Gavi’s health system and immunisation strengthening (HSIS) support aims to help countries address geographical, socioeconomic and gender-related barriers to ensure that every child can be immunised. Health system strengthening (HSS) grants form the basis of our HSIS support, which also includes other types of support.

Gavi has provided HSS support to eligible countries since 2007. We commission evaluations, and support evaluations commissioned by recipient countries, to inform evidence-based decisions and help evolve our HSS support.

There are several types of HSS support evaluations:

  • General HSS evaluations and meta-reviews
  • Evaluations of individual countries’ HSS grants
  • Full country evaluations.

General HSS evaluations and meta-reviews

In order to determine best practice, we have commissioned a variety of evaluations of our HSS grant window. We have also commissioned “meta-reviews”, which combine the results of multiple country evaluations to increase the level of learning in-country as well as across countries and regions.


This report presents the main findings from a review of Gavi’s health systems strengthening (HSS) support to countries. This review was conducted by Swiss Tropical and Public Health Institute in 2018. The objectives of the review were to:

  • Assess how Gavi’s HSS support contributes to increasing immunisation coverage and equity, strengthening health systems to deliver integrated primary health care, improving sustainability of national immunisation programs.
  • Identify elements available to learn from recent experience and establish recommendations regarding the relevance and feasibility of future HSS evaluations.

The review assessed the design, implementation and results of HSS grants. Its findings will provide important evidence for the review of Gavi’s funding policies and related processes in preparation for its 2021-2025 strategy and will inform the design of potential future evaluations of Gavi’s HSS.


  • Review of Gavi’s health systems strengthening (HSS) support (2019)


  • Gavi’s HSS Review Management Response (2019)



  • Meta-review of HSS grants (2016–2017)

In a bid to provide partners with an overview of new findings and trends across the HSS support window, we have updated the 2015 meta-review with six HSS evaluations undertaken in the 2016–2017 period.

View the 2016-2017 HSS meta-review update

  • Meta-review of HSS grants (2013–2015)

To ensure improved learning from and accountability of HSS grants, Gavi commissioned its first HSS meta-review in 2015. The review covers all 14 country HSS evaluations completed in the 2013–2015 period. Findings from the review will help inform future HSS grants as well as other types of Gavi support.

View the 2015 HSS meta-review

Other health system reviews and studies


During the 2014–2016 period, Gavi-supported countries were required to include a plan for an end-of-grant evaluation in their HSS proposals. Although this is no longer a requirement, we still encourage countries to plan for periodic evaluations of their HSS support.

View the evaluations


In 2013, Gavi initiated the full country evaluations project, which includes assessments of our HSS support to four countries: Bangladesh, Uganda, Mozambique and Zambia.

Last updated: 17 Feb 2020

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