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22nd Joint GAVI Alliance & Fund Board meeting
25 & 26 June | Geneva, Switzerland

25 & 26 June

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1. Executive Secretary/CEO report, including financial forecast

Julian Lob-Levyt, GAVI Alliance Executive Secretary and GAVI Fund CEO, presented his report. Discussion followed:

  • Very few organisations like GAVI are able to provide financial projections that extend beyond two or three years in the future. GAVI’s projections, which carry through to 2015, allow decision making on medium to long-term investments with a fair degree of certainty, and help identify future financing gaps. The current forecast indicates that, assuming donor contributions continue to grow, GAVI is in a strong position to expand its vaccine portfolio, but the Alliance will need to maintain and augment existing donor contributions both now and as it approaches 2015. Beyond 2015, projections become increasingly difficult to model. Future sustainability of new vaccines will also rely on countries’ ability to mobilise resources and close this gap.
  • Although GAVI is beginning to reach beyond its traditional donor portfolio by engaging countries like South Africa, Mexico and Japan, GAVI should work to expand its support from countries in Asia and the Middle East, recognising that this will require significant staff time.
  • As GAVI begins to introduce new vaccines, it is important to recognise that vaccine pricing and affordability may represent a limiting factor for countries. GAVI has been successful in encouraging emerging vaccine manufacturers to enter the market, as evidenced by the case of pentavalent vaccine. If GAVI repeats this success with future vaccines, it may in time help reduce the long-term cost to countries. However it should also be recognised that, given the current inflationary trend and rise in fuel and other commodity costs, the participation of developing country suppliers may not translate directly or quickly into lower vaccine prices.
  • GAVI has consistently focused on making vaccines affordable to the poorest countries, and continues to support the principle of tiered vaccine pricing.
  • Any decision to expand GAVI support to middle-income countries would require substantial board debate, considering the resource implications. GAVI may wish to explore ways that it can support a healthy global vaccine market to the benefit of middle-income countries, without providing direct financing.
  • The recent evaluation of Immunisation Services Support has confirmed the value of flexible, country-driven financing. However, GAVI should consider how it can continue to provide performance-based incentives without encouraging country over-reporting, and ensure that the objectives of ISS are met though its incentive structure. Evidence is beginning to emerge of possible perverse incentive effects. The Executive Secretary/CEO will establish a team with stakeholders to work on this issue.
  • The Alliance will need to apply similar levels of scrutiny to the evaluation of budgets for programme support activities and projects as it does to country applications and Secretariat costs. The Alliance procurement policy, first approved by the Boards in November 2006, should be applied and updated to bring more rigour to decisions on these partner activities. The Executive Secretary/CEO will work with stakeholders to establish an independent peer review process similar to those used for other GAVI programmes.
  • If GAVI is to significantly reduce the number of unimmunised children globally, it will need to develop effective strategies to engage large countries like India, who have the majority of unimmunised children. Success in these countries may not be a question of funding, but rather of focus. GAVI should consider strategies that take a state by state approach, targeting the poorest areas. This will require strong support from partners ranging from multilaterals to civil society organisations.
DocumentsPresentations
2. The GAVI Alliance Gender Policy

Sofia Ostmark, Programme Officer, GAVI Secretariat, presented an overview of the proposed policy. Discussion followed:

  • There is clear evidence of gender-based inequalities in access to immunisation. The Boards voiced their unified support for GAVI’s Gender Policy, stressing that a gender perspective, as part of a rights-based approach to health, should be an integral part of the fabric of GAVI programmes. In order for GAVI to implement this policy effectively, it will require the full support of Secretariat management and board members.
  • GAVI must remain mindful of other factors and discriminatory trends that limit access to immunisation and other vital health services. However, GAVI’s Gender Policy should remain focused so as not to lose its effectiveness.
  • As GAVI develops an implementation plan and timeline for the policy, it should review existing programme investments, such as health systems, and propose improvements.
  • The policy should inform all GAVI decisions from now on including that of board and committee membership, as GAVI’s current governance structures exhibit a gender imbalance. The boards may wish to consider adopting gender targets for future membership.
  • The implementation plan should be ambitious and must contain both progress and impact indicators, but not lose sight of the underlying realities in GAVI eligible countries. Countries may need support to realise the policy in full.
  • The experiences of partners should instruct the development of the Gender Policy implementation plan. The Governments of France and Ghana, as well as UNICEF have offered to share their knowledge and provide feedback on the development of the implementation plan.

