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Sixth GAVI Board Meeting, 17 October 2001, Ottawa, Canada
October 2001
1. Into
Implementation: Reports from the Field
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presentations:
Discussion
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The Board
greatly appreciated the comprehensive overviews of the health and
immunization situations in Africa and Central & Eastern Europe/Central
Asia.
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Some of
the lessons learned from the initial use of GAVI funds are
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In
Mali and Kenya: use of performance contracts,
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In
Tanzania: use of HIPC funds
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In
Ghana: reinforcement of infrastructure
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In
Zimbabwe: organisation of local immunization days in low
performing districts
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In
Rwanda: microplans for low performing districts reviewed by the ICC
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Some of
the regional concerns raised are:
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GAVI
is perceived as another project or organization rather than an
alliance
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Sustainability of national immunization programmes is a concern
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Unmet
needs of countries not eligible for funding from the Vaccine Fund,
and how GAVI experience can be used in such countries
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The
need for strategies to define, identify and reach the harder to
reach populations
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Unmet
needs in countries eligible for funding from the Vaccine Fund
(e.g. support to new vaccine introduction costs in countries which
receive system strengthening funds but in which this amount is
small)
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Conflicting messages on measles control
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The
presentations amply illustrated that with resources flowing from the
Vaccine Fund, GAVI Partners at all levels – national, regional and
global – are in an implementation phase of actively supporting
countries to strengthen routine immunization and introduce new
vaccines.
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Both
presentations highlighted the need for increased efforts to identify
new financing mechanisms to improve sustainability. The example of
Tanzania using HIPC relief to increase its immunization budget is
extremely important; there is a need to explore how this can be
related to other countries’ situations. The Board may wish to may come
back to this in later discussions (a HIPC and Health meeting on 3-7
December in Nairobi may be of interest to Board members). Leveraging
additional resources, including more long-term bilateral funding, is
also a message that needs to be advocated.
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The other
major challenge in country programs is insufficient managerial
capacity. We should also keep in mind that the new Global Fund to
Fight AIDS, TB and Malaria demands systems that can deliver.
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We need to
be watchful that enthusiasm and momentum gained with GAVI is not lost;
we have seen coverage rise in the past in response to infusion of
support and attention, and then dwindle. The challenge now is to
integrate these initiatives and ensure that GAVI support results in
sustainable immunization services, to strengthen advocacy efforts to
increase demand for immunization and that the support serves to
strengthen health systems in a long-term perspective. One strategy
would be to identify precise indicators that demonstrate how the polio
initiative contributed to the strengthening of health systems.
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GAVI needs
to consider its role with respect to middle-income countries (GNP
above $1,000 per capita).
DECISIONS
The
Board:
1.1 agreed that the next Board meeting agenda should also include
presentations from the field, and that Asia would be the most relevant
to examine at this time
1.2 agreed that a future Board meeting should allow for an in-depth
discussion of financial sustainability
1.3 welcomed the suggestion that ideas about how to support middle
income countries would be on the agenda at the next Board meeting
1.4 agreed that representatives from regions should regularly be
invited to future Board meetings as observers.
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