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Strategy update: indicators, progress and lessons learned
The GAVI Board meeting on June 14-15, 2017, reviewed the progress of the 2016-2020 strategy, highlighting data-driven insights and performance indicators. Key achievements included immunizing over 65 million children and a commitment to improve vaccine delivery and equity. The meeting emphasized ongoing challenges in vaccine introductions and the need for enhanced data quality and sub-national analysis for better vaccination strategies.
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Strategy update: indicators, progress and lessons learned
- 1. www.gavi.org UPDATE FROM THE SECRETARIAT,INCLUDING 2016-2020 STRATEGY, INDICATORS AND KPIs GAVI BOARD MEETING Seth Berkley 14 June 2017, Geneva
- 2. Second update onthe 2016–2020 strategy • Systematic, data-driven report on progress • Based on new, ambitious framework • Starting to bear fruit and strengthen our understanding • Learning what works well and where we should revisit Lessons on indicators discussed throughout 2 Board meeting 14-15 June 2017
- 3. The Alliance accountabilityframework Strategy indicators and targets Alliance KPIs Joint Appraisal Country Performance Management Secretariat Performance Management Team Performance Management (TPM) Individual Performance (PMP) PEF Functions Targeted country assistance Strategic focus areas PEF Performance Management High-Level Review Panel (HLRP) Grant Performance Framework (PF) Corporate Performance Management (CPM) Focus of update Joint Appraisal Country Performance Management Secretariat Performance Management Team Performance Management (TPM) Individual Performance (PMP) PEF Functions Targeted country assistance Strategic focus areas PEF Performance Management High-Level Review Panel (HLRP) Grant Performance Framework (PF) Corporate Performance Management (CPM) Board meeting 14-15 June 2017
- 4. 2016–2020 INDICATORS MISSION PROGRESS Boardmeeting 14-15 June 2017 2015 2017 2018 2019 2020 TARGETS 2016 Children immunised 300 million > 65 million 1 Future deaths averted 5-6 million > 1.2 million 2 Under-five mortality rate 58 per 1,000 10% reduction in rate from 2015 baseline by 2020 < 64 per 1,000 3 Future disability-adjusted life years (DALYs) averted 250 million > 56 million 4 Vaccines sustained after Gavi support ends 100%100% 5 Projected on track, based on assumed continued improvement over last report (latest available data shown) On track, based on data available year to date Estimate as of mid-2017: 100 million
- 5. 2016–2020 INDICATORS DISEASE DASHBOARD Boardmeeting 14-15 June 2017 Hepatitis B Percent of Gavi countries with low prevalence of under-5 hepatitis 83% (5 of 6 countries) Rotavirus 24% (25 countries) Proportion of acute gastroenteritis hospitalisations testing positive for rotavirus in children under 1 Measles 100% 50% (35 of 70 countries) 2015 2017 2018 2019 20202016 Percent of Gavi countries reporting fewer than 5 measles cases per million annually Availability of data