DECISIONS

The GAVI Alliance Board:

  1. Adopted the Gender Policy as drafted.
  2. Agreed to conduct an evaluation of the policy in 2012.
  3. Requested that the Secretariat present a full implementation plan, with timelines and cost implications, by the end of 2008.
DocumentsPresentations
3. Vaccine investment strategy

Andrew Jones, Senior Programme Officer, GAVI Secretariat, presented the proposed strategy. Discussion followed:

  • Board members commended the thorough process used to develop the strategy; all constituencies had the opportunity to shape and inform its development.
  • Selection of a vaccine portfolio at this stage reflects a strategic direction rather than a financial approval, and does not represent a decision to invest in any single vaccine. It is important that this is reflected in public pronouncements about the Board’s decision. A costed implementation plan, which will prioritise the vaccines, will be presented to the Boards in October 2008 and will provide the initial basis for financial decisions on future vaccine introduction.
  • The reduce overall disease burden portfolio most closely reflects country preferences, and will allow GAVI to address a range of important priorities including service integration and a gender perspective. Vaccines included in the portfolio will also have latent health and economic benefits, which may only be apparent several years in the future.
  • Certain vaccines within the proposed portfolio like rubella and rabies may pose challenges for implementation. As GAVI begins to consider individual investments, it will be important to conduct a measured and thorough analysis of the potential impact, feasibility and risks implied by each.
  • GAVI should also assess the long-term cost implications for countries, with a view that countries should become increasingly independent of GAVI support.
  • The reduce overall disease burden portfolio matches GAVI’s existing strategy. GAVI’s mission statement (“to save children’s lives and protect people’s health by increasing access to immunisation in poor countries”) was crafted in order to avoid limiting GAVI’s focus to children under five years of age. A child-only vaccine investment strategy would actually significantly narrow GAVI’s focus. GAVI already invests in hepatitis B vaccine, which, although administered in children, helps prevent liver disease and cancer in adults. Furthermore, inclusion of HPV and rubella vaccines will generate due attention to the immunization of adolescents, an age group often neglected in health initiatives.
  • The success of the vaccine investment strategy will rely on continued collaboration with partners like WHO, UNICEF, the World Bank and developing countries, but will also open the door for expanded partnership with other organisations. GAVI is currently in discussions with the Global Fund, UNITAID and UNFPA to explore potential synergies for portfolio vaccines.
  • Whilst investing in new vaccines, GAVI must not lose its focus on existing priorities such as rotavirus and pneumococcal. According to GAVI’s projections, there is scope to make investments in new vaccines as well as funding vaccines that the Board has already agreed are priorities.

DECISIONS

Suresh Jadhav of Serum Institute India recused himself from the decisions, stating Serum Institute’s commercial interest related to vaccines under consideration in the strategy.

Patrick Florent of Glaxo Smith Kline recused himself from the decisions, stating GSK’s commercial interest related to vaccines under consideration in the strategy.

The GAVI Alliance Board:

  1. Endorsed the Reduce Overall Disease Burden portfolio theme and associated vaccines (Cholera, Japanese Encephalitis, Typhoid, Meningitis A, HPV, Rabies, Rubella) for the years 2009-2013. Investment in an individual vaccine will be decided on the basis of a costed implementation plan, to be developed.
  2. Agreed that the vaccine investment strategy should be subject to period review and reassessment on the basis of changing information.
  3. Noted that the strategy should monitor the development of vaccines for malaria and dengue and consider accelerated development and pre-introduction activities for these vaccines.

