Strengthening health delivery systems

in page functions

Gavi supports countries in identifying and tackling the weak links in health systems that obstruct delivery of vaccines to the people who need them

Business challenge

Strengthening health delivery systems

Vaccines are one of the most effective and cost-efficient means to save lives, improve child health and advance towards the Millennium Development Goals for child and maternal mortality. But fulfilling that potential depends on the ability of health systems to deliver vaccines where, and on the scale, they are needed.

Service delivery in many low-income countries suffers from a lack of, or inability to retain, trained health workers, gaps in the cold chain or weaknesses in health system management.

Syringe 04  

Gavi's value added

Gavi strategy: the health systems goal

Gavi's commitment to making developing countries' health systems more effective in delivering vaccines to even the most remote district is enshrined in the second goal of its 2011-2015 strategy. This sets out three objectives: contibute to resolving constraints in delivering immunisation; increase equity in access to services (including gender equity); and, strengthen civil society engagement in the health sector.

Gavi allocates approximately 15% of its total funding support to cash-based programmes designed to encourage countries to strengthen immunisation delivery.

Tackling institutional barriers

Progress in immunisation delivery has often been impeded by broader health system constraints ranging from the poor distribution and motivation of health workers to a lack of adequate infrastructure and poor management of services.

Gavi has therefore provided health system strengthening support (HSS) to enable countries to tackle institutional barriers holding back progress. In line with the "country ownership" principle of Gavi's business model, countries design programmes to address what they see as their real needs rather than problems identified externally. This also ensures that programmes are aligned with national policies.

Countries mainly use HSS funding to deliver immunisation and maternal and child health (MCH) services, sometimes in selected districts. In particular, the Vaccine Alliance is now focusing its effort on strengthening immunisation supply chains to not only reach more people currently missed by immunisation services, but to reach them with a full set of safe and viable vaccines. Examples of HSS support include:

  • training nurses to administer the two shots and an oral dose required for pneumococcal vaccine;
  • giving expert health workers incentives to stop them leaving for other jobs;
  • ensuring there are sufficient carrying dispensaries (polysterene cool boxes) to maintain the cold chain for delivering vaccines from central to district level;
  • increasing the number of incinerators to dispose of waste;
  • conducting laboratory surveillance to monitor the impact of vaccinations.

CSOs are frequently the backbone of developing countries' health systems, delivering up to 60% of immunisation services; the Vaccine Alliance's funding support is designed to encourages CSO engagement in the national planning and implementation process.

Five ‘fundamentals’ for stronger supply chains: supporting countries to improve immunisation delivery systems.

Health workers travel often by any means possible to reach and immunise rural communities.

Delivering vaccines to a remote village in Kenya.
Credit : Gavi/2013/Evelyn Hockstein

As immunisation programmes expand to include new vaccines and strive to reach more people, they are increasingly constrained by outdated supply chains.

As vaccine volumes are expected to quadruple between 2010 and 2020, there is an urgent need for improvements in immunisation supply chain infrastructure and systems.

Gavi’s immunisation supply chain strategy

Developed by WHO, UNICEF, Bill & Melinda Gates Foundation and Gavi, the immunisation supply chain strategy provides an end-to-end perspective of the supply chain. It focuses particularly on the country level, from the arrival of vaccine doses at the port of entry or the national storage facility to immunisation sessions at the health clinic.

Every year, Gavi buys vaccines for more than US$ 1 billion. In 2015 alone, this catalysed more than US$ 130 million in additional co-financed vaccines paid for by developing countries themselves. Supply chain improvements are critical to ensuring that all these vaccines stay safe and effective, and that they reach the children who need them.

Stronger supply chains do not only help to reduce under-five mortality and improve overall health in countries; they also contribute to the Vaccine Alliance’s goal to increase immunisation coverage and make it more equitable.

The five fundamentals

At the core of the strategy are five fundamentals essential to strengthening immunisation supply chains:

1. Supply chain leadership

Supply chain leadership

Next-generation immunisation supply chains require dedicated and competent managers as well as adequate numbers of skilled, accountable, motivated and empowered personnel at all levels of the health system. The Vaccine Alliance helps countries strengthen and build supply chain managers’ capacity by providing focused technical assistance, tools, training and other resources.

2. Continuous improvement & planning

Continuous improvement & planning

Supply chains are dynamic systems that must be continuously monitored, managed and improved. The new comprehensive Effective Vaccine Management (EVM) approach provides a structure for continuous improvement. Regular comprehensive EVM improvement plans should be implemented as part of comprehensive multi-year immunisation plans and financed through health system strengthening support or other funding. The Vaccine Alliance provides guidance and technical assistance to countries as they engage in this process.

3. Supply chain data for management

Supply chain data for management

Managers need reliable and relevant data to manage key aspects of immunisation supply chains, including vaccine availability, quality of storage and transport facilities, and stock management efficiency. The Vaccine Alliance provides guidance and technical assistance on data standards and use to countries as they develop supply chain dashboards tailored to their needs.

4. Cold chain equipment

Cold chain equipment

Reliable, well-maintained and cost-effective cold chain equipment is vital to ensure that there is adequate, sustainable vaccine storage for current and planned vaccines, maintenance requirements are kept low and running costs are reduced. The Vaccine Alliance provides guidance, technical assistance and financial support to countries to help them better plan for, select, install and manage their cold chain equipment.

5. Supply chain system design

Supply chain system design

New approaches to supply chain design aim to improve supply chain performance and contribute to increasing immunisation coverage. The Vaccine Alliance provides technical support to countries that are embarking on immunisation supply chain system redesign projects, focusing on change management.

In support of these five fundamentals, the Vaccine Alliance provides ongoing direct technical support, develops relevant tools and resources, collaborates with equipment manufacturers and the private sector, leverages financial support mechanisms, and supports policy changes to help countries improve the performance of their immunisation supply chains.

Benefits to immunisation programmes

Through Gavi’s immunisation supply chain strategy, countries do not only benefit from tailored technical support and financial assistance. National immunisation programme leaders and supply chain managers also have access to more effective management tools, increased numbers of trained personnel and better technologies to help them reach their immunisation goals. The increased focus on and investments in strengthening supply chains make it possible not only to reach more people who currently miss out on immunisation services, but to do so with a full set of safe and viable vaccines.


In 2014, more than 70 countries were co-financing new and underused vaccines supplied by Gavi. Their contributions totalled over US$ 80 million. More than 20 countries are projected to be fully self-financing their vaccines by 2020.


More facts...

close icon

modal window here