- 6. 2 3 4 5 Improve sustainability3 Shapethe market4Accelerate vaccines1 Strengthen capacity2 2016–2020 INDICATORS STRATEGY PROGRESS 1 EQUITY: GEOGRAPHIC DISTRIBUTION 2016 DATA AVAILABLE Q3 2017 EQUITY: WEALTH DISTRIBUTION EQUITY: EDUCATION ROUTINE IMMUNISATION COVERAGE 2016 DATA AVAILABLE Q3 2017 1 2 3 4 5 SUPPLY CHAIN PERFORMANCE 2016 DATA AVAILABLE Q3 2017 DATA QUALITY PENTA1 COVERAGE & DROP-OUT RATE 2016 DATA AVAILABLE Q3 2017 INTEGRATED HEALTH SERVICE DELIVERY 2016 DATA AVAILABLE Q3 2017 CIVIL SOCIETY ENGAGEMENT 2 3 4 1 COUNTRY INVESTMENT IN VACCINES 2016 DATA AVAILABLE Q3 2017 COUNTRIES ON TRACK TO TRANSITION 2016 DATA AVAILABLE Q3 2017 INSTITUTIONAL CAPACITY CO-FINANCING COMMITMENTS 2 3 4 1 VACCINE PRICE REDUCTION VACCINE INNOVATION HEALTHY MARKET DYNAMICS SUPPLY SECURITY Measles-containing vaccine 1st dose Percentage point Pentavalent 1st dose Pentavalent 3rd dose MCV1 PP Penta1 Penta3 CURRENT: +1PP PENTA3 86% MCV1: 83% PENTA3: 81% MCV1: 78% 2015 VALUE 2020 TARGET CURRENT: +1PP 63%31% 2015 VALUE 2020 TARGET CURRENT: +1PP 26%16% 2015 VALUE 2020 TARGET 2020 TARGET 43%16% 2015 VALUE 2020 TARGET 36%26% 2015 VALUE 2020 TARGET PENTA1: 91% DROP-OUT: 3 PP PENTA1: 87% DROP-OUT: 6 PP 2015 VALUE 2020 TARGET 100%N/A 2015 VALUE 2020 TARGET ** Currently insufficient data to define target; targets to be defined after provision of one full year of PCA version 3.0 reports 1 Not published due to commercial sensitivity 35% TARGET: 49% (2020) 30% TARGET: 44% (2020) 49% TARGET: 53% (2020) 100% TARGET: 100% (2020) 9/11 TARGET: 11/11 (2020) $19 TARGET: N/A1 3 TARGET: 10 (2020) 2/11 TARGET: 6/11 (2020) ON TRACK MODERATE DELAYS / CHALLENGES SIGNIFICANT DELAYS / CHALLENGES 6 3 1 40% TARGET: ** 0% TARGET: **PREV: 39% PREV: 34% PREV: 45% 75%63% 2015 VALUE 2020 TARGET PREV: N/A PREV: N/A PREV: 85% PREV: 7/11 PREV: $20 PREV: 0 PREV: 1/11 BREADTH OF PROTECTION 2016 DATA AVAILABLE Q3 2017 TO BE REPORTED Q3 20178
- 7. SG1 Equity indicators % ofGavi countries with: Data source Geographic equity Administrative data >80% third dose pentavalent coverage in all districts Wealth equity Surveys≤10% point difference in coverage between richest and poorest quintile Gender equity Surveys≤10% point difference in coverage between children of mothers with no education vs secondary/higher education • Limited number and timing of surveys available • Quality of data • Thresholds can mask important developmentsChallenges MODERATE CHALLENGES Board meeting 14-15 June 2017
- 8. SG1 Alliance work onequity Equity mainstreamed in grant processes - key points: • Where are the under-immunised children? • What are the barriers to immunisation? • How can Gavi support? Improving sub-national data: • Sub-national administrative coverage for PEF priority countries reported this year • First reporting of sub-national data through joint reporting form • Support to triangulation of sources at sub-national level to strengthen decision-making Coverage with the third dose of pentavalent vaccine, 2016 0 – 49% 50 – 79% >= 80% Municipal level ANGOLA Board meeting 14-15 June 2017
- 9. SG1 Vaccine introductions acrossstrategy periods Board meeting 14-15 June 2017 27 Gavi 4.0 (2016-20) 215 Gavi 2.0 (2006-10) 67 Gavi 1.0 (2001-5) Gavi 3.0 (2011-15) Routine introductions Vaccination campaigns ~270
- 10. SG1 Target of 50introductions in 2017 Board meeting 14-15 June 2017 49 71 45 24 68 27 2020 72 2015 139 2014 59 10 ~35 2019 ~40 2018 ~80 2017 51 14 2016 Forthcoming/ projected Completed Gap to projection Introductions as of 12 June 2017 MODERATE CHALLENGES At risk (13) Target: 50
- 11. 14 introductions in2017 – majority are campaigns Since January 2017: 5 routine introductions 9 campaigns/demos Bolivia HPV Lesotho Measles-rubella Burundi Measles-rubella Uganda Meningitis A Ethiopia Measles CAR Meningitis A Côte d’Ivoire Rotavirus Burkina Faso Meningitis A Mali Meningitis A Meningitis A Cambodia HPV Measles-rubella India Measles- rubella Pneumococcal