    Note: The above decisions do not constitute financial approvals or commitment on behalf of the GAVI Alliance to fund or support any single vaccine.
DocumentsPresentations
4. Meningitis investment case

Claire Broome, Chair of the IRC investment case team, provided an overview of the investment case and the IRC’s recommendations. Discussion followed:

  • Whilst the global impact of meningitis A vaccine is limited when compared to other vaccines GAVI might support, meningitis epidemics can paralyse communities and slow economic growth. Since 2002, GAVI has prioritised the development of meningitis conjugate vaccine. It is a “low-hanging fruit” that could yield significant results.
  • The investment case is designed to build country capacity and strengthen routine immunisation while ensuring an effective and rapid response to annual epidemics. The programme will combine a polysaccharide vaccine stockpile for outbreaks with the introduction of conjugate vaccine for routine use.
  • Meningococcal A vaccine is included in the portfolio of vaccines endorsed by the boards as part of GAVI’s vaccine investment strategy in the previous agenda item. Financing for meningococcal A vaccine (both polysaccharide and conjugate) will be considered as part of the total budget envelope for the strategy.
  • Board members requested further information on the US$ 200 million in country costs that GAVI is not being asked to fund. Countries will be responsible for mobilising 50% of the campaign operational costs. Past experience with other types of campaigns (e.g. yellow fever, measles) indicates that countries will be able to meet this expectation, however it would be valuable to obtain official letters of commitment from countries to ensure that the campaigns are treated as a priority.
  • Operational costs for campaigns will be channelled through WHO, but will ultimately go to countries. The International Coordinating Group which is hosted by WHO, is responsible for managing outbreak response and allocates funds to countries based on real-time information.
  • The proposed budget may duplicate some activities already being funded by GAVI and other partners. Between now and October, the investment case developers will restructure the budget to reflect areas that will be funded outside of the investment case, for instance those included in GAVI’s Accelerated Vaccine Introduction (AVI) support. The Audit and Finance Committee will need to fully review the final budget before it is presented for board approval.
  • Although the overall budget for the investment case requires further review, funding is urgently needed to establish an emergency response capability that includes a polysaccharide vaccine stockpile in advance of the next epidemic cycle.

DECISIONS

Suresh Jadhav of Serum Institute India recused himself from the decisions, stating Serum Institute’s commercial interest related to the investment case.

Daisy Mafubelu of WHO recused herself from the decisions, stating WHO’s involvement as an investment case developer and recipient.

The GAVI Alliance Board:

  1. Approved the strategy as outlined in the Meningitis investment case.
  2. Approved US$ 55.2 million to fund an emergency response capability that includes the immediate creation of a meningococcal A polysaccharide vaccine stockpile for emergency response.
  3. Delegated authority to the Secretariat to work with the investment case developers to conduct an in-depth review of the budget, up to an envelope of $370 million (2009-2015), and define the specific amounts in funding agreements with WHO and UNICEF to implement their components of the strategy. The Boards will be presented with the final budget for approval at their October 2008 meeting.
DocumentsPresentations
5. Yellow fever stockpile extension investment case

Claire Broome, Chair of the IRC investment case team, provided an overview of the investment case and the IRC’s recommendations. Discussion followed:

  • The Independent Review Committee has requested additional information from the investment case developers, and recommended the boards withhold consideration until the clarifications are addressed and the IRC has made a final recommendation.
  • For all future decision-making that implicates vaccine supply, the industry must be closely involved, since industry requires sufficient lead times to be able to meet the expectations of the implementing GAVI partners. Lead time for production of vaccines is lengthy (on average 12 or more months), and the deferral of the decision on the Yellow fever stockpile extension investment case, until October 2008, may compromise the planned activities for 2009, as laid out in the Investment Case.
DocumentsPresentations
6. Accelerated Vaccine Introduction support strategy

