Increasing the effectiveness and efficiency of immunisation delivery as an integrated part of strengthened health systems.
In the first year of our 2016–2020 strategy, we saw improvements in several areas of our health system strengthening (HSS) efforts. 90% of countries’ applications for HSS support were recommended for approval on first review, showing a clear commitment to improving coverage and equity. Eighteen countries applied for support for more modern, energy-efficient cold chain equipment through our innovative platform. There was an increase in the proportion of Gavi-supported countries meeting our benchmark for data quality.
Still, coverage rates for a full course of basic immunisation in Gavi-supported countries have remained unchanged over the past few years. This is a clear indication that some delivery systems are still weak.
Measuring progress
We track our efforts to strengthen health systems through five key indicators:
1. Supply chain performance
This indicator allows countries to evaluate their supply chain performance over time against best practice standards, as well as to identify and respond to shortcomings. It assesses features such as vaccine control, storage capacity, vaccine management, human resources and information systems.
In 2016, 15% of Gavi-supported countries met the 80% benchmark for effective vaccine management. While this is below the target of 20%, there are encouraging signs that our supply chain strategy is making a difference.
2. Data quality
We measure data quality by tracking the degree of consistency between available estimates of coverage. Read more about our support to improving data quality.
3. Coverage with a first dose of pentavalent vaccine and percentage difference between the first and third dose
Measuring coverage with a first dose of basic vaccines and the “drop-out” between the first and last dose provides a good indicator of the ability of health services to deliver immunisation services. High first-dose coverage combined with low drop-out rates suggests a strong health system.
In 2016, coverage with a first dose of pentavalent vaccine in Gavi-supported countries stayed flat at 87% for the third consecutive year. The difference between coverage with the first and third dose increased from 6 to 7 percentage points.
4. Integrated health service delivery
This indicator measures the integration between immunisation with three key vaccines and antenatal care. If these services achieve similar levels of coverage, it generally means that the linkages and coordination between them are strong.
In 2016, 26% of Gavi-supported countries met the benchmark for integrated service delivery – the same proportion as the previous year. Direct support for integrated service delivery is a recent development for the Alliance, and results will likely take several years to materialise.
5. Civil society engagement
We use three criteria to assess the level of civil society engagement:
- inclusion of civil society organisations (CSOs) in national immunisation plans with clearly stated activities;
- defined allocations in the EPI budget for CSO plans and activities; and
- documented evidence that CSO plans have been completed and/or are being implemented.
In 2016, 4 of the 10 countries for which data was available met all three criteria. CSOs featured in the immunisation plans of seven of these countries. Seven had clear budget allocations for plans and activities and six showed evidence of plans being implemented.