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Strengthening service delivery =>> Contributing to alleviation of system-wide barriers =>>

Efforts in 10 high-performing and 10 low-performing countries undertaken, lessons learned, documented and best practices shared.

Responsible entity: NORAD
Completed by: December 2004
Total budget: $1,030,000

Target description and how it will help reach GAVI milestones

Based on the outcome of the preceeding activities under “Agreement by major health sector stakeholders on joint efforts to alleviate health systems barriers” the Board/EC will make its go/no go decision to continue the work within this priority area with the activities listed for this target.

The overall scope of this work plan area is to contribute to strengthen service delivery and increase immunization coverage by addressing system-wide barriers in countries supported by GAVI and the Vaccine Fund. The main approaches are to seek alignment at global level of key health sector development partners, promote alignment across global initiatives that face similar system wide barriers, and work with selected countries to find the best areas and workable options where the GAVI alliance can “add value”.

The work will be coordinated with the efforts of supporting countries in reaching the health MDGs and other efforts such as the work of the Macroeconomics and Health Commission (CMH). The work plan will be organized around three areas: (1) pathfinder function contributing to find innovative ways in addressing health systems barriers at country level, (2) Harmonization function: aligning with system-wide efforts to address system-wide barriers at country level (including improving ICC and coordination mechanisms); (3) Health systems development function: efforts at global level to address system-wide barriers.

ACCESS MILESTONE: Addressing system wide barriers will contribute to increased quality and system-friendliness of efforts to raise coverage, thereby promoting sustainable access.

Justification for selection of activities

The McKinsey report identified five groups of system wide barriers that need to be addressed for countries to attain targets. But approaches need to be tailored in-country.

Efforts will focus on system wide barriers causing low coverage at sub-national level.


Activities Budget Coordinating partner/ support partners Expected outcomes
Develop methods for in-country analysis of system barriers $140,000 NORAD WB WHO UNICEF • Approach and methodology established
Support barrier analysis in 10 low-performing countries $0 In-country partners • Priority barriers and actions to address them identified
Support implementation in 10 low-performing countries $500,000 In-country partners • Contributions made to addressing health systems barriers
Document in-country efforts $340,000 Local research WHO NORAD • Lessons learned available for 2006-2007 GAVI planning
Resource Group operations $50,000 GAVI Secretariat NORAD • Country and global imputs obtained during design and documentation

Detailed information on activities

A workshop will be held in spring 2004 for 20 selected countries (well performers and stagnating performers). Well performing countries will share experiences with stagnating countries. Countries will be encouraged to share experiences on challenges and issues which need to be addressed. Countries will be provided with after workshop support through linkages with other initiatives on system barriers and be given a period to define and implement strategies to address barriers. The process of addressing barriers will be documented by a national research institution. A final report summarizing countries experiences will be drafted and lessons shared.

Activities 1, 4, and 5 will be coordinated at the global level. Funds for activities 2 and 3 will be channeled to selected countries.

Targets by priority area

Strengthening service delivery

==>> Health information and monitoring systems

==>> Contributing to alleviation of system-wide barriers

Agreement by major health sector stakeholders on joint efforts to alleviate health systems barriers.
ICCs strengthened, with stronger links to NGOs and higher level national health coordination committees.
Efforts in 10 high-performing and 10 low-performing countries undertaken, lessons learned, documented and best practices shared.

==>> Enhanced efforts in large population countries

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 sutainability

==>> Recapitalization of The Vaccine Fund

Strategic planning & monitoring

==>> Setting priorities

==>> Monitoring progress


==>> Alliance coordination

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