- 12. SG2 Grant performance frameworks:long-term vision ✓ Completed/ongoing All countries have grant performance frameworks (GPFs) 80% of countries meet reporting requirement Compliance Joint appraisals Target: all 2017 joint appraisals use GPF analyses High-level review panels Programmatic & financial performance analysis Use Focus on improving quality Refine guidance, particularly for HSS metrics In progress Quality Analyses & visualisation Results & learning to inform 2021-2025 strategy Planned Learning Board meeting 14-15 June 2017
- 13. SG2 Using grant datato inform our strategy: Niger Examining data Bringing together and reallocating grants Monitoring Incorporating new data Underimmunised children concentrated in urban and a few rural areas Reinforcing outreach and mobile services in rural areas Some HSS funds reallocated towards underimmunised children in urban areas PEF technical support to ensure robust 2017 coverage survey % surviving infants receiving 3rd dose pentavalent vaccine through each of fixed, outreach and mobile immunisation services Use survey data to map unimmunised children by geographic areas Joint appraisal to focus on challenges with urban strategy Board meeting 14-15 June 2017
- 14. SG2 Supply chain strategy:progress Board meeting 14-15 June 2017 2020 deliverables 35 countries have dedicated and competent supply chain leaders All Gavi countries implement comprehensive supply chain management plans 30-40 countries use data to oversee supply chain and measure performance 40-50 countries have improved cold chain equipment At least 10 countries have done system design Leadership Continuous improvement plans Data for management Cold chain equipment System design On track 32/47 countries show improvement in EVMs; 6 countries with EVMs >80% 10 countries started analyses; 7 countries implementing Applications from 42/51 eligible countries 23 countries started implementation SC leaders in 10 countries meet competency requirements Current status
- 15. SG3 Transitioning countries 55 5048 47 47 43 40 21 161818 181717 2017 9 2021 12 2020 12 2019 9 2018 9 2016 5 2015 Fully Gavi-eligible Accelerated transition Fully self-financing Bhutan Honduras Mongolia Sri Lanka Ukraine 4 more countries transitioned end 2016 Based on current projections India Lao PDR Nigeria Solomon Isl. Ghana Guyana Indonesia Kiribati Moldova Angola Armenia Azerbaijan Bolivia Congo Rep. Cuba Georgia Timor-Leste - Vietnam Nicaragua PNG Uzbekistan Ghana Zambia ON TRACK 15 Board meeting 14-15 June 2017
- 16. SG3 Co-financing $36m $64m $91m $113m $123m 2016201520122011 $121m 20142013 % of countries notin arrears 94% 87% 79% 75% 85% 92% Pending Payments ON TRACK As of 31 May 2017. Countries with co-financing requirements aligned to fiscal years, with waivers and pending reconciliation of self-procurement amounts. 16 Board meeting 14-15 June 2017 Includes US$ 34m from Kenya and Pakistan, only due in June $39m $160m$20m Self-financed programmes $39m
- 17. SG3 Institutional capacity Country EPI capacity NITAGICC Burundi Cambodia Ghana Guinea Malawi Myanmar Nepal Niger N/a Nigeria N/a Togo National immunisation technical advisory group Interagency coordination committee NITAG ICC SIGNIFICANT CHALLENGES New indicator, measured through programme capacity assessments • 10 countries with data so far • ~12 more expected in 2017 47% of sub-indicators pass the threshold 17 Board meeting 14-15 June 2017
