry of Finance to become an advocate for immunization, and as a result Georgia’s immunization budget has increased every year since 2014.

Highlights from our Partners

MI4A Vaccine Purchase Data for Countries
WHO’s Market Information for Access Initiative (MI4A) provides a global perspective on vaccine markets, responding to WHA Resolutions and WHO SAGE requests for action. MI4A focuses in particular on addressing the needs of self-procuring Middle-Income Countries who often lack information and purchasing power. MI4A has developed a report that contains an analysis of 2017 data of prices reported by countries, organized by vaccine, listing all reported manufacturers and vial sizes (an update with 2018 data will be available in Q3). This report is intended to guide countries in their use of the MI4A vaccine purchase data. Prices are indicated by procurement mechanism, Gavi status, income group and WHO region. The dataset (including past years) can also be downloaded here.

UNICEF Recently Launched Massive Open Online Course (MOOC) on Health Systems Strengthening
The Massive Open Online Course (MOOC) on Health Systems Strengthening (HSS) was launched earlier this month. The course has been developed in collaboration between the UNICEF HSS unit and the Learning and Knowledge Exchange Unit, in partnership with the Nossal Institute for Global Health at the University of Melbourne and FutureLearn (UK). The course has been designed for busy professionals seeking to learn more and develop health systems skills and follows a complex adaptive systems approach in conceptualizing health systems and developing actions to strengthen them, bringing together global health expertise and evidence in an engaging and interactive multimedia experience. It consists of eight modules, each taking 2-3 hours to complete.

The first session launched on 8th July and will continue for eight weeks, but the course will run on a rolling basis several times per year, and participants can proceed at their own pace. People who complete the modules will receive a free certificate of completion from the University of Melbourne and UNICEF upon completion of the course. For more information, course details and enrollment to the course please follow this link.

Featured Resources

Wellcome Global Monitor 2018 Measures Attitudes on Vaccine Safety and Efficacy
The Wellcome Trust launched their first Global Monitor surveying over 140,000 individuals in 140 countries regarding their trust in science, scientists, health professionals and vaccines. The Global Monitor adopted the Vaccine Confidence Project’s Vaccine Confidence IndexTM to measure confidence in vaccine importance, safety and effectiveness. People were asked if they agree, disagree, or neither agree nor disagree with the following statements:

  1. Vaccines are important for children to have.
  2. Vaccines are safe.
  3. Vaccines are effective.

Summary of Chapter 5: Attitudes to vaccines:

  • There is a positive relationship between overall trust in scientists and overall attitudes towards vaccines, though the relationship is strongest in high-income countries.
  • In most regions, people who have high trust in doctors and nurses are very likely to consider that vaccines are safe. However, this is less true in Western and Eastern Europe.
  • Eastern Europeans are least likely to agree that vaccines are effective. In Moldova, only 49% of people ‘agree’ that vaccines are effective.
  • Lao PDR is among the countries where people are most likely to agree that vaccines are safe, effective and important for children to have. 98% of people strongly/somewhat agree that ‘vaccines are important for children to have’, 91% strongly/somewhat agree that ‘vaccines are effective’, and 92% of people strongly/somewhat agree that ‘vaccines are safe’.
  • Armenia, Moldova, and Indonesia are among the countries where people are most likely to disagree that vaccines are safe, effective and important for children to have. For example, only 11% of people in Indonesia strongly/somewhat agree that ‘vaccines are effective’ and only 12% of people in Armenia strongly/somewhat agree that ‘vaccines are important for children to have’.

Tackling the Triple Transition in Global Health Procurement
Despite its importance, procurement of vaccines, drugs, and supplies is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world. Within a changing global health landscape, a forward-looking approach is needed to anticipate tomorrow’s challenges and plan for the future. To this end, the Center for Global Development convened the Working Group on the Future of Global Health Procurement to review the evidence and formulate recommendations for how the global health community—international health organizations, their bilateral and foundation donors, and low- and middle-income countries—can ensure the medium- to long-term relevance, efficiency, quality, affordability, and security of global health procurement.

Looking Ahead

LNCT & VPPN Co-hosting Second Joint Regional Vaccine Procurement Workshop for Asia Region
We are looking forward to seeing our East Asia region members in Yangon, Myanmar September 12-13 for our second regional Vaccine Procurement Workshop, which we are co-hosting with the UNICEF Vaccine Procurement Practitioners Network (VPPN) and the National Institute of Vaccines (NVI) in Thailand. The workshop is scheduled between the EPI Managers meeting taking place in Naypyidaw, and the 7th Asian Vaccine Conference (ASVAC 2019) in Yangon. In alignment with the EPI Managers meeting as well as the ASVAC 2019, this year’s theme will be on sustainable introduction of new vaccines to national immunization programs, with the addition of a focus on vaccine security to ensure the sustained, uninterrupted supply of affordable, vaccines of assured quality. Participants from Indonesia, Lao PDR, Mongolia, Myanmar, Papua New Guinea, Philippines, Thailand, Timor Leste, and Vietnam are expected to: (1) learn from best practices to address identified challenges to ensure the sustained, uninterrupted supply of affordable, vaccines of assured quality;  (2) create and commit to implement a country action plan which strengthens vaccine procurement practices; and (3)  foster inter- sub-regional collaboration and community of practice around vaccine procurement that will continue to be supported through the Vaccine Procurement Practitioners Exchange Forum (VPPEF).

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