Buying Down Polio (Partnerships Series No. 2)

By partnering with the World Bank in an innovative way, Rotary has successfully leveraged  its funding for polio eradication, contributing to success towards one year without polio in Nigeria and in Africa. This post, the second in a series on partnerships, innovation, and evaluation, explains how the innovative polio buy-down mechanism has worked.

PIC 3. FROM LEFT: PRESIDENT MUHAMMADU BUHARI VACCINATING HIS THREE MONTHS OLD GRAND-DAUGHTER, ZULEIHA BELLO ABUBAKAR WITH ORAL POLIO VACCINE TO MARK ONE YEAR OF FREE POLIO CASE IN NIGERIA AT THE PRESIDENTIAL VILLA ABUJA ON SATURDAY (25/7/15). WITH HIM ARE: EXECUTIVE DIRECTOR, NATIONAL PRIMARY HEALTH CARE DEVELOPMENT AGENCY (NPHCDA) DR ADO MUHAMMAD AND THE INCIDENT MANAGER, POLIO EMERGENCY OPERATION ABUJA CENTRE, DR ANDREW ETSANO 028/JULY2015/ICE/STATE-HOUSE
Nigeria’s President vaccinates his granddaughter – Photo courtesy of Dr. Etsano.

Last month, Africa achieved a key milestone towards polio eradication, with no case of polio observed for a full year. It will still take a few weeks for the World Health Organization to officially certify this milestone, and for the region to be declared polio-free, no polio cases should be observed for a period of three years. Still, tremendous progress towards polio eradication has been accomplished. Just a few years ago, hundreds of cases of polio were observed annually in Nigeria. The country achieved its first full year without polio on July 24, 2015. This will leave only Afghanistan and Pakistan on the list of polio-endemic countries.

As noted in a recent post on the World Bank health blog, achieving one year without polio in Nigeria required persistence and courage. In some areas, professionals and volunteers who led the polio campaigns risked their life: Boko Haram assassinated nine polio vaccinators two years ago in the north of the country. Vaccinators had to rely on “hit and run” tactics to reduce exposure to risk, vaccinating children quickly in the morning and leaving the area by the afternoon. (For an understanding of the role of a wide range of people at the heart of polio eradication (in the case of Afghanistan), see the great slide show provided by the Global Polio Eradication Initiative.)

The polio campaigns also required great effort and creativity from multiple agencies, including through an innovative buy-down mechanism implemented by the World Bank and funded by the Bill and Melinda Gates Foundation, as well as Rotary International and the U.S. Centers for Disease Control via the U.N. Foundation. (The Gates Foundation and Rotary International are the two largest donors worldwide towards polio eradication over the last 30 years.) Partnership with the government of Nigeria, the World Health Organization (WHO), and UNICEF, among others, was also crucial to the success of the campaigns.

How did the polio buy-down mechanism work? The basic idea was for the World Bank to fund polio eradication projects through concessional IDA (International Development Association) loans. In the case of Nigeria, two projects worth $285 million, including additional financing, were implemented over the last dozen years. The projects included clauses that allowed loans to Nigeria to become grants if the country achieved a high level of polio immunization coverage. In other words, if the immunization targets indicated in the loans were achieved and verified independently through in-depth audits, the government would receive grant funding for polio eradication without the need to repay the loans.

For the government of Nigeria, this was potentially a great deal. And for the Gates Foundation and the Rotary Foundation of Rotary International, this was also a pretty good investment. In general, investments towards polio eradication have been shown to be fairly cost-effective. But with the buy-down mechanism, these investments were especially cost-effective.

Due to the concessional nature of IDA loans (long-term zero or low-interest loans which grace repayment periods), for every dollar contributed to the buy-down, the actual amount of resources that could be transferred to the government for the polio campaigns was two times larger. The buy-down funds were transferred by the Gates Foundation and Rotary International (in the case of Rotary in partnership with the United Nations Foundation) to the World Bank at the start of the project, and used to repay the loan at the end of the project if the target immunization rates had been achieved.

Through this buy-down mechanism, the Gates Foundation and Rotary International were able to offset all future loan repayment obligations with a much smaller amount of funding to pay back IDA than the face value of the loans granted to Nigeria. Again, one dollar invested by these private donors generated about $2 for polio eradication in Nigeria, with a similar mechanism in place for Pakistan. The mechanism also had built-in incentives to encourage strong implementation performance by the government of Nigeria since the loans would be transformed into grants only if the specific immunization targets were to be achieved.

At the time of the first buy-down mechanism for polio, then-World Bank President James. D. Wolfensohn stated, “The partnership to buy-down loans to grants on the basis of good performance is an example of the innovative thinking occurring in the private sector and the World Bank about how to increase finances for the fight against global diseases. This financial innovation is bringing the goal of a polio-free world one large step closer to becoming reality.”