- 18. SG4 Market shaping 9 7 20162015 11 Markets with sufficient& uninterrupted supply 2015 -5% 2016 $19$20 Average price to fully vaccinate a child* 3 0 20162015 10 Vaccines/products with improved characteristics 21 20162015 11 Markets with moderate/high market dynamics * with pentavalent, rotavirus and pneumococcal vaccines ON TRACK 18 Board meeting 14-15 June 2017
- 19. No target; trackingtrend over time 2015 baseline; value to be updated in Q3 following improvements to data sources to be implemented over 2017 JA season † * Partners3 1 2 3 4 5 6 7 Governance4 1 Secretariat & partners1 2 3 4 5 6 Secretariat2 1 2 3 4 5 6 1 2 3 2016–2020 INDICATORS ALLIANCE PROGRESS UPDATED: 25 April 2017 PARTNER GROUP Health system strengthening Targeted country assistance Strategic focus area Partners' engagement framework Civil society organisation HSS TCA SFA PEF CSO ON TRACK MODERATE DELAYS / CHALLENGES SIGNIFICANT DELAYS / CHALLENGES 5 10 1 11.6 MONTHS VACCINE INTRODUCTIONS TARGET: 90% (2016) 63% PREV: N/A NEW VACCINE COVERAGE TARGET: 90% (2016) 89% PREV: N/A MEASLES CAMPAIGN COVERAGE TARGET: 90% (2016) 75% PREV: N/A SPEED OF CASH GRANT DISBURSEMENTS TARGET: 9 MONTHS (2016) 11.6m PREV: 13.7M AUDITS ON TRACK TARGET: 80% (2016) 56% PREV: 30% PROGRAMME FINANCE FORECAST TARGET: +/- 10% (2016) -18% PREV: -11% TARGET: 80% (2016) PEFTCA ACTIVITIES ON TRACK 15% PREV: 30% DONOR ENGAGEMENT IN COUNTRY TARGET: 100% (2016) 20%* PREV: N/A SECRETARIAT SUPPORT TO GOVERNANCE TARGET: N/A† TO BE REPORTED AT JUNE BOARD HSS PROPOSAL QUALITY TARGET: N/A† 90% PREV: N/A HSS FUND UTILISATION TARGET: N/A† 61% PREV: 56% HSS GRANT TARGETS TARGET: 80% (2020) 45% PREV: 31% RISK MANAGEMENT PLAN PROGRESS TARGET: 80% (2016) 93% PREV: 90% OPERATING EFFICIENCY TARGET: N/A† $293K PREV: $233K OPERATIONAL DEMAND FORECAST TARGET: +/- 10% (2016) -10% PREV: N/A CSO ENGAGEMENT 70% TARGET: N/A CSO PREV: N/A PLEDGE CONVERSION 80% TARGET: 80% (2016) DONORS PREV: N/A EVALUATION ALIGNMENT TARGET: N/A† DONORS 16 EVALUATIONS PREV: N/A COUNTRY REPORTING TARGET: 75% (2016) COUNTRIES 80% PREV: 54% BOARD ATTENDANCE TARGET: 90% (2016) 81% PREV: 85% GENDER BALANCE TARGET: 40-60% (2016) 33% PREV: 37% TRACKING TREND ONLY (NO TARGETS OR PERFORMANCE RANKING)6 SFA/PEF ACHIEVEMENTS TARGET: 80% (2016) PEF PREV: N/A 71% Gender balance now 36% overall, 46% for the Board 2016 drivers of delays: IPV, HPV, rotavirus 1 percentage point from target 3 out of 4 countries with surveys met target Above target but limited number reporting Going down but still above target 10/18 completed; another 6 close to completion Caused by IPV and cash programme delays Nov 2016 reporting– 8 months after start Nov 2016 reporting Still reflects 2015 baseline from JAs Small decrease since last measurement Board meeting 14-15 June 2017
- 20.
Editor's Notes
- #3 Reminder for new members of role of update Framing that we are learning what is working and what isn’t. Reminder that update to most important Strategy Indicators is forthcoming at the end of the year
- #4 Reminder of the Alliance Accountability Framework
- #5 Mid-2017 estimate extrapolated from previous update The Vaccine Alliance tracks five key targets to help achieve our mission: to save children's lives and protect people's health by increasing equitable use of vaccines in lower-income countries. Figures are updated annually and cover 68 Gavi-supported countries. 2016 values will become available in Q3 2017.
