Health system strengthening 2000-2015

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Gavi recognised early on that strong health systems are essential to deliver and scale-up new vaccines and immunisation coverage.

This section outlines the evolution of the Vaccine Alliance’s health system strengthening (HSS) policies, from the opening of Gavi’s first HSS support window in 2005 to the introduction of performance based funding in 2012:

2005-2010: Gavi’s first HSS support window

In its first strategy (2000-2006), the Vaccine Alliance boosted the capacity of health and immunisation services through HSS. Once HSS cash support was made available in 2006, many countries submitted applications.

Initially, support focused on strengthening the overall health system through service delivery, training and management. Almost all grants in this early period targeted primary care and public health aspects of the overall system, in particular the delivery of services at community level – often to remote or underprivileged populations.

By the end of 2008, six meetings of the Independent Review Committee (IRC) had approved 46 grants with cash disbursements for HSS totalling $230 million. In 2009, 16 country applications were reviewed of which 10 were approved in two rounds of IRC meetings

2010-2012: the Health Systems Funding Platform


In 2009, following an HSS evaluation and at the recommendation of the High Level Taskforce on Innovative International Financing for Health Systems, the Health Systems Funding Platform (HSFP) was established as one way to accelerate progress towards health Millennium Development Goals 4 and 5 on reducing child and maternal mortality.

Gavi - together with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) - developed two funding modalities for HSS support, which aimed at enabling countries to submit a funding request template or common proposal form to the two agencies.

The platform brought together Gavi, the Global Fund, and the World Bank, with facilitation from WHO, linking their support behind developing countries' national health plans. Its aim was to streamline HSS support and align with country budgetary and programmatic cycles.

For past material regarding the HSFP, including HSFP guidelines, country stories or progress reports please contact

Until 2015: Improving immunisation coverage and equity through investments in health systems

Gavi’s five-year strategic plan for 2011-15 included a strategic health system goal. Strategic Goal 2 aimed to “contribute to strengthening the capacity of integrated health systems to deliver immunisation by resolving health systems constraints, increasing the level of equity in access to services and strengthening civil society engagement in the health sector.”

Countries were required to use Gavi health system strengthening (HSS) funding to target “bottlenecks” or barriers in the health system that stand in the way of increased access to immunisation and other child and maternal health services. Support was based on performance and linked to improvements in immunisation coverage and equity of access. In line with International Health Partnership (IHP+) principles, funding was also dependant on country proposals’ alignment with the annual planning and budgeting process of their national health plans.

>76 million

Our support has contributed to immunising over 76 million children against rotavirus diarrhoea. By the end of 2017, 43 countries had introduced the vaccine with support from the Vaccine Alliance.

WHO/UNICEF and Gavi 2018

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