Putting countries in charge

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From applying for funding to co-financing cost of vaccines, GAVI emphasises country ownership of immunisation programmes

Business challenge

Putting countries in charge

Developing country governments have long provided childhood immunisations as part of their national health services.

Yet, prior to GAVI, international aid programmes were project-based and short-term with external development agencies and donors setting the agenda.

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GAVI's value-added

GAVI's business model is built on the principle that countries and their local partners are best placed to run immunisation programmes and manage their own roll-outs:

  • Governments define their funding priorities/activities per programme support;
  • GAVI funds are channelled through existing government systems;
  • Governments report back on performance through Annual Progress Reports (APRs).

To avoid duplicating roles and tap into existing systems, GAVI immunisation initiatives work within the framework of overall national health service goals and objectives, and are carefully coordinated with both local agencies and other international aid sources.

Applying for support

Each year, the GAVI Secretariat, based in Geneva, announces 'funding windows' within which low-income countries are invited to apply for different types of programme support.

To ensure GAVI support focuses on the world's poorest countries, only countries meeting GAVI's official eligibility criteria can apply.

Proposals are submitted to the Alliance before an Independent Review Committee (IRC) composed of Alliance members, makes its final recommendations. The GAVI Alliance Board must approve the recommendations before funds can be disbursed.

With GAVI support spanning several years, countries are obliged to submit annual reports so the Secretariat can monitor progress.

1. Country-initiated proposals

Under the Alliance's funding mechanism, developing countries take the lead in initiating proposals for GAVI funding, choosing what support to apply for and when.

Governments are invited to take advantage of 'funding windows' by applying for different types of programme support:

Countries submit their funding proposals to the Secretariat before an Independent Review Committee (IRC) composed of Alliance members, makes its final recommendations to the GAVI Alliance Board. With GAVI support spanning several years, countries are obliged to submit annual reports so the Secretariat can monitor their progress.

2. Integration with national health plans

Countries must demonstrate that their funding proposals are integrated into the broader framework of their long-term health plans by submitting a comprehensive multi-year plan (cMYP) for immunisation. The cMYP forces health and finance ministries to work together on a single strategic approach to funding and determine which health sector interventions to prioritise.

To ensure that GAVI support meets countries' own priorities, support is committed for the duration of national health and immunisation plans.

3. Coodination with countries' development partners

As a condition for receiving support, GAVI-eligible countries must set-up an Interagency Coordination Committee (ICC), which brings together WHO and UNICEF as well as civil society organisations.

This is where GAVI's unique model is able to draw on the technical skills of its individual partners already in the field:

  • WHO's immunisation experts work closely with health ministries, to do due diligence on countries' vaccine needs, ensure that applications are based on evidence-based decisions and monitor results.
  • UNICEF's global vaccine procurement facility and widespread presence in developing countries helps applicants ensure that the right vaccines reach the right people in the right place.

The ICC is chaired by the local health ministry. GAVI requires ICC signatures on applications for NVS and ISS, as well as annual progress reports.

4. Country ownership

In another example of how the GAVI model encourages country ownership, the Alliance invites countries to propose their own solutions for improving the ability of health systems to deliver vaccines where and to the extent they are needed. This can range from funding healthcare training to providing support for sophisticate mobile telephone networks that monitor stocks.

GAVI then offers cash support for countries to implement the fixes. GAVI does not dictate how governments should spend the money as long as improved performance goals for immunisation coverage are met: more children reached, more lives saved.

5. Co-financing

GAVI has pioneered a co-financing model which requires that recipient countries contribute towards the cost of the vaccine.

Co-financing is a key pillar of putting countries in charge as it ensures their commitment to the long-term sustainability of immunisation programmes.

More on this topic

168 million

GAVI-supported vaccine campaigns have resulted in 100 million individuals being immunised against meningitis A and 68 million against yellow fever since 2000.

Meningitis A Conjugate Vaccine Immunizaton Campaign. Joint WHO/UNICEF 2011 Progress Report: January to December 2012. March 2013, p.3 | 2011 data. Yellow Fever Initiative. Joint WHO and UNICEF 2011 Progress Report Nov 2012, p.13, 15. 2012 data: Based on data from Epidemiology of Yellow Fever in the African Region: 2012 report. WHO Regional Office for Africa. April 2013, p.6.

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