- #6 Note: there was an expectation that more data would become available after the WHA resolution on hepatitis elimination in 2014 and subsequent increased attention on HepB birth dose. We have not seen that increase in data availability yet. First introduction to the Disease Dashboard Data on disease dashboard in its first year – trend will be analysed over the course of the strategy period as we build more data The Alliance is also defining secondary indicators below the primary indicators that will complement the primary indicators that are based on surveillance data Availability of data: Measles is reported through JRF and available for most countries but data quality is variable. Data availability is consistently high for this indicator. Countries reporting <5 measles cases per million annually: 2010: 29 2011: 28 2012: 30 2013: 36 2014: data requested from WHO, pending Rotavirus is reported through the WHO Global Rotavirus Surveillance Network. Only countries that reported for all 12 months were included – thus countries may drop out and come back in. 13 of 25 countries in the indicator had introduced Rotavirus vaccines in 2015 Hep B: data comes from WHO regional Hep B control initiatives. Only high-quality data is included in the indicator (countries with nationally representative serosurveys conducted for target population). The number of countries is currently low and it is unclear how much data availability will improve over the coming years. Countries included are those with currently strong Hep B control initiatives, so the indicator value is likely higher than the full picture in Gavi 73 countries. The team asked to remove quality of data as: All three (HepB, Rota, Measles) are surveillance based. Hep B has high quality surveillance but low quantity Rota is variable, based on sentinel sites – according to Daniella it is variable Measles is reported through the JRF, but is surveillance data. Daniella says the data is not that bad and it would send a negative message to highlight the measles data as poor Revisiting of indicators: Secondary indicators will be defined for dashboard indicators, which will use surveillance and impact study data. This will aim to supplement the primary indicators and to improve data availability to some extent The Hepatitis B indicator will be revisited as part of a broader exercise of revisiting indicators, as the global push on HepB serosurveysdid not materialise as expected. The Rotavirus indicator will be reviewed.
- #7 Blue boxes show which indicators were updated Equity indicators addressed in following slides Institutional capacity indicator discussed under SG3 Civil society engagement: CSO indicator is new, like the institutional capacity indicator It is also measured through PCAs. A country has to pass on 3 criteria: CSO included in national plans Budget lines are given for CSOs Does implementation proceed against plan The indicator is highlighted as amber due to the 40% value, but was not deemed low enough to warrant revisiting Hence not highlighted as ones to be revisited
- #8 Reporting Geographic equity is reported through JRFs 46 countries with surveys measuring wealth equity in the last 5 years (+2 from prior year – 6 additions, 4 dropped out) 38 countries with surveys measuring gender equity proxy in the last 5 years (maternal education) (no change – 5 additions, 5 dropped out) Indicator issues All indicators use a threshold. If a country improves equity, but doesn’t cross the threshold, it doesn’t show up in the indicator (e.g., if Nigeria were to decrease wealth inequity from >70% to 15%, the indicator would not change). Small changes around the threshold change the indicator, though (e.g., decrease from 12pp difference to 8pp adds one country to the indicator value)
- #9 Angola map: The map shows administrative coverage. Note that as the use of a lower denominator increased the 2016 coverage artificially, the 2016 map could overestimate the reality National pentavalent 3 coverage in 2015: 64% (WHO/UNICEF estimate) Please note – sub-national reporting is through JRF and the WUENIC methodology is being reviewed. Sub-national data was previously not reported up to global level through the JRF process. Analyses of where under-immunised children are and barriers to immunisation takes place at JAs Gavi support through PEF and HSIS grants Note on equity mainstreaming: The CEF and JA processes emphasise specific analyses on coverage and equity at country level The JA analysis guidance gives examples of analyses to be conducted, for example coverage analyses on a region by region level The JA template has also been adapted to focus discussions on Coverage and Equity
- #10 More Gavi-supported immunisation events in this period than ever before Nearly half of events will be non-routine. Raises a number of questions as described in paper: How will the Alliance ensure an integrated approach to disease control, grounded in routine immunisation strengthening and complemented by supplementary immunisation activities and outbreak response? What shifts in operational approaches would be needed to ensure campaigns strengthen and do not detract from routine immunisation? What new measures are needed to ensure campaigns are targeted to reach the consistently missed children and are of high quality? How does the Alliance ensure value for money? Significant shift in focus of immunisation events 2016-20: >80% of events are measles / MR (~100 events 2016-20), Men A (~50 events 2016-20) and HPV (~35 events 2016-20) and IPV (32 events 2016-20) vs. Penta, PCV and rota in previous periods Note: October Strategy Progress Update quoted approx 200 introductions in this period (estimate at that time was 235) May paper quotes approximately 300 (latest VI estimate is 308). We quoted a figure of 300 in the paper, but if HPV MAC are excluded (i.e. are considered as one event if implement concurrently with RI introduction), the figure is closer to 270. The 271 includes: 25 MR follow-ups 20 measles follow-ups
- #11 2017: In total 14 introductions to date in 2017 (as of 12 June) NOTE: 2014 and 2015 projections from June 2014 Board presentation. Number of introductions from VI. 2018: Events HPV: 1 demo (20 MACs excluded) JE: 1 MenA: 4 catchup, 1 other MR: 7 catchup, 9 follow up Routine HPV: 17 IPV: 16 JE: 2 Measles 2nd D: 2 Men A: 4 MR 1st D: 7 MR 2nd D: 5 Rota: 4 YF: 3
- #12 Introductions as of 12 June
- #13 Note: the 80% reporting refers to the Alliance KPI 3.7, i.e. 80% of countries reported on at least 80% of due indicators at the end of 2016, which is for 2015 (due to reporting timelines). We are making good progress vis-à-vis strengthening our understanding of results and using these to inform grant management decisions in HSS. While 2015 focused on developing and introducing the grant performance frameworks and establishing strong reporting compliance with countries, 2016 saw analyses of these beginning to be used in joint appraisals and by the high level review panel. We aim to further strengthen the use of data and analyses of results as part of joint appraisals this year and are working to improve the quality of grant performance frameworks, in terms of metrics, targets and analyses, going forward. Following this years’ joint appraisals and completion of reporting on 2016 performance, we will be able to perform more informative portfolio and thematic analyses, for example reviewing performance across grant categories and trends of performance across different grant objectives on a country by country basis. As more reporting comes in and with richer analyses being developed over time, we look forward to using these results and learning to ultimately inform our 2021-2025 Strategy.
