GAVI supports countries in identifying and tackling the weak links in health systems that obstruct delivery of vaccines to the people who need them
Vaccines are one of the most effective and cost-efficient means to save lives, improve child health and advance towards the Millennium Development Goals for child and maternal mortality. But fulfilling that potential depends on the ability of health systems to deliver vaccines where, and on the scale, they are needed.
Service delivery in many low-income countries suffers from a lack of, or inability to retain, trained health workers, gaps in the cold chain or weaknesses in health system management.
GAVI's value added
GAVI strategy: the health systems goal
GAVI's commitment to making developing countries' health systems more effective in delivering vaccines to even the most remote district is enshrined in the second goal of its 2011-2015 strategy. This sets out three objectives: contibute to resolving constraints in delivering immunisation; increase equity in access to services (including gender equity); and, strengthen civil society engagement in the health sector.
GAVI allocates approximately 15% of its total funding support to cash-based programmes designed to encourage countries to strengthen immunisation delivery.
Tackling institutional barriers
Progress in immunisation delivery has often been impeded by broader health system constraints ranging from the poor distribution and motivation of health workers to a lack of adequate infrastructure and poor management of services.
GAVI has therefore provided health system strengthening support (HSS) to enable countries to tackle institutional barriers holding back progress. In line with the "country ownership" principle of GAVI's business model, countries design programmes to address what they see as their real needs rather than problems identified externally. This also ensures that programmes are aligned with national policies.
Countries mainly use HSS funding to deliver immunisation and maternal and child health (MCH) services, sometimes in selected districts. Examples of HSS support include:
- training nurses to administer the two shots and an oral dose required for pneumococcal vaccine;
- giving expert health workers incentives to stop them leaving for other jobs;
- ensuring there are sufficient carrying dispensaries (polysterene cool boxes) to maintain the cold chain for delivering vaccines from central to district level;
- increasing the number of incinerators to dispose of waste;
- conducting laboratory surveillance to monitor the impact of vaccinations.
Partnering other multilateral agencies
HSS objectives are shared by other multilateral agencies, and, in 2009, GAVI joined the Health Systems Funding Platform with the Global Fund to Fight HIV/AIDS, Malaria and TB and the World Bank, with support from WHO, to improve coordination in health system strengthening and to leverage additional funds for countries in need.
CSOs are frequently the backbone of developing countries' health systems, delivering up to 60% of immunisation services; the Alliance's funding support is designed to encourages CSO engagement in the national planning and implementation process.