BACK TO SEVENTH GAVI BOARD MEETING
Seventh GAVI Board Meeting, Stockholm, 11 March 2002
1. Performance-based grants
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- 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
- 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
- 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
- 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.
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’
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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