Nina Schwalbe, Director of Policy, GAVI Secretariat, provided an overview of the strategy. Discussion followed:

  • Although the strategy currently focuses on vaccines for pneumococcal and rotavirus, it will serve as a platform to support the introduction of future vaccines, reducing the costs and time for their introduction.
  • In order to support country capacity building, the outsourced entity that will support country decision making on vaccine introduction should be required to actively partner with in-country institutions.
  • The additional budget set aside for future special studies will allow GAVI to support countries in their decision making on vaccine introduction. Such studies will be needed on a case-by-case basis and will help countries address such issues as disease burden and optimisation of a new vaccine introduction within existing schedules. These individual studies will likely be conducted with the help of in-country research partners.

DECISIONS

The GAVI Alliance Board:

  1. Endorsed the scope, capabilities and budget envelope of $99.6 million (2009-2015) for a request for proposals to allow for follow on activities to the ADIPs through an outsourced entity ($48 million of which would be set aside for future special studies).
  2. Endorsed a budget of $14.9 million for WHO for surveillance activities in 2009-2010 (GAVI will need to decide whether to fund these activities post-2010). Currently funded under the ADIPs, these activities are scheduled to come to an end as of December 2008.
  3. Endorsed a budget of $256,800 for WHO/UNICEF and $2.8 million for six countries to support the introduction of pneumococcal 7-valent vaccine in pre-filled syringes.
DocumentsPresentations
7. GAVI introduction of pneumococcal vaccines – financial implications and support for the AMC

Dr. David Fleming, co-Chair of the AMC Implementation Working Group, and Alice Albright, Executive Vice President and CFIO of the GAVI Secretariat, presented the structure and financial implications of the AMC for pneumococcal vaccines. Discussion followed:

  • The AMC is in many ways comparable to a $5 billion start-up company. It is critical that it have the right internal controls and monitoring systems in place to meet this heightened responsibility. Given that GAVI and AMC donors are strongly signalling the intent to purchase vaccine, the AMC mechanism should not only give industry the incentive to develop the product quickly, it should include measures to ensure that manufacturers comply with the terms and expectations of the deal, amongst other things helping ensure sufficient long-term supply capacity to meet the demand from developing countries.
  • Although the concept behind the AMC is simple, it has been challenging to establish an incentive framework that will effectively encourage industry whilst representing value for money, affordability and predictability for developing countries. Existing guidelines and policies, including co-payment from developing countries, within GAVI will apply also to the pneumo vaccine under the AMC.
  • The AMC model has been designed in order to avoid creating a supply monopoly. The AMC has been designed to allow ample opportunity for developing country vaccine suppliers to enter the market. The AMC will not accept supply commitments that exceed projections of demand beyond five years in the future. Furthermore the fixed price components represent ceilings and can be set lower if deemed viable by manufacturers. This will create the potential for more manufacturers to enter the market. In addition there will be an opportunity to monitor vaccine costs over time and the potential to adjust pricing through the proposed periodic reviews (if required) based on inflation and independent expert advice.
  • The pneumococcal demand estimates that have informed AMC costing are the best that have ever been available for a new vaccine, largely thanks to the work of the Pneumo ADIP.
  • GAVI should not lose sight of the fact that the AMC is a pilot project both in terms of accelerating developing countries’ access to new vaccines and innovative financing. mistakes may be made, and lessons will be learned. Future work on the AMC, amongst other things on the basis of the scheduled baseline study and evaluations, should continue in an environment that allows for the project to undergo “constructive evolution”.
  • The industrialised country vaccine industry representative recused himself from the decision but made the following points: Prices are usually not fixed outside the context of a tender negotiation; prices must be related to volume; the tail price may be a disincentive for new entrants; and the tail price will be the driver of the AMC mechanism.

