Synergies between the GAVI Alliance and health systems strengthening

1. Synergies between the GAVI Alliance and health systems strengthening Dr. Craig Burgess, GAVI Secretariat 29 May 2008

2. Overview • GAVI Alliance: recognising importance of systems • Integration of immunisation • Immunisation services support (ISS) • Health Systems strengthening (HSS)

3. An innovative public-private partnership”To save children’s lives and protect people’s health through the widespread use of vaccines”

4. GAVI Alliance strategic goals Strengthening the capacity of the health system to deliver immunisation and other health services in a sustainable manner Accelerate the uptake and use of underused andnew vaccines and associated technologies and improve vaccine supply security Increase the predictability and sustainability of long-term financing for national immunisation programmes Increase the added value of GAVI as a public-private global health partnership through efficiency, advocacy and innovation

5. Estimated costs & financing gaps for immunisation, 2006-15 Source: Global Immunisation Vision and Strategy – WHO costing

6. Estimated portfolio - systems / new vaccines ratio1/3 systems / 2/3 new vaccines New vaccines figures taken from May 2007 GAVI Board financial forecasts HSS + ISS / total GAVI support

7. Integration Not an end in itself or an objective. Rather as a means to achieve more effective and efficient service delivery • Routine / campaigns / immunisation days • Scale up rapidly and delivery costs shared • ’Schedules’ provide contacts with health system • Multi-valent vaccines • Reach Every District strategy • G.I.V.S. - Integrating immunisation in a health systems context - Other linked interventions

8. Linking immunisation with other interventions Timing and scheduling of service delivery crucial De-worming ITNs Malaria Control Future ?HPV? IPTi Vitamin A

9. Immunisation services support (ISS)Performance based flexible funding$218 million disbursed by Dec 2007 • Investment: 3 years, proportional to birth cohort • Reward: Reward good performance • Incentives - $20 per additional child vaccinated • DQA during the 2nd year of support 3. What was it spent on?: Per diem, recurrent expenses, training, outreach, demand generation, supervision, M+E, vehicles, cold chain, capital expenditures

10. Coverage of DTP3 Hepatitis B and Hib immunisation in GAVI-eligible countries Projections Source – WHO Report on GAVI Progress 2000-2006 & Projected Achievements 2007-2010, 15 November 2007

11. GAVI HSS ‘To achieve and sustain increased immunisation coverage, through strengthening the capacity of the health system to provide immunisation and other health services (with a focus on child and maternal health)’ Maximum impact at periphery Three non-exclusive themes: Health workforce Supply, distribution and maintenance Organisation and management $800 million approved by board for investment 11

12. GAVI HSS principlesInterventions complementary to work of other stakeholders • Country driven • Country aligned • Harmonized • Predictable • Additional • Inclusive and collaborative • Catalytic • Innovative • Results orientated • Sustainability conscious UNICEF/Giacomo Pirozzi

13. Rate and pace of uptake of HSS unpredicted51 countries applied for HSS40 approved or pending approval

14. Analysis of 49 proposals ($427 million)75% funding for ‘operational’ level (district and below)16% funding for upstream level (above district)9 % management Source: WHO / Unicef / UNFPA University of Queensland analysis of first 49 GAVI HSS proposals

15. Technical Support-Largely domestic, limited dependence on consultants

16. Constraints: Contextualised, comprehensive, but with blind spots Non Fragile Fragile S O

17. Challenges • Immunisation – systems dynamics (MoH & partners) • Changing the ‘project’ mentality • Monitoring frameworks • Fiduciary risk • Adapting performance based funding • Knowledge sharing