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Strengthening service delivery =>> Enhanced efforts in large population countries =>>

The large population countries are back on track or show tendency of getting back on track in immunization coverage.

Status Achievement of overall target
Ongoing process • A total of $2,750,000 has been allotted to this target.
• First disbursements have gone to DR Congo.
• An interim report will be produced in 2005, informing about the remaining distribution of funds.

Responsible entity: UNICEF
Completed by: December 2005
Total budget: $2,750,000

Target description and how it will help reach GAVI milestones

This is the last of four targets that aim to ensure that the seven selected large population countries get back on track towards their goals of immunization coverage. These can be demonstrated with validated assessment of immunization coverage and the presence of technical, financial and political inputs in the 7 countries. In some of these countries, special efforts need to be done to reach the marginalized populations. Regular and intensified technical support from key partners is needed to enhance national, sub-national and district level capacity to accelerate EPI coverage. In cases where increased support to the Ministries of Health may be inefficient for improving immunization services, other mechanisms such as the use of NGOs may be explored and used. It is essential that key political and civil society leaders commit to actively engage in supporting coverage improvement plans. There is a need to ensure that regular monitoring meetings and in-country reviews are undertaken to monitor progress made against benchmark, and to adjust acceleration plans as appropriate. By doing these, barriers to successful implementation are identified and addressed in a timely manner. UNICEF/WHO to work with MoH and key partners dependent on country (e.g. CDC, PATH, BASICs, BRAC, and bilaterals).


  • Advocacy aimed at policy makers and other influential stakeholders in the countries is needed to support achieving the GAVI access milestone.
  • Intensified technical assistance essential in these countries
  • Special efforts required to reach marginalized groups

Justification for selection of activities

  • Influential leaders and partners at global, regional and country levels must commit to routine immunization activity.
  • Strengthening capacities of key country partner agencies (WHO and UNICEF) to support routine immunization is necessary to provide intensified technical assistance, advocacy and communication support. Increased staff capacity will enable UNICEF and WHO to better use the ICC mechanism to advocate for action by decision makers, institutions and local partners for improving immunization services.
  • Annual meetings with all seven large population countries to review progress will provide the opportunity of not only sharing best practices but also getting lessons learned from these countries.


ActivitiesBudgetCoordinating partner/ support partnersExpected outcomes
Develop key messages and effect strategies to keep influential leaders and partners at global, regional and country levels committed to routine immunization.$200,000UNICEF WHO MoH• Key political and civil society leaders actively engaged to support efforts to accelerate progress towards routine immunization coverage targets; Opportunity to engage GAVI Board members in advocacy efforts
Strengthening capacities of partner agencies to support routine immunization$2,500,000UNICEF WHO PATH CDC key partners• Each country has designated "routine" staff persons from key partners dependent on country (WHO, UNICEF, PATH, BASICS, CDC, BRAC, other NGOs, bilaterals) to provide intensified technical assistance, advocacy, communication support, and continuous follow-up on strategies and activities for improving immunization coverage (and overcoming barriers);
• Stronger promotion, implementation, and follow-up of opportunities to use in-country polio human resources, particularly at sub-national levels; Improved coordination and performance of ISS-funded national staff who have been recruited in some countries (e.g. Nigeria, Bangladesh);
• Improved capacity for field operations and vaccine and cold chain management to increase coverage
Implement follow-up mechanisms such as quarterly monitoring meetings at sub-national level and in-country reviews undertaken twice a year to monitor progress, and adjust activities as appropriate$0UNICEF WHO MoH key country partners• Continuous collection/analysis of data, monitoring of progress, and problem-solving;
• Barriers to successful implementation are identified and addressed in a timely manner;
• Successful innovations are shared among districts, and replicated if appropriate.
Annual meetings with all 7 countries to review progress ( 2 meetings total) In-country reviews undertaken twice a year to monitor progress, and adjust activities as appropriate$50,000UNICEF WHO key country partners• Maintain momentum and advocacy;
• Sharing of experiences and innovations; Trouble-shooting/problem solving if progress slow;
• Progress report prepared for GAVI Board
Document the lessons-learned in accelerating routine immunization coverage, and the critical factors to sustain and expand including coverage validation$0MoH UNICEF WHO key country partners• Validated assessment of immunization coverage;
• Technical/financial/political inputs needed to keep the momentum beyond 2005 are in place

Detailed information on activities

UNICEF/WHO to work with MoH and key partners dependent on country (e.g. CDC, PATH, BASICs, BRAC, other NGOs, and bilaterals).

The staff will assist Government counterparts to:

  1. prepare strategic plans, state/province action plan and budget documents to leverage additional in-country resources for immunization;
  2. support monitoring of district level operations and establish system for monitoring vaccine stock-out and other key indicators;
  3. support training to expand the “access/RED approach", field operations and vaccine/cold chain management.

Targets by priority area

Strengthening service delivery

==> Health information and monitoring systems

==> Contributing to alleviation of system-wide barriers

==>> Enhanced efforts in large population countries

• Seven large population countries have made analysis of the barriers and possible solutions, and have agreed with their ICCs on action plans.
• GAVI and partners have established new policies to support the seven large population countries.
• Lessons from accelerated disease control initiatives (ADCs) applied in the large population countries as appropriate.
• The large population countries are back on track or show tendency of getting back on track in immunization coverage.

Ensuring access to vaccines and related products

==>> Procurement/Supply of existing products

==>> Development and introduction of new, near-term products

==>> Managing process for country support from Vaccine Fund

Securing long-term financing

==>> Financial sustainability

==>> Recapitalization of The Vaccine Fund

Strategic planning & monitoring

==>> Setting priorities

==>> Monitoring progress


==>> Alliance coordination

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