DECISIONS

The GAVI Alliance Board:

  1. Approved a budget envelope of US$1.3 bn for the GAVI Alliance contribution to the AMC pilot.
  2. Delegated authority to the GAVI Alliance and Fund Executive Committees to approve the AMC legal documents, based on the guidance provided by the Boards.
DocumentsPresentations

  • AMC (PDF 470K)

8. Audit and Finance Committee report

Wayne Berson, Chair of the GAVI Fund Audit and Finance Committee provided a report of the Committee’s activities over the past six months. The boards thanked the Committee Chair for the thorough and informative report.

  • The Committee has worked with Management to develop a recommendation for transferring the assets of the GAVI Fund to the GAVI Foundation as part of the governance transition should the Board decide it would be within its charitable purpose to do so.
  • The Committee has provided oversight of the construction of the financial terms of the AMC and was comfortable with its recommendation to the boards.
  • The Chair updated the boards on the 2007 audit, work plan and budget process, policy and risk oversight, the audits of the International Finance Facility for Immunisation Company (“IFFIm”) and the GAVI Fund Affiliate (“GFA”), and the process to select the 2008 external auditor.
  • The GAVI Fund’s external auditor, Deloitte & Touche, noted a high level of response from Management to comments made in the last management letter. Further, the draft management letter from the 2007 audit shows no material internal control weaknesses and demonstrates an improvement over the 2006 audit.
DocumentsPresentations
9. Investment Committee report

George Wellde, Chair of the GAVI Fund Investment Committee provided a report of the Committee’s activities over the past six months, and introduced the proposed Cash Investment Policy. Discussion followed:

  • The boards congratulated the Investment Committee, along with the Secretariat team, for maintaining the integrity of GAVI’s investment portfolio, despite times of global financial turbulence and uncertainty. Board members also thanked the committee chair for the concise and thoughtful report.
  • The Committee has conducted an extensive study of socially responsible investment (SRI) options, including dedicated SRI funds. The Committee will propose a new policy for socially responsible investment at a forthcoming meeting.

DECISIONS

The GAVI Alliance Board:

  1. Approved the cash investment policy as drafted.
DocumentsPresentations
10. Development Committee report

Dwight Bush, Chair of the GAVI Fund Development Committee provided a report of the Committee’s activities over the past six months and an update on recent fundraising initiatives.

  • The boards thanked the Committee Chair for the report and commended the success of the private fundraising effort, noting that the sums raised represent an equivalent amount to some bilateral contributions.
DocumentsPresentations
11. Vaccine co-financing default policy

Logan Brenzel of the World Bank provided an overview of the proposed policy. Discussion followed:

  • The policy is designed to place emphasis on default prevention rather than consequences. It is intended to build ownership by putting countries in control, while maintaining an open channel of communication and support.
  • The Secretariat and partners are already monitoring country co-financing arrangements to ensure that problems can be addressed early on in the process. Ongoing cases studies in several countries will provide information on how countries are integrating vaccine support into their budgets.
  • The policy must allow GAVI to make compromises in instances when countries face extenuating circumstances, such as internal conflict or emergency situations.
  • GAVI has reason to believe that default will be a rare occurrence. For those countries that have introduced, or are in the process of introducing pentavalent vaccine, the majority previously funded the purchase of their own DTP3 vaccine which has a cost roughly equivalent to or greater than the co-financing commitment. Most countries that have received GAVI’s time-limited support for injection safety materials have continued independently financing the cost of these materials once GAVI support ended.
  • GAVI should recognise countries that consistently meet or exceed the requirements of GAVI’s vaccine co-financing policy.

