Gavi's impact

As a result of Gavi's immunisation services support, an additional 76.5 million children were immunised between 2001 and 2010

A 2007 review of Gavi’s immunisation services support (ISS) programme said ISS had a “significant, positive impact” on immunisation coverage. The review looked at the first five years of ISS in 53 countries approved for ISS support, and said ISS helped boost coverage in countries with both high and low baseline coverage rates.

Between 2001 and 2010, an extra 76.5 million (WHO projections 2010) children were immunised as a result of ISS.


In  2007, Gavi commissioned an external review of the first five years of its pioneering immunisation services support. Download the final report.


In the Democratic Republic of Congo (DRC), for example, ISS supported a WHO/UNICEF strategy to boost immunisation in low-performing districts, paying for vehicles and transportation, personnel, training, and staff supervision.

After one year, 70 percent of children in these districts (more than half of the country’s 276 health zones) were immunised with three doses of diphtheria-tetanus-pertussis vaccine (DTP3) by their first birthday, compared with 54% in the other districts.


Tanzania’s rural Mpwapwa district also received ISS support. The 280,000 population had not been generally supportive of immunisation, but the district used US$ 13,000 of Tanzania’s ISS funding to educate and sensitise the people.

Once solid support was in place, ISS funds paid for training, fridges, bicycles for outreach, calculators for data collection, and a stock of vaccination cards. Within one year, DTP3 coverage rose and then stayed high.

Please note that this type of Gavi support is being phased out with all cash-based support channelled through health system strengthening.

The issue

Building a country's immunisation system is the first step to increasing children's access to live-saving vaccines

Building a country’s immunisation system is often the first step in increasing children’s access to life-saving immunisation and other essential health services.

And the effectiveness of any immunisation system is generally measured by the proportion of children who receive the required three doses of diphtheria-tetanus-pertussis vaccine (DTP3) through routine immunisation.


In 2000, for example, when Gavi was established in 2000, DTP3 immunisation coverage in Gavi-supported countries was just 65%. Today that figure is closer to 80%.

This illustrates the success of earlier efforts to boost immunisation levels, including notably WHO’s Expanded Programme on Immunisation (EPI) which started in 1974. But Vaccine Alliance partners, including WHO, wanted to see immunisation coverage even higher.

As DTP3 coverage increases, a country generally has increasing capacity to introduce new and life-saving vaccines, such as the pneumococcal and rotavirus vaccines to help protect against the world’s biggest killers of children, pneumonia and diarrhoea.


From 2012 onwards, countries who wish to receive Gavi support with the introduction of new vaccines will need to have DTP3 coverage above 70%.

Obstacles to expanding immunisation coverage vary from country to country. In some countries, the issue might be a lack of refrigerators; elsewhere a lack of public awareness about the importance of immunisation might be the critical issue.

Gavi's response

One of the first performance-based programmes of its kind, countries decide how and when to use ISS funding as long as DTP3 coverage rates rise

Established in 2000, Gavi’s immunisation services support (ISS) is a flexible programme which countries can use to improve their immunisation performance. Countries have complete control over how and when to use their ISS funding on the condition that DTP3 coverage rates continue to rise.

One of the first performance-based programmes of its kind, the ISS programme has two main characteristics aimed at supporting countries to increase their immunisation coverage.


The first characteristic is that the ISS funding is performance-based.

After an initial two years of investment funding, countries receive funding based on the additional number of children receiving immunisation. The amount of funding was equal to US$ 20 per extra child immunised above the number previously reached.


The second characteristic is that ISS funding is flexible, so that countries and governments spend ISS funding as they consider most appropriate. For example, they can use the funding to plug gaps or support underfunded areas.

By the end of 2010, the Gavi Board had approved US$ 337.2 million for the ISS programme, of which the largest sums were for Pakistan (US$ 48.8 million), Nigeria (US$ 47.2 million), the Democratic Republic of Congo (US$ 25.8 million), and Bangladesh (US$ 23.3 million).

Please note that this type of Gavi support is being phased out with all cash-based support channelled through health system strengthening.


The second of Gavi's four strategic goals for 2011-2015 captures health service as a key principle of Gavi's mission. The health systems goal targets strengthening the capacity of integrated health systems to deliver immunisation.

Although most of Gavi’s support to countries is for the purchase of vaccines, 15-25% of funding support is to be directed to achieving this strategic goal.

As well as ISS support, Gavi has provided two other types of support targeting delivery systems:

Related content

Immunisation services support evaluation

External review of effectiveness of Gavi's ground-breaking Immunisation Services Support over its first five years (2000-2005).

Last updated: 24 Nov 2019

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