Step 4: Budget Sustainability
During this campaign step, you will assess program impact, budget needs for the next budget cycle, potential new sources of funding, and build demand for epidemic preparedness financing sustainability.
Inefficient disbursement of resources is a frequent challenge to budget sustainability. To support budget sustainability, advocacy must be continuous along the four steps of the framework and extend beyond one budget cycle to ensure program funding is efficiently utilized and sustained in the medium and long terms. If new funding is not disbursed and effectively used, the goal of epidemic preparedness will not be achieved, and the funding stream will likely not be sustained. Increased budget allocations are a vital, but only an initial step toward sustainable financing for epidemic preparedness.
An evaluation of program improvement supported by concrete metrics—such as a higher Joint External Evaluation (JEE) ReadyScore, increases in 7-1-7 response timeliness and/or return-on-investment assessments—will inform advocacy in the next budget cycle and make the case for increasing and sustaining allocated resources in subsequent budget cycles.
Country Examples
Nigeria: The Nigeria Centre for Disease Control (NCDC), the coordinating agency responsible for the prevention, detection, and response to infectious diseases, documented how new funding received through the federal government’s Basic Health Care Provision Fund (BHCPF) was used to improve the country’s health security. Advocates used the report to support retaining and increasing funding through annual budget allocations and the BHCPF. GHAI worked closely with lawmakers, key gatekeepers in the government, media and civil society (particularly the Health Sector Reform Coalition) to support the advocacy and ensure continued funding for NCDC through the BHCPF.
At the national level and in Kano, GHAI and its partners assessed the campaign’s experience and lessons learned from the previous budget cycle to inform advocacy into the next budget cycle. Drawing on relationships with the government and civil society, the campaign identified new policy approaches to finance health security beyond increasing and sustaining current budget allocations. For example, GHAI and its partners, Nigeria Health Watch, LISDEL and BudgIT, supported NCDC’s convening of National Action Plan for Health Security (NAPHS) focal ministries, departments, and agencies (MDAs) to coordinate budget submissions to the Ministry of Finance. The budget submissions resulted in N 1.61 billion (US$3.9 million) in funding for NAPHS focal point MDAs in fiscal year 2022, of which N 1.46 billion (US$3.5 million) was new funding, close to a 90 percent increase for health security functions in one year. In Kano, GHAI identified a potential new source of funding for health security through the Kano State Health Trust Fund (KHETFUND) - a funding stream separate from the epidemic preparedness and response budget. In addition, a proposed Kano State Health Security Fund with multiple revenue sources will contribute to the sustainability of funding dedicated to epidemic preparedness and response at the state level.
Download case study: Epidemic Preparedness in Nigeria: Making the Case for Increased Federal, State and Local Investments