Chapter 4: Polio Eradication: the final challenge
Finding the funds
Sabin's vision of a world without polio required reaching all children with multiple doses of OPV, which in turn required substantial financial resources and in-kind contributions from national and international sources. To mobilize and manage resources on this scale, the polio partnership established a mix of strategies and mechanisms. The success of this approach is reflected in the mobilization of more than US$ 5 billion in funding and in-kind contributions for polio eradication activities, over a 20-year period (8). While the majority of these funds went to time-limited eradication activities, a substantial proportion was directed to the strengthening of routine immunization and surveillance services.
In any given country, the proportion of costs covered by national and international sources has correlated most closely with income level and health system capacity. China, for example, has estimated that over 95% of its costs were borne by the country itself. Even in the poorest countries with virtually non-existent formal health services, such as Somalia, the community absorbs 25--50% of the real costs of implementing polio NIDs through in-kind contributions. Because of the diversity of the communities, governments and partners that have contributed to the implementation of polio activities, it is impossible to quantify accurately the value of all financial and in-kind expenditures. Of the over US$ 5 billion that will have been spent on the initiative, however, a conservative estimate based on the time of volunteers and health workers during NIDs -- the most labour-intensive of the strategies -- suggests that polio-endemic countries will have contributed at least US$ 2.35 billion in volunteer time alone between 1988 and 2005 (8) Additional public and private sector resources from the national, state, province, district and local community levels paid for petrol, social mobilization, training and other costs.
External sources will have provided at least US$ 3 billion to help endemic countries cover polio eradication costs. Of the more than 100 external donors to date, 26 will have contributed more than US$ 1 million over the lifespan of the initiative and 12 at least US$ 25 million (see Figure 4.2). A particular strength of the polio initiative has been its strong partnership with a number of non-traditional donors of development aid, most notably Rotary International (see Box 4.3). The country-level budgeting and resource management processes, combined with centralized tracking of resource requirements and funding flows, have allowed the programme to accommodate the needs of donors and recipient countries while improving the efficient use of available financing. Despite their limited infrastructure, many low-income and lower-middle-income countries have clearly demonstrated a tremendous absorptive capacity for health resources, which can rapidly achieve real health outcomes.
Box 4.3 A public--private partnership for polio eradication
Rotary International is one of the four spearheading partners of the Global Polio Eradication Initiative, having endorsed the concept of a global effort even before the World Health Assembly resolution of 1988. In 1985, Rotary pledged its commitment to the international health goal of a "polio-free world" by the time of its centenary in 2005.
In endemic areas, Rotarians -- from more than 160 countries -- have volunteered their time to help ministries of health with every aspect of the programme, including polio vaccine delivery, health worker transport, provision of critical equipment, and community mobilization. In polio-free countries, Rotarians have continuously raised the profile and importance of polio eradication through advocacy and public information campaigns.
Rotary International has provided financial support to polio eradication on an unprecedented scale. By 2005, Rotary's direct financing will have reached over US$ 500 million since 1988, 20% of the total external financing for the entire initiative. In addition, Rotary has been at the centre of the multi-agency advocacy effort that has mobilized US$ 2.4 million in further external funding from donor governments, foundations, development banks and the private sector.
Rotary International has campaigned with key political leaders of both endemic and polio-free countries to ensure their active participation in the programme. This regular, high-level advocacy by a private sector partner has kept polio eradication high on the global agenda, despite many competing priorities
Although the coordinated international advocacy and resource management of this initiative have been very successful, the most striking aspect of the financing for polio eradication has been the substantial contribution of endemic countries and communities themselves to ensuring that their children share fully in the global vision of a world without polio.