Immunisation services support evaluation

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External review of effectiveness of GAVI's ground-breaking Immunisation Services Support over its first five years (2000-2005)

In 2007, an external review of the first five years of GAVI's pioneering immunisation services support (ISS) was commissioned by GAVI to assess the effectiveness of possibly the first truly performance-based programme of its kind.

How ISS works

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.

Set-up in 2000, ISS provides flexible funding that countries can use towards immunisation services and 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 diphtheria-tetanus-pertussis (DTP3) coverage rates continue to rise.

Method

The evaluation, carried out by independent consultants Abt Associates included both quantitative and qualitative elements; reviewing financial sustainability plans, annual progress reports and coverage data for all countries that received ISS funding, and conducting an in-depth analysis of the ISS experience in six countries.

The evaluation report was completed in 2007 and then went through a review process by the ISS Steering Committee (September 2007) and the GAVI Working Group (October 2007). The GAVI Senior Management team prepared a formal response to the recommendations for the GAVI Alliance Board in November 2007.

Conclusions

The evaluation demonstrated that:

  • GAVI now has 'proof of concept' that ISS works with the report estimating that nearly 2.4 million children were immunised with DTP3 who would have not otherwise have been immunised had ISS expenditures been zero.
  • countries spend ISS funds where they were needed most;
  • countries integrate ISS into national immunisation plans;
  • ISS had a positive effect on immunisaiton systems as a whole, not just on DTP3;
  • GAVI should not place restrictions on how countries spend their ISS funds;
  • enhanced partner coordination for immunisation;
  • strong technical support is critical to success.

Lessons for harmonised development assistance

Lessons learnt from ISS can help build a case for flexible, harmonised development finance, while providing early insights on what works and what does not.

The success of the ISS window demonstrates that flexible, integrated funding works when countries are expected to manage for results. The ISS evaluation also highlights the critical importance of coordinated donor support at the country level.

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