Intensified Local Resource Mobilization for the Polio Eradication Initiative: The Experience of World Health Organization in Nigeria During 2008-2015

Abstract

Background: Since the World Health Assembly (WHA) resolved in 1988 to eradicate poliovirus, several rounds of immunization campaigns have been conducted by member states. By 2000, with the support of the Global Polio Eradication Initiative (GPEI) partners, the number of polio cases decreased by 99%. Eradicating the remaining 1% proved to be more challenging. Although the GPEI, being the largest public health project, required >$9 billion between 1988 and 2012, economic analysis showed the estimated incremental net benefits of $40 billion-$50 billion between 1988 and 2035. In 2012, the WHA declared that the completion of poliovirus eradication is a programmatic emergency for global public health. Nigeria, as one of 3 remaining polio-endemic countries, developed an emergency plan to interrupt the transmission of poliovirus. The plan included the introduction or scale-up of various new innovations and strategies, which had substantial financial implication.

Methods: This is a retrospective study to document the intensified resource mobilization efforts made by the World Health Organization (WHO) in Nigeria to meet the increased financial requirements and bridge the remaining gap in funding. In addition to the established coordination platforms, the WHO Nigeria Country Office team directly engaged with national authorities, donors, and partners throughout the process of resource requirement analysis, project appraisals, proposal development, and implementation of activities, joint monitoring, and evaluation exercises. The office strengthened its capacity for direct funds disbursement and systematic implementation of a rigorous accountability framework.

Results: Between 2008 and May 2015, $538 million was mobilized locally, of which 82% was mobilized since 2012. The percentage of the total funding requirements that were locally mobilized averaged 31% between 2008 and 2011 and increased to 70% between 2012 and May 2015. During the same period, the WHO Nigeria Country Office team produced and submitted 102 grant reports and facilitated >20 joint project assessment exercises.

Discussion: The polio program in Nigeria has achieved unprecedented gains, despite prevailing security and operational challenges, with no case of wild poliovirus infection since July 2014. Through rigorous, transparent, and accountable funds management practice, the WHO country office in Nigeria gained donors' confidence. The locally mobilized funds have made a remarkable contribution to the successful implementation of the strategies set out in the polio emergency plan. We face the challenges of a narrow donor-base, donor fatigue, and competition among other emerging agencies joining the polio eradication initiative efforts over the last few years. We actively engage the national authorities and partners for effective coordination of the polio eradication initiative program and harmonization of resources, using the existing platforms at national, state, and local levels. We recommend strengthening the local resource mobilization machinery and broadening the donor base, to support the polio endgame strategy. Such efforts should also be adopted to support routine immunization, introduction of new vaccines, and strengthening of health systems in the country as part of polio legacy planning.

Keywords: Nigeria; World Health Organization; donor relations; financial resources requirements; polio eradication initiative; polio legacy; resource mobilization.

Figure 1.

Resource mobilization and management coordination matrix for polio eradication activities in Nigeria. The direct disbursement mechanism (DDM) is a system put in place by the World Health Organization (WHO) in 2004 to disburse funds to the field level for supplementary immunization activities (SIAs) and to provide direct payment to several thousand vaccination personnel engaged at the grassroots level during every SIA round. Imprest is an internal WHO financial system used to electronically produce payment vouchers and financial reconciliations. It is installed at a central location and 37 field offices and is monitored online. Abbreviations: FRR, financial resource requirements; ICC, Inter-Agency Coordinating Committee; LGA, local government authority.

Figure 2.

Amount (left) and source (right) of funds mobilized locally to support polio eradication in Nigeria through World Health Organization systems, 2008–May 2015. Data are from World Health Organization internal records and donor agreements. Abbreviations: BMGF, Bill and Melinda Gates Foundation; EC, European Commission; FGoN, Federal Government of Nigeria; NPHCDA, National Primary Health Care Development Agency; USAID, US Agency for International Development.

Figure 3.

Funds mobilized locally in relation to the overall funding requirement under World Health Organization (WHO)–Nigeria's responsibility and the gap in funding covered by international sources, 2018–May 2015. The green arrow denotes the time at which a number of new innovative strategies were implemented to increase locally mobilized support. Data are from WHO internal records, Global Polio Eradication Initiative financial resources requirements for 2008–2015, and donor agreements.