DECISIONS

The GAVI Alliance Board:

  1. Approved that countries enter into “default” status if they do not fulfil their co-financing commitment by 31 December of the concerned year.
  2. Approved the following actions when a country enters default status:
    1. GAVI Secretariat advises the country it is in default in January of given year;
    2. Existing GAVI support (vaccines, HSS, ISS) is continued;
    3. GAVI Secretariat and partners at regional and country levels work with the country to help it fulfil its co-financing commitment;
    4. New vaccine applications may be submitted but approval will be contingent upon a country coming out of default;
    5. Information about the country’s default status is posted on the GAVI website;
  3. Approved the following actions if a country remains in default for a longer time:
    1. More than one year: Support for the specific vaccine is suspended until the co-financing arrears are paid in full;
    2. Two years or more: HSS and/or ISS funding is suspended until the co-financing arrears are paid in full.
  4. Agreed that in rare instances when natural, economic, civil, or political catastrophes interfere with a country’s ability to meet its co-financing agreements, the Board may consider granting a grace period and/or exemption.
DocumentsPresentations
12. Governance Transition Committee recommendations

Sigrun Møgedal, Chair of the Governance Transition Committee, presented draft GAVI Alliance bylaws for the new board structure. Discussion followed:

  • The Boards thanked the Committee and its Chair for their hard work and dedication over the past months, recognising that progress toward finalising the transition would not have been possible without the Committee’s efforts.
  • General consensus on the bylaws for the new Alliance Board is needed at this point to ensure that the Swiss Government can make a decision about GAVI’s future status as an organisation in Switzerland. Whilst a draft will usefully inform Swiss authority deliberation at this time and ensure the best outcome for GAVI, Government representatives have requested final bylaws for inclusion in the dossier on GAVI that will be submitted to the Ministry of Foreign Affairs on 1 August.
  • Although there has already been substantial consultation on the bylaws, GAVI must ensure ownership and buy-in from all its partners before the bylaws are finalised.
  • The terms of reference for the Governance Implementation Committee have been constructed based on directions first proposed and agreed at the February 2008 joint Board meeting.
  • Board members made specific comments about the components of the bylaws, including gender equality, reasons for board member removal, board member terms, and timelines for scheduling board meetings and requesting no-objection voting, which will be reflected in a subsequent draft.

DECISIONS

The GAVI Alliance Board:

  1. Welcomed the draft by-laws, noting that they appropriately reflect the approved statutes and will now serve as the basis for a final review of text.
  2. Agreed that all board members shall provide their comments on the draft by-laws to the Governance Implementation Committee with copies to the full board and the Secretariat by Thursday 10 July.
  3. Requested the Secretariat to schedule a meeting on 11 July for board members’ legal advisors that wish to participate in a discussion of the draft by-laws, based on inputs provided by the Board members, in order to align all advice, and submit the revised draft by-laws to the Governance Implementation Committee.
  4. Requested the Governance Implementation Committee to review all of the proposed changes and finalise the draft by-laws for submission to the full boards by Friday 18 July, along with a rapid response procedure from Board members, to allow final comments by 22 July.
  5. Agreed to call a meeting of Board members by teleconference on 24 or 25 July for adoption of the by-laws in order that they be submitted to the Swiss authorities.
  6. Endorsed in principle the draft terms of reference for the Governance Implementation Committee, pending revisions discussed at the meeting including more specificity about the handover between the responsibilities of the Transition Committee and this committee.
  7. Noted the authority of the Governance Implementation Committee to establish the necessary sub-groups and consultation processes to facilitate the conclusion of its work to be presented to the Boards for approval at the October joint Board meeting.
  8. Applauds the composition of the Governance Implementation Committee proposed by the two board chairs: Jaime Sepulveda, Chair, George Wellde, Wayne Berson, Yoka Brandt, a representative of the multilateral partners and Julian Lob-Levyt, representing the Secretariat, with further consultation to take place also on representation of developing country governments.
DocumentsPresentations
13. Governance transition mechanics and budget

Alice Albright, Executive Vice President and CFIO of the GAVI Secretariat, presented the mechanism for transferring assets from the GAVI Fund US to the GAVI Foundation, as well as the proposed budget. There was no discussion.

