The health system strengthening (HSS) support evaluation was commissioned in February 2009 by the Gavi Secretariat to HLSP and shared with the Gavi Board in November 2009.


Recognising that achieving immunisation coverage is dependent upon strong service systems the Gavi Board took the first steps to widen Gavi support to HSS in early 2005.

Countries are encouraged to use Gavi HSS funding to target the "bottlenecks" or barriers in the health system that impede progress in improving the provision of and demand for immunisation and other child and maternal health services.


The study covers all 21 countries for whom HSS funding had been approved by December 2008 and explores five questions:

  1. What has been the experience at country level with Gavi HSS in terms of design, implementation, monitoring, integration (harmonisation and alignment), management and outputs/outcomes?
  2. What have been the main strengths of Gavi HSS at the country level, and what are specific areas that require further improvements?
  3. How has Gavi HSS been supported at regional and global levels - what are the strengths of these processes and which areas require further improvement?
  4. What has been the value-added of funding HSS through Gavi as compared to other ways of funding HSS?
  5. What needs to be done, and by when, at country, regional and global levels to prepare for a more in-depth evaluation of impact of Gavi HSS in 2012?


Findings are based primarily on case studies on each of the 21 countries approved for HSS support up to December 2008, and interviews and questionnaires consulting a wide selection of individuals involved in the Gavi HSS process. The evaluation is presented in three volumes:

Volume 1: an extended summary of key findings and recommendations;

Volume 2: a full evaluation report providing details and integrated evidence;

Volume 3: the individual country case studies, the evaluation study guidelines and summarised responses to questionnaires.

Visit the Country Hub section to find HSS Evaluation country reports for: Bhutan, Burundi, Cambodia, DR Congo, Ethiopia, Georgia, Ghana, Honduras, Kenya, Kyrgyzstan, Liberia, Nepal, Nicaragua, Nigeria, Pakistan, Rwanda, Sierra Leone, Sri Lanka, Vietnam, Yemen, Zambia.


The report's final recommendations help inform the Gavi Board decision in 2010 about whether or not to increase funding available for HSS; improve current and future implementation of Gavi HSS; and, enhance the quality of the HSS evaluation planned for 2012.


  • Gavi health system strengthening support evaluation 2009: Volume 1 key findings and recommendations


  • Gavi health system strengthening support evaluation 2009: Volume 2 full evaluation report


  • Gavi Secretariat management response to the health system strengthening support evaluation 2009


  • World Bank response to the Gavi health system strengthening evaluation


Last updated: 10 Oct 2022

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