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Sixth
GAVI Board Meeting, 17 October 2001, Ottawa, Canada
October 2001
1. Into Implementation: Reports from the Field
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Discussion
- The Board greatly appreciated the comprehensive
overviews of the health and immunization situations in Africa
and Central & Eastern Europe/Central Asia.
- Some of the lessons learned from the initial use
of GAVI funds are
- In Mali and Kenya: use of performance contracts,
- In Tanzania: use of HIPC funds
- In Ghana: reinforcement of infrastructure
- In Zimbabwe: organisation of local immunization days in
low performing districts
- In Rwanda: microplans for low performing districts reviewed
by the ICC
- Some of the regional concerns raised are:
- GAVI is perceived as another project or organization rather
than an alliance
- Sustainability of national immunization programmes is a
concern
- Unmet needs of countries not eligible for funding from the
Vaccine Fund, and how GAVI experience can be used in such
countries
- The need for strategies to define, identify and reach the
harder to reach populations
- Unmet needs in countries eligible for funding from the Vaccine
Fund (e.g. support to new vaccine introduction costs in countries
which receive system strengthening funds but in which this
amount is small)
- Conflicting messages on measles control
- The presentations amply illustrated that with resources
flowing from the Vaccine Fund, GAVI Partners at all levels –
national, regional and global – are in an implementation
phase of actively supporting countries to strengthen routine immunization
and introduce new vaccines.
- Both presentations highlighted the need for increased
efforts to identify new financing mechanisms to improve sustainability.
The example of Tanzania using HIPC relief to increase its immunization
budget is extremely important; there is a need to explore how
this can be related to other countries’ situations. The Board
may wish to may come back to this in later discussions (a HIPC
and Health meeting on 3-7 December in Nairobi may be of interest
to Board members). Leveraging additional resources, including
more long-term bilateral funding, is also a message that needs
to be advocated.
- The other major challenge in country programs is
insufficient managerial capacity. We should also keep in mind
that the new Global Fund to Fight AIDS, TB and Malaria demands
systems that can deliver.
- We need to be watchful that enthusiasm and momentum
gained with GAVI is not lost; we have seen coverage rise in the
past in response to infusion of support and attention, and then
dwindle. The challenge now is to integrate these initiatives and
ensure that GAVI support results in sustainable immunization services,
to strengthen advocacy efforts to increase demand for immunization
and that the support serves to strengthen health systems in a
long-term perspective. One strategy would be to identify precise
indicators that demonstrate how the polio initiative contributed
to the strengthening of health systems.
- GAVI needs to consider its role with respect to
middle-income countries (GNP above $1,000 per capita).
DECISIONS
The Board:
1.1 agreed that the next Board meeting agenda
should also include presentations from the field, and that Asia
would be the most relevant to examine at this time
1.2 agreed that a future Board meeting should
allow for an in-depth discussion of financial sustainability
1.3 welcomed the suggestion that ideas about
how to support middle income countries would be on the agenda
at the next Board meeting
1.4 agreed that representatives from regions
should regularly be invited to future Board meetings as observers.
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