DECISIONS

The GAVI Alliance Board:

  1. Endorsed the “grant” transaction method
  2. Delegated to the GAVI Fund Audit and Finance Committee the responsibility to oversee the Secretariat’s construction of the grant and make a recommendation to the Boards
  3. Approved an initial governance transition budget in the amount of US$ 3,000,000.
DocumentsPresentations
14. Hosting transition update

Carole Presern, Director of Change Management presented an update on the hosting transition. Discussion followed:

  • Under the UNICEF pension scheme, the employer contribution is lost if an employee leaves the organisation prior to serving for 15 or more years. Management felt strongly that, since it is not the staff’s decision to transition out of the UN system, GAVI should recoup the loss of employer pension contributions.
  • UNICEF is eager to do anything to ease the strain on GAVI staff during this transition period. The boards expressed their gratitude for UNICEF’s continued support.

DECISIONS

The GAVI Alliance Board:

  1. Agreed to set aside a one-time sum of approximately US$1.7 million to be paid into the new pension scheme, to compensate staff on UN contracts for the employer’s element of the pension contribution. This budget approval is needed to ensure that the pension scheme can be effective as of 1 January 2008.
  2. Agreed that new administrative policies, including travel and procurement, can begin to be phased in on a stepwise basis during 2008, and in advance of the October Board meeting.
DocumentsPresentations
15. Transparency and accountability policy

Alice Albright, Executive Vice President and CFIO of the GAVI Secretariat, provided an overview of the proposed policy. Discussion followed:

  • With increased programme support in the form of cash transfers comes an increased chance for misuse. Problems with misuse of ISS funds has shown how vulnerable we already are. GAVI needs to adopt this policy to mitigate reputational risks that could damage GAVI’s future ability to fund its programmes.
  • A main goal is to encourage countries to channel their GAVI cash support through joint financing mechanisms that benefit from strong country ownership, and financial management practices that adhere to international best practice. The policy will employ an individual, ‘best-fit’ approach for those countries lacking joint financing mechanisms.
  • The support and contributions of partners with experience in this area will be critical. GAVI should avoid any duplication of existing partner roles, especially in the area of the financial management capacity building, assessments, etc.
  • The policy is carefully designed to build upon and be consistent with the Paris Declaration for Aid Effectiveness.
  • GAVI should capitalise on upcoming opportunities such as WHO Regional Committee Meetings, to ensure that developing country partners can provide input into the implementation plan, which will be submitted for board consideration in October 2008.
  • The policy would benefit from increased attention to the area of mutual accountability; GAVI should continue its current practice of disclosing information about the funding it provides to individual countries.
  • It is critical that GAVI strengthen and empower its Independent Review Committee to take an active role in ensuring compliance with the policy.

DECISIONS

The GAVI Alliance Board:

  1. Adopted the Transparency and Accountability Policy, subject to finalisation of a full implementation plan.
  2. Endorsed the next steps for implementation of the policy.
DocumentsPresentations
16. Uganda – resumption of financial support

Marc Hofstetter, Deputy Executive Secretary and Chief Operating Officer of the GAVI Secretariat presented the proposed steps to resume financial support to Uganda. Discussion followed:

  • Given the specificities around the Uganda case and on an exceptional basis, GAVI is taking on the responsibility for funding technical assistance for country financial management systems: this was indeed requested by the government and in-country development partners.
  • The proposed measures have been jointly negotiated with both the Ugandan Ministry of Health and Ministry of Finance, to encourage shared ownership and compliance.

DECISIONS

The GAVI Alliance Board:

  1. Endorsed the Aide Memoire which has been negotiated by the Secretariat and signed by the Government of Uganda The use of Uganda’s Long Term Institutional Arrangement (LTIA) for future GAVI Alliance cash transfers.
  2. Endorsed the agreement reached with the Government of Uganda regarding reimbursement of $500,000 in misappropriated GAVI ISS funds: ISS funds recovered from individuals accused of the misappropriation will be transferred to a specific Ministry of Health account, and used in accordance with agreed rules and regulations. Any remaining gap will be filled by Ministry of Health funds. Uganda has committed to ensure that the full amount will be reimbursed by December 2009.
  3. Approved the provision of technical assistance to Uganda to strengthen financial management in the health ministry, and to support the costs of independent audits. This would be a 2008 budget item (approximately $135,000) in addition to the already approved support for Uganda.
  4. Approved the continuation of cash support to Uganda, pending the satisfactory implementation of the terms of the Aide Memoire.
DocumentsPresentations
17. HSS monitoring update, including decision on tracking study

