Civil society organisation support

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Civil society organisations play a crucial role in strengthening health systems and delivering immunisation services in some of the poorest regions of the world.

Health Services Pakistan

Photo courtesy of Aga Khan Health Services, Pakistan

Civil society organisations (CSOs) - including non-government organisations, advocacy organisations, a range of professional and community associations, faith-based organisations, and academia - have a long history of involvement in public health in developing countries and have an important role in supporting Gavi’s mission.

Improved health outcomes and equity

CSOs have a proven track record for working in partnership with governments in a number of Gavi-eligible countries to ensure the delivery of vaccines. This is also true in extending healthcare services to marginalised communities, particularly in remote areas that are difficult to reach.

In many Gavi-eligible countries, CSOs provide a large proportion of health services. For example, CSOs provide 43% of medical services in Tanzania, 40% in Malawi, 34% in Ghana, 15% in India (which has over 200 CSO hospitals), 13% in Bangladesh, 12% in Indonesia, and 9% in the Democratic Republic of Congo. CSOs are also instrumental in vaccine delivery, providing up to 60% of immunisation services in some countries.

The Type A and Type B pilot civil society organisation (CSO) support programmes focused on supporting stronger engagement of CSOs at the country level, including in immunisation service delivery

In 2006, two funding windows were approved as pilot programmes for civil society support, with a total budget of US$ 29.2 million:

  • Type A support was designed to strengthen the coordination and representation of civil society organisations (CSO) through the provision of lump-sum grants;
  • Type B support, intended for 10 countries, was aimed at including CSOs in the implementation of Gavi health systems strengthening (HSS) proposals or comprehensive multi-year plans (cMYPs).

The pilot countries for Type B support included Afghanistan, Bolivia, Burundi, the Democratic Republic of CongoEthiopia, Georgia, Ghana, Indonesia, Mozambique, and Pakistan. Although initially introduced for the period 2007–2009, the Gavi Board subsequently extended support further.

By 2012, over US$ 21 million had been disbursed to encourage stronger involvement of CSOs in the implementation of national programmes and in health system strengthening. Subsequently, in 2012, through the independent review committee process a further US$ 7.4 million was allocated to pilot countries already receiving Type B support. These extensions are intended to support the continuation of CSO activities, until a country initiates an application to the Health Systems Funding Platform (HSFP).

Evaluation of Type A and Type B pilot programmes

An independent evaluation of the Type A and Type B pilot programmes was completed in early 2012. The main findings suggested that Gavi support to CSOs remains important for the achievement of countries’ immunisation goals, particularly in those instances where CSOs play a significant role in delivering immunisation services. The report also highlighted the scope for improvements in programme design and implementation.

In response, Gavi has made important changes to its CSO programmatic support. Gavi is now transitioning to an approach where CSOs will receive support through a country’s Health Systems Funding Platform application. See Gavi’s management response to the independent evaluation.

Civil society organisation support is primarily through the Health Systems Funding Platform which aims to support countries in advancing their national health strategies

Current support for civil society organisations (CSOs) builds on the experience and evaluation of the pilot Type A and Type B programmes. Support to CSOs can now be requested as part of a country’s Health Systems Funding Platform (HSFP) application, whereby the allocation of funds to CSOs is determined by governments based on a country’s national health strategy. This is the recommended option for CSO support. However, governments may identify CSOs to receive direct funding under the HSFP. Gavi’s programmatic support is detailed in CSO implementation framework which has been developed to define CSO engagement more strategically at the country levels.

The Gavi CSO Constituency leads the implementation of the Gavi Business Plan activity that aims to increase civil society participation in HSFP processes and development of immunisation policies at the country level. 

In September 2011, on behalf of the Gavi CSO Constituency, Catholic Relief Services (CRS) was contracted for this purpose. CRS and the Gavi CSO Constituency work closely with the Gavi Secretariat to strengthen country-level civil society networks and platforms. This approach aims to encourage better coordination of CSOs in national health sector planning and policy processes in countries transitioning to the HSFP.

To date, CSOs have been engaged through the HSFP in Burkina Faso, the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, and Malawi.

Country-by-country approaches

In addition to the option for direct support for CSOs under the HSFP as described above, where rare and exceptional circumstances warrant a tailored approach, Gavi also retains the flexibility to support CSOs directly. 

Any such approach will be developed in response to a country-specific analysis, particularly taking into consideration those cases where CSOs play an integral role in delivering vaccines and the relationship between CSOs and governments is not well established.

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