Strengthening the delivery of routine immunisation services and primary healthcare systems is fundamental to Gavi’s mission of ensuring every child receives a full course of vaccines. This strong focus on reaching underserved and marginalised populations is what sets the Alliance’s approach to health system strengthening (HSS) apart.
“Gavi’s health system strengthening (HSS) support is a key component of strategies to help countries reach the unreached. To ensure grants target the final 20%, Gavi is focusing HSS support in this period on communities with the largest number of underimmunised children.”
Mid-Term Review report, page 6
Gavi’s approach to health system strengthening: overview
In line with its 2016–2020 strategy, which prioritises coverage and equity improvements, Gavi seeks to help countries locate unreached communities and understand why they are being missed. This allows the Alliance to better target its support to overcome these barriers. By extending the reach of service delivery, supply chains, data systems and other critical health systems components, Gavi is improving access both to immunisation services and to the wider primary healthcare system.
Since 2007, Gavi has provided over US$ 1.4 billion in HSS support to 69 countries. A total of 56 countries currently receive HSS grants.
The Alliance has scaled up its investments in HSS over the past decade (see below). To achieve higher, more equitable coverage, Gavi is increasingly targeting this support at core bottlenecks preventing children from being immunised, as well as the communities that are home to the largest pockets of underimmunised people.
Partners’ Engagement Framework
In 2016, the Alliance launched the Partners’ Engagement Framework (PEF) to make Gavi-funded technical assistance more country-centric, transparent and accountable. The Alliance now funds over 200 partner staff in-country – many of whom are embedded in health ministries – to provide technical assistance to governments.
Under PEF, the Alliance has significantly scaled up its budget for technical support (from US$ 123m in 2016 to US$150m in 2018) and expanded the number of partners with whom it works. To date, over 50 different partners are providing Gavi-funded technical support around the world, each based on their comparative advantage.
Cold chain equipment optimisation platform (CCEOP)
A robust cold chain is critical to ensure that vaccines reach the communities where they are needed regularly, safely and without losing potency. A functioning cold chain is a specific requirement for the immunisation supply chain, which is not required for most other health interventions. As a result, the cold chain has always been a focus of Gavi’s HSS investments.
Historically, many countries have faced gaps in their cold chain. The equipment was often energy inefficient, expensive to run and maintain, as well as unreliable. In 2015, the Gavi Board decided to establish a dedicated cold chain equipment optimisation platform (CCEOP) to help shape the market for cold chain equipment and accelerate the development and deployment of new technologies in Gavi-supported countries (see below). The CCEOP is an integral part of Gavi’s efforts to strengthen country supply chains and primary healthcare systems.
The Alliance has defined four strategic focus areas, which are particularly critical – along with targeted investments in service delivery – to ensuring immunisation services reach every community:
- an efficient supply chain;
- appropriate local demand for vaccines;
- accurate and timely data; and
- adequate country leadership, management & coordination (LMC).
In each of these areas, the Alliance has developed a cross-cutting strategy and theory of change to help ensure HSS and PEF support is well-targeted (as well as CCEOP in the case of the supply chain SFA), cross-cutting investments to help drive innovation and learning, and metrics to monitor progress and ensure Gavi’s investments are delivering the desired change.