title: World Health Organization's Innovative Direct Disbursement Mechanism for Payment of Grassroots Immunization Personnel and Operations in Nigeria: 2004-2015.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Yared G
authors.initials: YG
authors.lastname: Yehualashet
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Alieu
authors.initials: A
authors.lastname: Wadda
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Koffi B
authors.initials: KB
authors.lastname: Agblewonu
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Zhema
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Al-Asi A
authors.initials: AA
authors.lastname: Ibrahim
authors.affiliation: World Health Organization, Regional Office for Africa, Brazzaville, Congo.
authors.forename: Alhagie
authors.initials: A
authors.lastname: Corr
authors.affiliation: World Health Organization, Headquarters, Geneva, Switzerland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linkins
authors.affiliation: World Health Organization, Regional Office for Africa, Brazzaville, Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Mkanda
authors.affiliation: World Health Organization, Country Representative Office.
authors.forename: Rui G
authors.initials: RG
authors.lastname: Vaz
authors.affiliation: Global Public Health Solutions, Atlanta, Georgia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nsubuga
authors.affiliation: National Primary Health Care Development Agency, Abuja, Nigeria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ashogbon
mesh_terms: D005381:Financing, Organized; D006282:Health Personnel; D049674:History, 21st Century; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000458:organization & administration; D009549:Nigeria / Q000453:epidemiology; D011051:Poliomyelitis / Q000453:epidemiology* / Q000266:history / Q000517:prevention & control*; D000078329:Workforce; D014944:World Health Organization
keywords: WHO Nigeria; direct disbursement mechanism; mobile payment; polio funds management; supplementary immunization activities; vaccination personnel payments