cusco , 10 november 2009
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GAVI HSS and Future Joint Programming with the World Bank and the Global Fund to fight AIDS, TB and Malaria. Santiago Cornejo. 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 - PowerPoint PPT PresentationTRANSCRIPT
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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