- #14 Poor data quality affects ability to monitor progress across Note on data sources for mapping / equity analysis: The mapping was done based on the last coverage survey in 2013 and surveillance data. An equity analysis is currently being conducted with a coverage survey planned in the coming weeks. A polio assessment has recently been completed, which will be used in the next mapping of under-immunised for this year’s JA This example of Niger shows how we are moving from situation analyses, based on available data and analyses, to inform our response and key activities, to using results and data to refine our response and ensure our support is targeted at those most in need. Here you can see that efforts are being made to ensure we are reaching those unimmunised children in rural areas and tracking intermediate results through our grant performance framework to understand whether targets related to outreach services and mobile services (which are essential while efforts to improve fixed site service delivery are ongoing) are being met. You can also see that we, along with our Alliance partners and country colleagues, are seeking to address concerns around the poor quality of data and using newly available data to verify our support is appropriately targeted. Niger’s DTP3 coverage was just 65% in 2015, with inequities across wealth, gender and geography Urban population in Niger: According to World Bank statistics, approximately 19% of the total Niger population lives in urban areas. You should note that most of urban residents live in Niamey region (approximately 40%). In terms of our funds going to urban, the original HSS proposal did not allocate any funds to urban areas; as part of the reallocation process, we have earmarked USD 100,000 for 2017 (out of a total budget of USD 10 million) for testing new strategies. The idea is to shape the new HSS which will come in effect in 2019.
- #15 Leadership Based on competency framework from “People that Deliver”, a health supply chain consortium Mid-term assessment will be conducted in late June, together with partners, at UNICEF SD Target of 15 leaders by end 2017, 20 by end 2018 Continuous improvement plans 47 countries have 2 EVMs since 2010, of which 32 have increased their score 6 countries have a composite score higher than 80% 2015 EVMs completed: 20 2016 EVMs completed: 6 2017 EVMs planned: 8 2018 EVMs planned: 10 Description of Accelerating arrows: Leadership : training of supply chain leaders has accelerated in 2016, for example through implementation of e-learning modules (>500 users trained) and STEP training. STEP training will further accelerate in 2017 with integration off an HR module in EVM (STEP: 45 persons trained in 2016, 100 planned for 2017) Data for management: 2017 is a stock-taking year , identifying how to accelerate the implementation, e.g., standardisation of LMIS systems, remote temperature monitoring with Google and Nexleaf of data for management interventions with UNICEF CCEOP: processes have been mapped. This is now accelerating implementation and, e.g., by shortening procurement timelines System design: the number of countries implementing interventions has increased from 2016 to 2017. We anticipate further acceleration in 2017. Data for management The goal for 2020 for Data for Management is 30-40 countries use data to oversee and manage key aspects of their immunisation supply chain. 