By Etuka Sunday
The Federal Government of Nigeria, represented jointly by the Ministers of Budget and National Planning, Finance, and Health, announced a new innovative financing agreement with the Bill & Melinda Gates Foundation aimed at strengthening both routine immunisation (RI) and broader primary healthcare (PHC) services.
Under the agreement, Nigeria will receive incentive financing of up to US$75 million over five years from the Gates Foundation as the government meets existing commitments to increase domestic funding of its RI program.
The incentive financing will be directly invested in Nigeria’s Basic Healthcare Provision Fund (BHCPF), and used in strengthening RI financing and other PHC services for the poorest. Coming at a time when the nation’s revenue generation is constrained, the deal will direct new funds to Nigeria’s broader health sector even as more domestic resources are dedicated to critical childhood vaccines specifically—creating a win-win opportunity for essential PHC services to grow in tandem.
“Childhood immunisation is one of the most effective and cost-effective health interventions, and I can think of few better long-term investments in Nigeria’s human capital and future prosperity,” said Senator Udoma Udo Udoma, Honourable Minister of Budget and National Planning.
In April of last year, the Federal Government—through the National Primary Healthcare Development Agency—finalized its Nigeria Strategy for Immunisation and PHC System Strengthening, 2018-2028 (NSIPSS), which outlined plans to spend US$1.95 billion on immunisation services over ten years via the national budget and some World Bank loan financing.
In June, Gavi, the Vaccine Alliance, committed to supporting the NSIPSS with extended donor financing as domestic resources scale up. During this extended transition window, international donors via Gavi will provide Nigeria with US$1 billion, on top of the US$1.95bn domestic commitment. Together these funds will cover procurement of vaccines—the lion’s share of the costs—as well as operational costs for routine and supplementary immunisation activities, and PHC system support.
However, even with the additional Gavi support and loan options, the NSIPSS financing strategy requires significant annual increases in funding for vaccines until the government assumes full responsibility after 2028. While Federal Government planning accounts for this, the incentive financing with the Gates Foundation will help reduce the pressure this creates on the overall health budget by providing new grant financing for PHC each year as domestic vaccine financing commitments are met.
“There’s no question that immunisation is an all-around ‘best buy’ for Nigeria, and extremely high value-for-money, but we still have limited resources” said Honourable Minister of Finance Zainab Ahmed. “This innovative financing will allow us to limit trade-offs in the health sector by ensuring that every additional Naira released for vaccines unlocks additional resources for broader PHC improvements.”
The BHCPF implementation formally rolled out on January 8, 2019 finances critical PHC interventions for children, women and families with a focus on rural and underserved areas, and by providing direct funding to facilities for operational expenses. By channeling incentive financing through the BHCPF, the Federal Government and the Gates Foundation will ensure that those resources, like RI commitments, directly benefit Nigerians most in need.
“Full implementation of the NSIPSS will ensure that millions more Nigerian children are reached with vaccines and potentially save millions of lives,” said Professor Isaac Adewole, Honourable Minister of Health. “Meanwhile, we know that a strong overall PHC system can take care of more than 80 percent of Nigerians’ health needs. So full utilization of the BHCPF will go that much further.”
Under the agreement, the Gates Foundation will provide up to US$15 million per annum for five years to the Federal Government of Nigeria for financing PHC. Payments will be made based on the conditions that the Federal Government is budgeting for RI programs per the NSIPSS financing plan, that a sustainable balance of direct budget contributions and loans are being directed to RI, and that budgeted funds are released as required by the immunisation program.
The government will also focus on improved data accuracy and sustained efforts to interrupt polio transmission. Disbursement of funds will be through the BHCPF so long as the fund continues to meet its operational guidelines.
“With the NSIPSS, the Nigerian government is committing to a long-term investment in its people—and to ensuring that children will have the vaccines they need for the next ten years and beyond,” said Dr. Paulin Basinga, Nigeria Country Director, Bill & Melinda Gates Foundation. “We know this isn’t easy given the many demands on Nigeria’s limited resources. So, we’re pleased to extend the health benefits of fulfilling this pledge even further, by supporting PHC for all of Nigeria’s children and families.”