TERMS OF REFERENCE (TORS) FOR IMMUNIZATION FINANCING ANALYSIS AND DEVELOPMENT OF A DOMESTIC RESOURCE MOBILIZATION (DRM) STRATEGY FOR SUSTAINABLE IMMUNIZATION FINANCING IN SIERRA LEONE.
- INTRODUCTION
Sierra Leone faces critical challenges in financing for immunization and primary healthcare, resulting in inadequate coverage and health disparities. Despite efforts, many children—especially zero-dose children—remain unvaccinated due to insufficient domestic resource mobilization and utilization. The health system is hampered by limited financing, heavy reliance on donor funds, delayed fund transfers, and weak coordination. In 2024, the immunization budget dropped from 0.3% to 0.2% [Ministry of Finance – Budget Profile] of the Ministry of Health’s allocation, further straining resources. Coupled with disbursement delays, these issues disproportionately impact vulnerable populations, particularly in remote and underserved areas, undermining Universal Health Coverage goals. Implemented in Sierra Leone by Health Alert and WASHNet, this project aims to increase domestic resource mobilization and enhance transparency and accountability in immunization and primary healthcare financing across all five regions of Sierra Leone, reaching six key districts (Kailahun in the Eastern Region, Moyamba in the Southern Region, Bombali and Tonkolili in the Northern Region, Port Loko in the North-West Region, and the Western Rural Region). Targeted stakeholders include national and district-level government officials, healthcare providers, CSOs, community leaders, and the media. The goal is to secure sustained financing—through new domestic resources and efficient use of domestic and Gavi funds—to reach zero-dose children and improve public expenditure tracking. Through strategic advocacy, capacity strengthening, and public awareness, the project seeks to influence policy changes, enhance the timely flow of funds, and ensure the introduction and co-financing of new vaccines. Two Joint Learning Agenda (JLA) partners, Health Alert and WASHNet, will drive efforts to strengthen accountability at national and sub-national levels, thereby increasing immunization coverage and reducing the number of zero-dose children.
- ASSIGNMENT OBJECTIVE
In the context of the ongoing challenges posed by the pandemics, climate change, and rapid scientific innovations, Gavi-eligible countries like Sierra Leone are facing increasing needs to finance national immunization strategies. With full coverage of traditional vaccines, the introduction of new vaccines, and the gradual withdrawal of Gavi support, it is imperative for countries to take ownership of their immunization financing. These Terms of Reference (ToRs) aim to provide decision-makers with strategic options for domestic resource mobilization (DRM) to guarantee secure, sustainable, and easily accessible financing for immunization in Sierra Leone.
- SPECIFIC OBJECTIVES
The study will aim to:
- Analyze (a) the context and perspective of immunization in Sierra Leone; (b) the costs of immunization; and (c) the financing of immunization, including identifying the financing gap.
- Develop a comprehensive Domestic Resource Mobilization (DRM) strategy for immunization based on evidence from the analytical study.
4. SCOPE OF WORK
4.1. Context Analysis and Perspective of Immunization in Sierra Leone
- Macroeconomic Impact: Assess the impact of the macroeconomic context on the health sector and the immunization system. Analyze whether economic growth projections (2025–2030) could translate into an increased state budget, and whether targeted advocacy might secure enhanced health and immunization funding.
- Government Commitment: Evaluate the government’s commitment to immunization by examining recent finance laws (2021–2024) with focus on total state budget, health budget allocation, the proportion allocated specifically to immunization, and public spending per surviving child.
- Future Prospects and Challenges: Analyze the prospects for routine vaccination (2025–2030) and identify new challenges, such as the introduction of new vaccines, increased Gavi co-financing, and potential Gavi phase-out.
4.2. Cost Analysis of Immunization in Sierra Leone
- Define the base of calculation and review the national vaccination calendar.
- Break down the total costs of vaccination by expenditure categories (investment vs. recurrent costs).
- Determine the distribution of these costs, calculate the cost per fully immunized child (FIC), and analyze the evolution of FIC-related expenses between 2025 and 2030.
4.3. Financing Immunization in Sierra Leone
- Examine, for the period 2025–2030, the sources of financing using trends from the 2021–2023 finance laws.
- Estimate the total probable/available funding versus the total funding required, and identify the financing gap.
4.4. Proposed DRM Strategy for Sustainable Immunization Financing
- Assess the weaknesses and strengths of the current immunization financing system, as well as the opportunities and threats affecting domestic resource mobilization.
- Define a clear vision, objectives, and key principles for mobilizing domestic resources for immunization.
- Develop strategic options for mobilizing resources from various sources (government, private sector, decentralized local authorities, etc.) and formulate an action plan for each option, including cost estimates and potential partnerships.
5. STUDY DELIVERABLES
- Analytical Report: A comprehensive analysis of immunization financing in Sierra Leone.
- DRM Strategy Document: A detailed strategy for sustainable immunization financing.
- Executive Summary: A concise summary of the DRM strategy.
- Advocacy Brief: A brief note for key decision-makers outlining strategic recommendations.
6. CONSULTANT PROFILE
The consultant should possess:
- A master’s degree in Economics, Health Economics, Public Health, or a related field.
- At least 5 years of relevant experience in health financing, public health expenditure reviews, and/or health budget advocacy.
- Proven expertise in health budget preparation and the costing of vaccination programs.
- (Knowledge of the WHO One Health tool is desirable but not mandatory.)
- Excellent analytical, research, and report-writing skills, with the ability to engage diverse stakeholders in Sierra Leone.
7. PAYMENT TERMS AND SUBMISSION REQUIREMENTS
Payments will be milestone-based, aligned with the delivery and approval of key outputs as per the agreed work plan. Interested consultants should submit a detailed proposal, including a work plan, budget and CV by 21st February 2025 to Health Alert, #1 Blachhall Road, Freetown, Sierra Leone. Submit to healthalertsl@gmail.com with a copy to info@wash-net.org.
