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Seventh GAVI Board Meeting, Stockholm, 11 March 2002

1. Performance-based grants disbursement strategy

Click here to download issues paper [MS Word, 197kb]

Click here to download presentation [Powerpoint, 117kb]

• The Data Quality Audit (DQA), developed by WHO and the Children’s Vaccine Program, was field-tested in eight countries in 2001. Through this process it was found that the information systems, especially the retention of primary data at the health centre level, is weaker than anticipated, making the level of consistency in countries' immunization reporting system too low to satisfactorily provide a 'correction factor'.
  
  
• The main findings of the field test were that the DQA:
  • can evaluate quality of reported data;
  • can identify problems with reporting systems;
  • is relatively expensive ($60,000 average per country)
  • can be used as self-assessment tool;
  • cannot provide a mathematical formula to adjust share calculations due to its low precision but could be used to classify reporting system as ‘validated’ or ‘not validated’.
    
    

• A particular concern is that the reliance on reported data as the means for payment will lead to inflation of reported figures. Although the ICC is expected to validate the reported figures, the point was made that many ICC members have not been able or willing to jeopardise partnerships (which go way beyond immunisation) by challenging reported coverage data, even if they suspect it is inaccurate.
  
  
• Some Board members felt that the assessment of performance should make use of indicators that are already available and include indicators other than just DTP3 coverage, since this could provide a broader view of progress. Others felt that increasing the number of indicators could increase imprecision and burden on countries.
  
  
• The problems identified in the pilot test of the DQA are not new. Furthermore, even if the DQA is not the most powerful tool in terms of precision, it may give countries the opportunity to look at the problems and identify strategies to assess them.
  
  
• The DQA is an excellent opportunity to build capacity, but some saw the proposed approach as overly prescriptive, and called for easing of restrictions on the use of coverage surveys to measure performance.

DECISION

The Board: 

1.1. Agreed that GAVI must retain its focus on performance-based systems.  However, in recognition of the realities facing countries and the intention of GAVI to be equitable, this system will need to be modified from its original design.

1.2. Approved the proposal that the first planned ISS reward (for DTP3 increase over baseline) be converted to a third investment ($10/child projected DTP3 increase) for all countries, providing one full year of ISS investment. All subsequent reward payments for all countries will be based on validated increases in DTP3.

1.3. Endorsed changing the DQA methodology so that instead of calculating a mathematical adjustment to the reported coverage figures, the DQA would result in a classification of the immunization reporting system as ‘validated’ or ‘not validated’ so that: 

1.3.1. In countries where reporting systems are classified ‘validated’ by the DQA conducted during the third year of investment, the reward payment in the subsequent year will be based on reported DTP3 figures endorsed by the ICC; and

1.3.2. In countries where reporting systems are classified ‘not validated’ by the DQA conducted during the third year of investment, a second DQA will be conducted in the subsequent year. If the system is again classified as ‘not validated’, the reward payment will be deferred until reporting is improved or validated by another method (vaccine coverage surveys) as outlined in the methodology. 

1.4. Agreed that the performance-based disbursement should be assessed after the system has had a chance to be implemented (i.e., at the end of 2003). This assessment should consider the costs, opportunity costs and benefits of the scheme (in terms of both increased coverage and health systems development).

1.5. Requested that investigation into alternative methods of assessing performance should be initiated simultaneously with the ongoing implementation of the DQA. 

1.6. Requested that further analyses be made on how the confidence interval of DQA can be reduced (impact of complete reporting, larger sample size, etc.) and report this back to the Board as soon as possible.

1.7. Requested that GAVI partners with presence in countries emphasize the message about the importance of keeping primary immunization records.

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