Evaluation of GAVI Immunization Services Support (ISS)
Abt Associates, August 2004
GAVI immunization services support (ISS) is a new idea in international development co-operation: outcome-based grants that give governments responsibility and autonomy to decide how money is used, but if they don’t show results, the funding stops.
This policy is intended to create a strong incentive to increase immunization coverage while at the same time giving countries the freedom not only to use the funding as they see fit but also to pool these funds (e.g., in SWAp baskets) if they wish.
GAVI has so far disbursed $67 million to 52 countries under this program.
The GAVI Board decided to conduct an evaluation of the system; Abt Associates was selected to conduct the study in the first half of 2004.
Summary of main findings and recommendations:
- The complete flexibility of GAVI funds is its most valuable characteristic. It allows national immunization programmes to use funds when and where they are most needed -- to operationalize locally-appropriate strategies for improving performance and in response to acute problems. ISS funding allows strategic plans to become a reality. Overall, funding allocations and expenditures seem appropriate to address obstacles identified (page xv).
- The true value-added of ISS funding would be significantly diminished if GAVI were to prescribe to countries how to use this funding, or required funds to be disbursed within a specified time period (page xii).
- Despite lack of specific requirements, most countries have in place adequate financial reconciliation procedures. Full compliance with these procedures is an issue in some countries, although there is no evidence of misuse of funds (page xii)
- In most countries, the allocation process appears systematic and strategic. Countries used funds to address specific obstacles identified and to implement coverage improvement strategies. Where allocation processes seemed less thoughtful and transparent, the country ICCs seemed less coherent and functional (page xii).
- Several key factors emerged that contribute to successful implementation of ISS funding. The presence of a coherent ICC [interagency coordinating committee] and strong technical capability within or easily available to the national immunization programme appeared to be the key factors determining strategic allocation of funds (page xiv).
- Across the 52 desk study countries, 62 percent of ISS funding disbursed has been spent.
- In Mali and Tanzania, districts that did not return receipts for ISS funds previously disbursed could not get new funding, thereby slowing down the expenditure rate (page 13)
- In Kenya, the immunization program deliberately delayed releasing ISS funds to districts at certain times to avoid commingling ISS funds with the measles campaign funds, and to avoid ISS fund disbursement just before the Christmas holidays, preempting possible misuse of funds at the district level (page 13).
- The allocation practices were not static, but evolved over time as countries gained more experience in managing the ISS funds. In Cambodia, once it was clear that 2002 coverage rates showed a continued decrease in coverage, it was decided to use ISS funds in 2003 to support outreach in the first quarter of the year (when it is the dry season and all districts are accessible, but government funding is generally unavailable) (page 16).
The following documents are available for download:
The full study
In-depth country analyses:
Presentation by Abt Associates to the July GAVI Board meeting.