BackgroundThere are encouraging preliminary signs that GAVI may be contributing to an increase in overall coverage rates in countries supported by the Vaccine Fund in the past two years. Since the inception of the Alliance, routine immunization has received more attention and many countries have worked hard to improve their immunization services, achieving remarkable results.
However, it has become apparent that that some countries are having difficulty in reaching their immunization goals. Recognizing this, last October the GAVI Board commissioned McKinsey and Company to conduct an in-depth study of the current coverage situation and forecast the likely evolution over the coming years. McKinsey was also asked to make recommendations to the GAVI Board on possible actions it may take to address the situation.
The McKinsey team analyzed multiyear plans submitted to GAVI, examined data from UNICEF and WHO, and interviewed national, regional and international experts to prepare their report. The work was conducted over a matter of months and therefore may not fully reflect the countries’ situations and the work required to improve immunization services. Countries’ own analysis of their current situation and the constraints and barriers they face is most important. The report may, however, be a useful starting point from which to stimulate this analysis and consider possible solutions that eventually benefit the entire health system.
The Board was presented the report in draft form at its meeting on 6 March. One immediate outcome was that the Board decided to align its milestones more closely with the Millenium Development Goals and the objectives agreed to in the United Nations Special Session on Children in 2002. Intensified efforts in immunization therefore will serve to achieve your country’s own immunization targets as well as the globally agreed objectives for health development.
The Board also decided to share the final report with countries and GAVI partner constituencies for reactions and further input. Important findings of the report have also been incorporated in the GAVI Strategic Framework which forms the basis for the development of the GAVI work plan 2004-05.
The most important of these aspects are:
- Contributing to alleviation of system-wide barriers. One of the major findings in the report was that many countries which are unlikely to reach their immunization targets face multiple and system wide barriers.GAVI will now work with countries to analyze these barriers, to improve partner coordination and encourage partners to work with countries. This is a vital application of the barriers approach to improving immunization.
- Enhanced efforts in large population countries. Seven countries missing their immunization targets have been designated for enhanced efforts from GAVI. These countries will be challenged to develop action plans to get back on target. This is in line with the findings to target countries missing their targets for timely action to reach the joint targets.
- Ensuring access to vaccines and related products. GAVI will seek to further enhance forecasting and procurement in order to increase the availability of the required vaccine combinations and other products.
- Increasing immunization coverage at the health facility level - A planning guide developed jointly by WHO and UNICEF (PDF 633K)
- An example from Cambodia of a plan to increase coverage at the district level (Word 132 K)
- An example from Sudan of a plan to increase coverage in low-perform districts (Powerpoint 188K)