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

Overview 1.GAVI Alliance: recognising importance of systems 2.Integration of immunisation 3.Immunisation services support (ISS) 4.Health Systems strengthening (HSS)

An innovative public-private partnership To save childrens lives and protect peoples health through the widespread use of vaccines

GAVI Alliance strategic goals 1.Strengthening the capacity of the health system to deliver immunisation and other health services in a sustainable manner 2.Accelerate the uptake and use of underused and new vaccines and associated technologies and improve vaccine supply security 3.Increase the predictability and sustainability of long-term financing for national immunisation programmes 4.Increase the added value of GAVI as a public-private global health partnership through efficiency, advocacy and innovation

Estimated costs & financing gaps for immunisation, Source: Global Immunisation Vision and Strategy – WHO costing

Estimated portfolio - systems / new vaccines ratio 1/3 systems / 2/3 new vaccines New vaccines figures taken from May 2007 GAVI Board financial forecasts 44%43%32%29%28%27% HSS + ISS / total GAVI support

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 Integration Not an end in itself or an objective. Rather as a means to achieve more effective and efficient service delivery

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

Immunisation services support (ISS) Performance based flexible funding $218 million disbursed by Dec Investment: 3 years, proportional to birth cohort 2.Reward: Reward good performance Incentives - $20 per additional child vaccinated DQA during the 2 nd 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

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

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

GAVI HSS principles Interventions complementary to work of other stakeholders 1.Country driven 2.Country aligned 3.Harmonized 4.Predictable 5.Additional 6.Inclusive and collaborative 7.Catalytic 8.Innovative 9.Results orientated 10.Sustainability conscious UNICEF/Giacomo Pirozzi

Rate and pace of uptake of HSS unpredicted 51 countries applied for HSS 40 approved or pending approval HSS IRC Nov 2006Board approved 5 countries Feb 2007 $92.1 million Approved HSS IRC April 2007 Board approved 4 countries May 2007 $77.6 million Approved HSS IRC June 2007 Board approved 7 countries July 2007 $95.9 million Approved HSS IRC Nov 2007 Board approved 13 countries November 2007 $135 million Approved HSS IRC April countries pending approval June 2008 $94.6 million pending TOTAL - $495 million approved or pending approval

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

Technical Support -Largely domestic, limited dependence on consultants

Constraints: Contextualised, comprehensive, but with blind spots Non FragileFragile S O

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