Linking programmes and systems: lessons from the GAVI Health Systems Strengthening window

Abstract

Summaryobjectives To analyse the first four rounds of country applications to the GAVI Alliance Health Systems Strengthening (GAVI-HSS) funding window; to provide valuable insight into how countries prioritize, articulate and propose solutions for health system constraints through the GAVI-HSS application process and to examine the extent to which this process embodies alignment and harmonization, Principles of the Paris Declaration.methods The study applied multiple criteria to analyse 48 funding applications from 40 countries, submitted in the first four rounds, focusing on the country analysis of health systems constraints, coordination mechanisms, alignment with national and sector planning processes, inclusiveness of the planning processes and stakeholder engagement.results The applications showed diversity in the health systems constraints identified and the activities proposed. Requirements of GAVI for sector oversight and coordination, and the management of the application process through the Ministry of Health's Planning Department, resulted in strong alignment with government policy and planning processes and good levels of stakeholder inclusion and local technical support (TS).conclusion Health Systems Strengthening initiatives for global health partnerships (GHPs) can provide a link between the programmatic and the systemic, influencing policy alignment and harmonization of processes. The applications strengthened in-country coordination and planning, with countries using existing health sector assessments to identify system constraints, and to propose. Analyses also produced evidence of broad stakeholder inclusiveness, a good degree of proposal alignment with national health plans and policy documents, and engagement of a largely domestic TS network. While the effectiveness of the proposed interventions cannot be determined from this data, the findings provide support for the GAVI-HSS initiative as implementation continues and evaluation begins.

Ten years of the Global Alliance for Vaccines and Immunisation

“…9 Evidence suggests that GAVI grants have largely been used for downstream short term fixes, rather than the upstream long term structural reforms really needed to strengthen health systems. [10][11][12] More operational research is urgently needed to understand how GAVI might best support HSS for child immunisation that could,…”

Health systems strengthening in global and national contexts

“…Previous studies mapped how the concept of HSS may have evolved from a disease-specific approach for healthcare service delivery to a more system-wide approach for improving health (Galichet et al, 2010). I supported such findings with evidence identifying how key public health conferences and events have pushed the global health agenda towards more preventive and promotive aspects of health care.…”

“…With these grants, countries are allocated a dollar amount based on their Gross National Income and population (Galichet et al, 2010).…”

“…Ministries of Health were invited to use available health sectoral reviews to identify health systems constraints and plan health systems to improve immunisation and wider primary health care services (Galichet et al, 2010). The funding is to be considered as additional and complementary to existing government and other local health sources (Galichet et al, 2010).…”

“…The funding is to be considered as additional and complementary to existing government and other local health sources (Galichet et al, 2010). : Gavi 2016(Gavi, 2016 The application process required the countries to submit core and tailored indicators to form part of their Grant Performance Framework, which is a new monitoring and reporting tool introduced by Gavi in early 2015 The Grant Performance Framework is an upfront agreement between a country and Gavi on the key metrics that Gavi can use to monitor and report on grant performance during HSS implementation.…”