Study Details

Linking programmes and systems: lessons from the GAVI Health Systems Strengthening window

Author(s)

Galichet B  Goeman L.  Hill P.  Essengue M.  Hammami N.  Porignon D.  Kadama P.  Leberghe W. 

Date

January Unknown
Reference

Tropical Medicine and International Health  15:2 pp 208-215
Web Link

View PDF

Organisation

World Health Organisation (WHO)
Keywords

GAVI, health systems strengthening, ownership, governance, alignment, harmonization, financing
Study Type

Documentary review
Aims

To analyse the first four rounds of country applications to the GAVI Alliance Health Systems Strengthening (GAVI-HSS) funding window; to determine how countries prioritize, articulate and propose solutions for health system constraints through the GAVI-HSS application process; to examine the extent to which this process embodies alignment and harmonization principles of the Paris Declaration.

Methods

The study applied multiple criteria to analyse 48 funding applications from 40 countries, submitted in the first four rounds, focusing on the country analysis of health systems constraints, coordination mechanisms, alignment with national and sector planning processes, inclusiveness of the planning processes and stakeholder engagement.
Findings

A positive assessment of the GAVI HSS application process, with evidence of good alignment, coordination and inclusive stakeholder involvement.

Alignment: Of 48 applications, 14 applications were fully aligned, 18 mainly aligned, 6 partially, 6 poorly, and 4 unaligned (when measured against 3 objectively verifiable core criteria aligned with budget cycles; comparison of health systems issues identified in the application and the National health Plan (NHP); implementation through existing structures and mechanisms)

Coordination, inclusiveness and stakeholder involvement: of 29 applications 13 were inclusive, 11 partly, 3 poorly and 2 were not inclusive (against 4 objectively verifiable core criteria evidence of a Health Systems Coordination Committee meeting at least twice per year; participation of at least 4 international stakeholders in application process; presence of one or more representatives from private sector, civil society, independent health professionals, or academics; documentary evidence of stakeholder attendance at preparatory meetings).

Increased inclusivity was evident across the three stages of the application process drafting, review and endorsement (although more pronounced during the initial stages) with Technical Support being the primary form of support provided by stakeholders during the drafting stage.
Conclusions /
Recommendations

  • HSS initiatives can serve to link health program and health system reforms. The high proportion of activities identified in this study that have broad health systems linkages suggest that programme specificity has been transcended, and that GAVI HSS process was instrumental in achieving this outcome.
  • By giving countries a free hand to identify for themselves health systems constraints, GAVI HSS flexibility avoids problem specificity and allows locally appropriate responses. There are significant transaction costs attached to this process, however because it requires structural change.
  • Health systems constraints have mostly focused on operational responses (supplies, training, financial incentives for the workforce), raising issues of sustainability.
  • Country-led proposal development can contribute to alignment and harmonization. In 9 cases, the GAVI HSS process was a catalyst to establishing national coordination capacity; it links proposals to alignment with national cycles; it creates a political space for policy alignment and building strong local coalitions.
Sponsored by DFID, Danida, Irish Aid