Could similar buy-down mechanisms be applied in other areas? That was probably the hope when this innovative mechanism was created for polio a dozen years ago. It seems however that with few exceptions the idea has not yet been replicated much in other development areas, even if it has been mentioned in a number of reports, including in a Results for Development report on education.

A number of conditions have to be met for this type of buy-down mechanism to be successful. But in the case of polio, it has been successful, enabling the Gates Foundations, individual Rotarian donors through the Rotary Foundation, the United Nations Foundation, and the World Bank to achieve higher impact towards polio eradication than would have been the case otherwise.

A brief on polio in Africa and the buy-down mechanism is available here.

This post is reproduced with minor changes from a post published by the author on September 2, 2015 on the World Bank’s Financing for Development blog at http://www.fin4dev.org/.

Partnerships, Innovation, and Evaluation, 1: Introduction

This post is the first in a series on increasing the impact of Rotary. The series will feature case studies of great service projects that have achieved larger impact through partnerships, innovation, and evaluation. The hope is that the case studies will encourage clubs and districts to think bigger in their service work.  The series will cover each of the areas of focus of the Rotary Foundation, as well as polio.

Service work through volunteering or projects is at the heart of what Rotary is all about. Membership surveys suggest that the main reason why members join and remain in Rotary is the opportunity to serve (see my recent book on Rotary). Fellowship and networking are also very important, but service is first.

Rotary is a fairly decentralized organization with at its core the Rotary club. Rotarians come in many shapes and forms, beliefs and passions. There is amazing diversity in the types of service work that Rotarians engage in. This is a strength as members choose to contribute to the causes they are most passionate about.

Most of the service work that Rotarians engage in is done through volunteering, not through service projects that benefit from financial support from the Rotary Foundation (TRF). In adition, many projects implemented with TRF support are small and based on local opportunities identified by clubs. These projects may not rely on partnerships, they may not be especially innovative, and they may not be evaluated in depth. As long as it is clear to clubs and local communities that the projects are helpful, a lack of partnership, innovation or evaluation is not necessarily a major drawback. One straitjacket does not fit all in Rotary.

At the same time however, if Rotary is to have a larger impact globally, there is also a need to put together more and larger projects that do rely on partnerships, are innovative, and are monitored and evaluated properly.

Partnerships help to implement larger projects and benefit from the expertise of organizations that are among the best in their field. Partnerships may also generate visibility and media coverage for Rotary (polio is the best example). Partnerships have a cost since effort is required for collaborations to work. But if partnerships deliver scale, expertise, or visibility, gains outweigh the costs.

Innovation is even more important than partnerships to achieve larger impact and discover better ways to serve communities. Without innovation, the contribution of TRF is a drop in the development assistance bucket. TRF does have a respectable size, but in comparison to development funding, it is very small.

Total annual giving by the foundation represents less than half a percent of what the World Bank provides in development assistance every year, and this is just one of a number of development agencies. But if Rotary experiments and innovates, pilots that prove successful can be scaled up by other organizations with deeper pockets, thereby achieving larger impact.

Without serious monitoring and evaluation, innovation does not help much because impact on the ground must first be demonstrated at the pilot stage for a promising intervention to be scaled up. Innovation and evaluation are like twins: they work best as a pair. Evaluation is also needed for Rotary to learn internally from both successes and mistakes.

All three ingredients ̶ partnerships, innovation, and evaluation, can help increase the impact of Rotary’s service work. In order to encourage clubs and districts to move in that direction, this series will show how partnerships, innovation, and evaluation can be harnessed to serve Rotary’s mission of service above self.

The series will tell the story of projects in each of the areas of focus of TRF: promoting peace, fighting disease, providing clean water, saving mothers and children, supporting education, growing local economies, and eradicating polio.

You will learn about an innovative financing mechanism for polio eradication; an award winning project reducing under five mortality in Mali; a program that is transforming teaching and learning in Nepali classrooms; a project to save the life of mothers and children in Nigeria; a program to invest in the writing skills of disadvantaged youth in the United States; projects and initiatives to improve access to water and sanitation in Uganda; and the work done by Rotary with Peace Centers.

All these projects are in one way or another innovative. They all leverage partnerships. And virtually all build on solid monitoring and evaluation mechanisms. Hopefully, the series will give you additional insights into some of the great projects that clubs and districts are implementing around the world.

Please do not hesitate to send me an email through the Contact Me page of this blog if you believe other projects should be featured (perhaps in another series), and feel free to post comments on the projects that you find particularly inspiring.