Santiago Cornejo

GAVI HSS and Future Joint Programming with the World Bank and the Global Fund to fight AIDS, TB and Malaria

Cusco, 10 November 2009

Overview

What is GAVI?

Why GAVI HSS?

What and how of GAVI HSS support

Current status and emerging issues from ongoing work

Joint systems platform for programming and funding

Overview

What is GAVI?

GAVI mission statement

To save children’s lives and protect people’s health by increasing access to immunisation in poor countries.

Strategic goals

Accelerate the uptake and use of underused and new vaccines and associated technologies and improve vaccine supply security.

Strengthen the capacity of the health system to deliver immunisation and other health services.

Increase the predictability and sustainability of long–term financing for national immunisation programmes.

Increase and assess the added value of GAVI as a public-private global health partnership through efficiency, advocacy and innovation.

The GAVI Alliance Board structure

GAVI’s programmes of support for countries

New and underused vaccines

Immunisation services

Health system strengthening

Civil society organisations

Injection safety

Countries eligible for GAVI programme support in 2009

Data source: GAVI AllianceThe boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the GAVI Alliance concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not be full agreement.

Number of countries eligible for GAVI support and approved by July 2009

Source: GAVI Alliance, July 2009

US$ 4 billion committed to countries (as of 31 Dec 2008)

Source: GAVI Alliance data as at December 2008

Immunisation coverage with DTP3, hepatitis B and Hib vaccines in GAVI-supported countries, 2000-2009

Source/credits: WHO-UNICEF coverage estimates for 1980-2007, as of August 2008; WHO-ICE T coverage projections for 2008-2010, as of September 2008

Overview

Why GAVI HSS?

What are we trying to do?

VACCINES

CHILDREN

‘Saving children's lives and protecting people’s health by increasing access to immunisation in poor countries’

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Criticisms of GAVI phase 1

GAVI study 2004 – barriers toincreasing coverage: 1.Unpredictable funding at peripheral level2. Transport3. Shortage of human resources4. Health workforce motivation

Not harmonized or aligned approach – admin burden to countries

WORLD HEALTH REPORT 2000

BELLAGIO STUDIES

MACRO ECONOMICS AND HEALTH 2001

INTERNATIONAL TASK FORCE ON GLOBAL PUBLIC GOODS2006

GLOBAL IMMUNIZATION VISION AND STRATEGY 2005-2015

Health systems must be strengthened for: a) MDG 4+5 scaling upb) new technology introduction

Disease specific approaches are not sustainable and can weaken health systems

New technologies need strong systems

High staff turnover and low training

Salaries / incentives not paid on time

Poor supervision

Interrupted vaccine supply

Lack of data for planning

No outreach transport

Weak planning and management

Low demand and poor quality

Lack of inter-sectoral partnership

Evolution of EPI

Overview

What and how of GAVI HSS support

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GAVI Health Systems Strengthening: $800 million‘Hard to get, easy to use’ Armenia MoH

‘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

Coordinated by dept of planning

Three non-exclusive themes: Health workforce

Supply, distribution and maintenance

Organisation and management

GAVI HSS principles

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

Parameters

Align with National Health Plan for duration and content

Endorsed by MoH, MoF, and HSSC Country ‘budget envelope’ based on number of

newborn children and GNI per capita:a) Countries with GNI / capita <$365 =

$5 / newborn / year

b) Countries with GNI / capita >$365 =

$2.50 / newborn / year

Only 3 mandatory indicators

Technical support (TS) & pre review

GAVI does not have country presence

Partners support countries to implement, monitor and evaluate HSS activities

Proposal preparation grant $50,000 per country

Pre review critical documents

Overview

Current status and emerging issues from ongoing work

45 / 72 countries now applied for HSS

$525 million ‘committed’; $258 million disbursed

75% funding for ‘operational’ level (district and below)

16% funding for upstream level (above district)

9 % management

Analysis of 49 proposals ($427 million)

Source: WHO / Unicef / UNFPA University of Queensland analysis of first 49 GAVI HSS proposals

Emerging Issues

Finalizing an evaluation of the window and in-depth, real time tracking of finances and implementation to guide the design

Issues:

- Historical context of vertical EPI (country/partners)

- IRC review and redesign

- Fund disbursement

- M&E

- Partnership and technical support

Overview

Joint systems platform for programming and funding

Current attempt- IHP compact Health Systems Support

Financing oriented to MDGs

Govt.$

GAVI HSS $

GFATM HSS $

BilateralDonor $

IDA$

Bilateral & Multilateral Partners• 1 plan•1 policy•1 monitoring framework• 1 fiduciary framework• 1 coordination body

One Country Health Plan

Implementation

MDG-related outcomes

M&E

Compact

Recent developments: High level taskforce (HLTF) on innovative financing and IHP+ ministers review, UNGA announcement

IHP+ ministers requested GAVI, GFATM and WB to explore mechanism for joint programming

HLTF welcomed proposals to explore the feasibility of GFATM, WB and GAVI Alliance systems investments, WHO facilitation

World Health Assembly resolution and GAVI consultations

UNGA announced expanded IFFm for HSS of $1 billion

Opportunities

Political, financial and increased effectiveness, in line with IHP+ principles

Leverage new resources

Increase sustainability of the GAVI Approach

Increase efficiency in aid flows

Reduce fragmentation and thus transaction costs

Reduce fiduciary risk

Increase inter-secretariat efficiency

For immunisation and the GAVI Alliance: increase resources for ‘systems components’ of new vaccine introduction; ensure immunisation specific outputs are key deliverables

Principles

Flexible/differentiated approach for different countries – NOT one size fits all

IHP+ principles

Improve information sharing between the 3 agencies

Focus on country results and value for money

Common frameworks for HSS assessment, monitoring and funding (approval)

Strong analytical basis for HSS

Purpose

‘To improve health outcomes through strengthening countries’ health systems to deliver health services equitably and sustainably (focussing on all health MDGs), and to use resources more effectively and efficiently’

Reduced transaction costs for countries

accelerated progress towards MDGs Practical step to make global health aid

architecture more effective and responsive Increased global focus on HSS

Fund one health plan, use one monitoring framework using one funding modality where possible

Possible Components of a Joint Approach to HSS

1. Support for national health / plan / strategy development with harmonised technical support

2. Joint HSS Processes – including Joint Assessment of National Strategies for funding HSS components

3. Common monitoring framework using annual review processes for monitoring performance

4. Common funding/disbursement channels

Challenges (!)

Complexity of harmonisation between funding entities

Criteria for budget envelopes

Ensuring investment leads to programme specific outcomes

Ensuring performance based approach

Different paradigms on HSS

AccountabilityBetter health outcomes – whose health?

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