Craig Burgess, Programme Officer, GAVI Secretariat provided an update on HSS monitoring, and introduced the request for a tracking study. Discussion followed:

  • The outcomes of the tracking study will be fully reflected in the full evaluation of the HSS window, to be conducted in end-2009/early 2010. Selection of countries for the study will reflect a wide range of circumstances, to ensure the results provide a balanced assessment of the issues.

DECISIONS

The GAVI Alliance Board:

  1. Approved an envelope of up to $1.6 million for the expanded GAVI Health Systems Strengthening (HSS) tracking study.
DocumentsPresentations
18. Country programmes – IRC recommendations on HSS proposals

Clifford Kamara of the IRC team for HSS presented the outcomes and recommendations of the HSS proposal review. Discussion followed:

  • The boards commended the HSS IRC team for its thorough work and commitment to high standards when reviewing country proposals.
  • GAVI’s support for civil society organisations is challenging “business as usual” at the country level; it is to be expected that countries will face some challenges and delays as they work to build relationships with CSOs and design their proposals.
  • For HSS proposals, representatives from WHO and UNICEF provide a great deal of support in the development process at country level; GAVI should explore how the partnership can offer this same high level of support in developing CSO proposals.
  • The IRC recommended, in view of the relatively short time frame of existence of the CSO proposal process and the time required to generate sound proposals to this new initiative, that the CSO window be extended for at least one year and initial evaluations postponed by at least one year. This recommendation met with general approval in Board discussion.

DECISIONS

The GAVI Alliance Board:

  1. Endorsed budgets for multi-year programmes for Health Systems Strengthening (HSS) totalling US$ 94,619,500 and for Civil Society Organisation (CSO) support totalling US$ 6,326,000.
DocumentsPresentations
19. Cash management plan

Alice Albright, Executive Vice President and CFIO of the GAVI Secretariat, presented the cash management plan. There was no discussion.

DECISIONS

The GAVI Alliance Board:

  1. Endorsed the cash management and requested the GAVI Fund Board to implement it.
DocumentsPresentations
20. GAVI Evaluation Policy

Nina Schwalbe. Director of Policy at the GAVI Secretariat, provided an overview of the proposed policy. Discussion followed:

  • It would be valuable if the boards could receive further information on how the proposed policy has been informed by other partners’ evaluation policies.
  • It is critical that GAVI maintain independence in all of its evaluations; the Executive Secretary/CEO advised the Boards of the recruitment of a Head of Monitoring & Evaluation, one of whose roles will include to ensure an independent process for both the Board and the outside world.
  • An implementation plan will be submitted for board review in October 2008, and will provide additional information, including how the results of individual evaluations will inform programme decisions, how the policy will be executed, and how it will be integrated into the GAVI Work Plan.

DECISIONS

The GAVI Alliance Board:

  1. Approved the policy, subject to the development of an implementation plan.
DocumentsPresentations
21. Executive session

The Boards discussed a number of important issues during this closed session.

DECISIONS

The GAVI Alliance Board:

  1. Approved the continuation of funds to the Government of Burundi, subject to final signature of a Memorandum of Understanding with the country.
  2. Requested that the Secretariat develop a set of guidelines and actions to respond to allegations of fund misuse. These should be build into the transparency and accountability policy.
  3. Reaffirmed GAVI’s commitment to tiered pricing, which should be heeded in discussions with procurement organisations including current negotiations with PAHO. The challenge of ensuring access by middle income countries, even if not directly financed by GAVI merits further discussion.