31 – Country driven programmes

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A fundamental principle in GAVI’s business model is that the EPI program is the responsibility of the country and that it is owned and driven by the country

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Copyright GAVI/2012/Eva-Lotta Jansson

The panel was introduced by Violaine Mitchell, from the Bill & Melinda Gates Foundation. Hind Khatib-Othman, GAVI, provided an overview on the principles of GAVI support.

A fundamental principle in GAVI’s business model is that the EPI program is the responsibility of the country and that it is owned and driven by the country. The GAVI Alliance can facilitate expansion of the EPI programme and in different ways contribute to a successful implementation and outcome of the program.

The country should be in charge of strategic planning, coordination of support, implementation, monitoring and reporting, of-course using and involving in-country stakeholders and partners. This session was about exploring different aspects of country ownership, and challenges to fostering and sustaining country ownership looking at and sharing experiences

An example of ownership and country leadership is demonstrated by a country like Ghana which launched two new vaccines this year (rota and PCV), a first in Africa. A film illustrating this launch was presented to the panel. Worth mentioning is also the fact that Ghana has developed a data reporting system with high data quality coming out of the system. The capacity and experience Ghana has developed can and has been used in other countries.

Hon. Deputy Minister of Health, Malawi Dr Halima Daud explained her approach to country ownership, which for her means that the country can plan the allocation of resources. Real ownership also means sharing responsibilities, involving all the stakeholders at the various levels of decision making and implementation.

Babar Idris Abugarda, Minister of Health of Sudan, presented the impressive progress made by Sudan in immunization. From 64% DTP3 coverage in 2002, the country reached 93% in 2011, which means that additional 400,000 children are reached every year. Sudan was the first African country introducing rotavirus vaccine in 2011, and pneumococcal vaccine will be introduced in 2013. To get the best out of GAVI’s support, monitoring of service delivery is indispensable, notably to identify the gaps areas. Sustainability is an important issue, and Sudan is innovating in establishing the “SAVI”, calling upon local private partners to support immunization, illustrating that country ownership is about building trust.

Another example is Bangladesh. Bangladesh has a very strong EPI programme, which was presented by Dr Haque, Minister of Health. The country has seen a dramatic reduction in under 5 and infant mortality rate. Valid fully vaccinated children increased from 52% in 1991 to 80.2% in 2011. These impressive successes are based on strong community participation, with people who donated land for clinics, a high level political commitment, and strong financial commitment, notably in terms of co-financing. The most important and most difficult is to reach the last 10-15% children.

Dan Osei, from the Ghana Health Service, presented country ownership using the metaphor of the car driver: you either own the car or are in the driver’s seat, but what is important is who decides where the car is going. Therefore country ownership means that the country decides on the program, manages the resources which are channeled using country systems. It also means shared responsibility and accountability, for successes and failures. He cited the experience of Ghana health information system, which was not initiated by the country, but the country took over and made decisions on the way forward.

Participants brought the issue of decision making in program implementation, notably how to strike the balance between reaching the unreached and bringing in new vaccines. The principle is that the country should fully agree on what is going to be done, and that the question of timing should be left to the country. However, some participant raised the point that new vaccines introduction is also providing countries with a chance to improve program components.

The question of what accountability means was also debated, and participants insisted that the development partners should also be accountable, and proposed that they present their activities and results, notably in the context of sector reviews. Two elements were identified as particularly important: being accountable “to the last mile”, and generating and using good data to monitor successes and challenges.

The question of whether GAVI should work downstream, and engage directly with local levels in a country, received a very clear response from the countries’ participant: GAVI should work with the national level, and not try to by-pass in reaching out directly to sub-national levels. The government has to be in the driver’s seat.

The final comment summarized the main discussion points: getting people (including civil society) involved, trust is indispensable, flexibility from GAVI (for re-programming for example) is critical, robust information systems are required to report and keep partners accountable.

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GAVI has provided funding to strengthen health systems and immunisation services in more than 70 countries.

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