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World Health Organization´s Innovative Direct Disbursement Mechanism for Payment of Grassroots Immunization Personnel and Operations in Nigeria: 2004–2015

Sunday, 6th of March 2016

Field operations suffer when vaccinators are not paid. In Nigeria, WHO funds were channeled through private banks, rather than the government, to assure that the right payment went to the right person. In 2012, I watched hundreds of happy vaccinators line up at a community center in Lagos to show their IDs and claim their payments. Are there any other countries where such mechanisms would be useful?

World Health Organization´s Innovative Direct Disbursement Mechanism for Payment of Grassroots Immunization Personnel and Operations in Nigeria: 2004–2015

1. 1.        Yared G. Yehualashet1, 
2. 2.        Alieu Wadda1, 
3. 3.        Koffi B. Agblewonu1, 
4. 4.        Theophilus Zhema1,
5. 5.        Al-asi A. Ibrahim1, 
6. 6.        Alhagie Corr3, 
7. 7.        Jennifer Linkins5, 
8. 8.        Pascal Mkanda3, 
9. 9.        Rui G. Vaz1,
10. 10.     Peter Nsubuga4 and 
11. 11.     Daniel Ashogbon2

+Author Affiliations

1.        ¹World Health Organization, Country Representative Office

2.        ²National Primary Health Care Development Agency, Abuja, Nigeria

3.        ³World Health Organization, Regional Office for Africa, Brazzaville, Congo

4.        ⁴Global Public Health Solutions, Atlanta, Georgia

5.        ⁵World Health Organization, Headquarters, Geneva, Switzerland

1. Correspondence: Y. G. Yehualashet, World Health Organization, Nigeria Country Office, Abuja (yehualashety@who.int).

 

Abstract below. Full text is at http://jid.oxfordjournals.org/content/early/2016/02/21/infdis.jiv485.full?sid=5bde244d-23b9-48c1-bb79-95f324f6fe2e

Background. Following the 1988 World Health Assembly resolution to eradicate polio, the government of Nigeria, with support from partners, has been implementing several rounds of supplementary immunization activities (SIAs) each year. In addition to the technical requirements, the success of the polio eradication initiative depends on timely provision of adequate financial resources. Disbursement of funds for SIAs and payment of allowances to numerous vaccination personnel at the grassroots level are enormous operational challenges in a country the size of Nigeria. Upon donors´ request for a transparent and effective payment mechanism, the World Health Organization (WHO), in consultation with national counterparts, created the innovative direct disbursement mechanism (DDM) in 2004. The objective of the DDM was to timely deploy operational funds at the field level and directly pay vaccination personnel allowances at the grassroots level.

 

Methods. A detailed operational guideline for funds disbursement was developed in close consultation with central and field stakeholders. Multiyear financial resource requirements and operational budgets for every campaign were produced by an interagency-coordinated finance subcommittee. The WHO engaged a bank and an accounting firm as DDM partners to support disbursement of and accounting for the SIA funds, respectively. The 37 WHO field offices were equipped with electronic financial systems to support the DDM process, and temporary payment sites were set up to facilitate payment to vaccination personnel at the grassroots level. Coordination meetings among DDM partners were held regularly to reconcile financial records and address operational challenges.

 

Results. Between 2004 and 2014, DDM supported 99 polio and nonpolio vaccination campaigns, disbursing more than $370 million to about 16 million beneficiaries across 280 temporary payment sites. To mitigate security risks and reduce operational costs, the WHO and DDM partners introduced mobile payment to vaccination personnel in May 2015 in compliance with national regulations. A total of 97% of the targeted 1871 beneficiaries in 2 pilot sites were successfully paid through mobile payment, although some challenges remain to be addressed.

Discussion. The DDM has met its objectives with a high rate of financial accountability and transparency, despite persistent operational and security challenges. With support from Nigeria, the Pakistan polio vaccination program successfully adopted the DDM. The DDM continues to play an important role in effective implementation of the polio endgame strategy and the national immunization strategic plan. As part of polio legacy planning, we recommend the DDM as a model for other opportunities that involve the engagement of large field-level teams as new vaccines are introduced in Nigeria and elsewhere.

 

• © 2016 World Health Organization; licensee Oxford Journals.

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