23 countries have initiated the work under D4M, which means using data to increase supply chain visibility DISC (Data Indicators for Supply Chain) have been developed and are starting to be integrated into Grant Performance Frameworks in 2017: Closed vial wastage Forecasted demand ratio Full stock availability Functional status of cold chain equipment On-time and in-full delivery Stocked according to plan Temperature Alarm Rate Cold chain equipment To date, 24 countries have submitted applications for support and 18 countries are approved or recommended for approval (Haiti, DRC, Uganda, Cameroon, Kenya, Niger, Madagascar, Pakistan, South Sudan, Uzbekistan, Guinea, Liberia, Malawi, Togo, Sierra Leone, Djibouti, Kyrgyzstan, Vietnam) The CCEOP targets 55 countries and 51 of those are the ones we are targeting as the remaining 4 are in their accelerated transition phase countries with at least 2 full years from date of review by IRC prior to becoming fully self-financing. System redesign For System Design implementations, there is no simple answer. However, for countries where implementation has started, the supply chain network looks completely different from the original one. Couple of examples below: Nigeria is removing the LGA level to deliver direct from the State to the HF’s from strategically placed regional warehouses. This has created more efficiency and responsiveness to HF needs. They’ve rolled out this new supply chain with an outsourcing partner that is managing the order, stock, and distribution. They are in the process of analyzing national level changes in response to national level storage capacity constraints. Senegal’s NMS, in close collaboration of IntraHealth, is implementing and starting scale-up of an Informed Push Model (IPM) distribution systems that bring brings >50 essential medicines to health centres by using private sector to distribute from district level. Discussions are pending inclusion of vaccines DRC is being driven from the Province, while there has already been separate redesign at the national level, but the national redesign (done in the past) would benefit from the learnings at the provincial level. This is an interesting story because they are eliminating most of the District stores to go directly to the HF’s, but they are keeping some existing District warehouses, where optimal, to store goods across HF’s for resiliency. Further, they are using the system design analysis to inform the placement of the cold chain equipment procured in the CCE OP. Benin is scaling up a new distribution system which consolidates multiple commune stores into one heath zone store in charge of collecting vaccines from the department store and distributing them to each of the health facilities on a monthly basis.
- #16 Notes on Ghana and Zambia: Zambia no longer projected to transition in this strategy period because of GNI changes Ghana – situation is different: could become eligible again, due to GNI changes, but not certain, situation needs to be monitored HSS no cost extensions: Existing – 2 countries Honduras: final year was 2015, HSS through 2016; info on final implementation of grant pending; potential final PBF payment in 2017 Timor Leste: final year 2017, HSS through 2018, potential final PBF in 2019 Potential – 2 countries Bolivia: final year 2017, HSS ending 2017, potential PBF payment in 2018 Congo Rep: final year 2017, HSS ending 2017, potential PBF payment in 2018 Catalytic vaccine support to countries after transition: MR (3) Indonesia Congo Rep. Angola HPV (8) National (4) Sri Lanka Honduras Guyana Bolivia Demo (4) Moldova Armenia Georgia Indonesia
- #17 Note: the 160 million in 2016 is based on the amounts communicated in decision letters. 2016: The difference is due to the alignment to fiscal years of Kenya and Pakistan (July-June), waivers and final reconciliation of procurement with actual amounts, including self procurement. Note: projections from EO dashboard on co-payments 2017: $163m co-payments + $72m fully self financing 2018: $169m + $89m 2019: $228m + $109m 2020: 249m + $132m Total: $935m (incl 2016) + $402m FSF (excl 2016) Note: information on lower co-financing than investment case shared in Dec 2016 through financial forecast, drivers include lower vaccine prices and delays in introductions. Co-financing picture will continue evolve in line with financial forecasts.
