GAVI supports countries in identifying and tackling the weak links in health systems that obstruct delivery of vaccines to the people who need them
Business challenge
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 goalGAVI'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. This support flows through three main channels:
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.
CSOs are frequently the backbone of developing countries' health systems, deliveirng up to 60% of immunisation services; the Alliance's funding support is designed to encourages CSO engagement in the national planning and implementation process.
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.
Equity in access to vaccines
In 2000, GAVI pioneered possibly the world's first truly performance-based programme, to improve immunisation coverage rates in the world's poorest countries.
How ISS worksThrough ISS, GAVI makes an upfront investment in a country's immunisation services, disbursed as a cash grant over a three year period. Thereafter, countries are eligible to receive US$ 20 for each additional child they reach with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine, as compared to the previous year's target. GAVI is currently exploring results-based financing approaches to address the particular needs of countries where immunisation covers less than 70% of the population. Drawing on the experience in designing and delivering ISS, this initiative would provide financial incentives to broaden coverage to sub-national/district levels. |
ISS provides flexible funding that countries can use to improve immunisation services delivery, according to their own national immunisation plan. Countries have complete control over how and when to use their ISS funding with one condition: that the number of children reached by the basic vaccines against diphtheria-tetanus-pertussis (DTP3) continues to rise.
ISS relies upon the technical support of key GAVI partners in each country. The interagency coordinating committee (ICC), which brings together WHO and UNICEF as well as civil society organisations and is chaired by the local health ministry, helps applying countries develop ISS proposals and reports to ensure funds are put to best use
Countries eligible for ISS receive funding for a three-year investment phase and subsequent payments are subject to achieving performance benchmarks. A 2008 assessment of ISS found it had helped to improve immunisation coverage in 62 countries from an average of 65% to 78%.
According to GAVI's Second evaluation (2010), "ISS is highly valued by countries as being the only source of donor funding to expand routine immunisation coverage to the unreached."
