The response to flexibility: country intervention choices in the first four rounds of the GAVI Health Systems Strengthening applications

Abstract

Since December 2005 the GAVI Alliance (GAVI) Health Systems Strengthening (HSS) window has offered predictable funding to developing countries, based on a combined population and economic formula. This is intended to assist them to address system constraints to improved immunization coverage and health care delivery, needed to meet the Millennium Development Goals. The application process invites countries to prioritize specific system constraints not adequately addressed by other donors, and allows them to allocate their eligible funds accordingly. This article presents an analysis of the first four rounds of countries' funding applications. These requested funding for a variety of health system initiatives that reflected country-specific requirements, and were not limited to improving immunization coverage. Analyses identified a dominance of operational-level health service provision activities, and an absence of interventions related to demand and financing. While the proposed activities are only now being implemented, the results of this study provide evidence that the open application process employed by the HSS window has led to a shift in analysis and planning-from the programmatic to the systemic-in the countries whose applications have been approved. However, the proposed responses to identified constraints are dominated by short-term operational responses, rather than more complex, longer term approaches to health system strengthening.

Perceptions of the usefulness of external support to immunization coverage in Guinea-Bissau: a Delphi analysis of the GAVI-Alliance cash-based support

“…This alignment notwithstanding, the actual measures proposed for action ignore important recommendations such as the need to address barriers at the level of leadership and governance and at the level of the financing system. The blindness of GAVI HSS proposals to the need to address issues related to the financing system has also been identified in a previous study 47 . This blindness to strategic gaps may reflect the challenges global health initiatives face in shifting from management through programs to managing through systems 50 .…”

“…The qualitative analysis was similar to the one described by Goeman et al 47 . It was based on WHO's health system building block categories -service delivery, health workforce, health information systems, logistics (medical products, vaccines and technology), financing and leadership & governance 48 .…”

“…Where an intervention could be considered systemic and operational, it was classified as systemic. No one building block was considered to be uniquely systemic or operational 47,49 . These were complemented by an additional category, community level.…”

From Millennium Development Goals to post-2015 sustainable development: sexual and reproductive health and rights in an evolving aid environment

“…31 All the Ministries of Health in the 2011 case study reported receiving specific health systems strengthening grants from the GAVI Alliance and/or Global Fund, releasing significant revenues for national health budgets. 26,32 Coordinating coordination in the new aid environment With the growing participation of agencies such as the GAVI Alliance and Global Fund, and their attempts to extend their engagement beyond their narrowly defined mandates, Ministry of Health staff and their WHO and UNFPA country office advisors were now grappling with a growth in mechanisms to coordinate this increasingly diverse field of development stakeholders and programmes. By 2011, all countries studied had faced requirements for new coordination structures: the PRSPs and reporting of MDG progress brought national stakeholders together; the GAVI Alliance made a health sector coordination committee a prerequisite for health systems strengthening funding; and the Global Fund had set up its own Country Coordinating Mechanism (CCM), often with overlapping, but not identical, membership.…”

Beyond patents: The GAVI Alliance, AMCs and improving immunization coverage through public sector vaccine production in the global south

“…(p. 1923) 22 GaVi has taken some tentative steps in recognizing this impasse through its Health Systems Strengthening window launched in 2006, but it needs to make this a priority. 10,23 fundamentally, using aMcs to supply vaccines to developing countries reflects an acceptance of the patent system as the best method for increasing vaccine coverage. We reject this position.…”