- #18 Notes: Indicator currently stands at 0% of countries For a country to “pass”, it has to meet the thresholds on all three areas (EPI, NITAG, ICC) The thresholds are: EPI capacity: 10 of 12 questions in PCA tool on EPI capacity score at least 3 of 5 NITAG: PCA question assessed with a score of at least 3 of 5 ICC: PCA question assessed with a score of at least 3 of 5 In addition to the 10 countries that have data, another 19 countries should be going through the process in 2017, increasing the data set Questions on EPI capacity: 2.1.1: The goals and mandates of the EPI team are clearly defined and appropriate for achieving the objectives of the immunization programme and the broader health system. 2.1.2: The reporting line of the EPI team to MoH leadership supports the team’s ability to carry out its mandates. 2.1.3: The EPI team is able to influence its own staffing policies and staffing decisions taken. 2.1.4: The EPI team is able to influence its own budget. 2.1.5: The EPI senior management is well acquainted with the relevance of operational planning, timely grant implementation, and monitoring of implementation. 2.2.1: The current organizational structure of the EPI team is well designed to support its mandates. 2.2.2: Each position on the EPI team has clearly defined and appropriate roles and responsibilities 2.2.3: The recruitment and retention of the EPI manager and other staff are effective. 2.2.4: There are clear, relevant and effective linkages between the national EPI team and sub-national level leaders and teams relevant for EPI. 2.3.1: The EPI team has adequate number of staff for managerial and technical functions to deliver on the programme. 2.3.2: The team (not necessarily any specific individual) has adequate managerial and technical competencies to deliver on the programme. 2.3.3: The team has adequate tools and processes to deliver on the proposed programme.
- #20 1.1: Introductions Drivers of delays: IPV introductions (14), HPV (3), Rota (4) 1.2: new vaccine coverage Very close to target (89% vs 90% target) The definition for Alliance KPI 1.2 was clarified to better reflect methodology: the indicator tracks the number of new routine vaccines (PCV, Rota, and MCV2) reaching 90% of reference vaccine (Pentavalent for PCV/Rota and MCV1 for MCV2) within a benchmark time following year of launch 1.3: campaign coverage: Gambia, Zambia, Kenya met Nigeria had coverage below and uneven There were additional countries where surveys were not yet available 1.4: approvals on first submission High number in 2015, will have to revisit how we measure this as we work more through the CEF 1.5: HSS fund utilisation This data still reflects the last year of the previous strategy period, due to country reporting timelines 1.6: HSS intermediary targets Big increase from 7% in 2014 and above target, but we had a limited number of countries reporting (33 countries). We are addressing this by making reporting a stricter requirement for renewals 2.1: speed of cash grant disbursement Baseline was corrected from 11.3 to 13.7m, when using exact dates Previous baseline used an approximation of dates Trend is down, but still above target of 9 months. Links to trade-off between time to disburse and risk management The target is 9 months, so the bar was designed to only show the excess over 9 months (similar to the operational forecast showing the deviation from the target) 2.2: audits on track 10 of 18 items were completed (3 of 8 internal audits, 7 of 10 programme audits). Another 6 (3 internal, 3 prog) audits were close to completion, but not finished in 2016 This first year has been a learning period for the team to to refine the planning of audit timelines 2.4: Operating efficiency Measured as Secretariat cost per programme, and is affected by countries transitioning out and a changing number of programmes. We don’t have a target for this indicator and have begun tracking it 2.6: programme finance forecast Caused by IPV and cash programme delays. Also, December supplier pre-payments were moved to January 2017, versus forecasted December 2016 3.1: TCA activities 3 of 20 PEF countries reported more than 80% of TCA milestones completed Reporting was in Nov, after a start in March (8 months), which contextualises the reporting figure. Overall, we saw an increasing % of TCA milestones completed, but not crossing the threshold 3.2: PEF Functions This is from Nov 2016 reporting, as partners report on PEF Functions once a year. PEF Function reporting is new and is gathering momentum. We will continue to observe the evolution. 3.3: CSO engagement Indicator tracks if CSOs are integrated into national plans (sub-indicator of CSO Strategy indicator) 3.5 : donor engagement This still reflects the 2015 baseline. Donor engagement will be tracked through JAs and updated after this year’s round of JAs. 3.6: Evaluation alignment Gavi conducted 16 reviews, audits and evaluations requested by five sovereign donors (including the Multilateral Organization Performance Assessment Network (MOPAN) and one private sector donor; these reviews include those outside of regular grant processes as well as those required as part of the regular granting process 4.1: Board attendance Measures attendance of the Board and Board Committees. Small decrease since last measurement, below 90% target Although overall attendance is good, developing country attendance is more variable, with average attendance of under 60% since beginning of 2014. Board guidance on what more we can do to support greater engagement of developing countries would be welcome. June 17: 60% April 17: 50% Dec 16: 40% 4.2: Gender balance * Measures the gender balance on Board and Board Committees. Should be between 40 – 60% of either gender. Small improvement since December. Board alone falls within the target range, but not with committees.