Evaluation of Phase 1 GAVI Immunization Services Support (ISS) Funding Grace Chee, Natasha Hsi Kenneth Carlson, Slavea Chankova, Patricia Taylor

GAVI Alliance Formerly known as the Global Alliance for Vaccines and Immunization Provides support to Governments for: New vaccines Injection safety Immunization Support Services Health System Support Civil Society Support

Immunization Services Support Performance-based funding given to governments Flexible funding to be used for strengthening immunization services Funding comprised of an investment share and a reward share Reward share contingent on increasing the number of children immunized and passing a Data Quality Audit (DQA)

Areas of Evaluation Experience of the ISS scheme Impact of ISS on overall immunization financing Impact of ISS on immunization program performance Factors correlated with differences in performance Impact of ISS design and structure on immunization performance

Evaluation Methods Regression model with data from 52 countries that received ISS funding by Dec 2005 In-depth comparative study of three pairs of GAVI-recipient countries

Data for Regression Model Data from 52 countries that received ISS funding by Dec 2005 Relies on Annual Progress Reports, WHO-UNICEF JRFs, FSPs (29) Disbursement data from GAVI Secretariat WHO-UNICEF Best Estimates of DTP3 coverage rates WHO & World Bank data on economic, health expenditure, and political indicators

Modeling Methods Builds on regression model developed by Lu et al. to test effects of ISS expenditures on DTP3 coverage rates Model consisted of ISS expenditures, WHO-UNICEF Best Estimates DTP3 coverage rate, and covariates Covariates: GDP per capita, IBRD Political Stability Index, average DTP3 coverage rate 1998-2000 Tested for effects of ISS expenditures using the logistic transformation of DTP3 coverage rates as the dependent variable

In-depth Country Studies Studied three pairs of countries with similar characteristics at beginning of GAVI, but different outcomes Cambodia Laos PDR Tanzania Zambia DRC Guinea DTP3 at baseline (application 65% 56% 74% 75% 31% 57% DTP3 in 2005 82% 49% 90% 80% 73% 69% LICUS status Yes No Political stability index in 2000 -0.93 -0.27 -0.52 -0.73 -2.93 -1.44 Political stability index in 2005 0.29 -0.11 -0.37 0.02 0.23 DQA verification factor 98% 59% 79% 88% 95%

Qualitative Questions for In-depth Country Case Studies How has ISS been integrated into health system planning? What are factors that foster or constrain improvements? How does flexibility of ISS funding affect performance? How do rewards affect coverage? What do countries do when they fail their DQA?

Findings and Results Evaluation concluded Sep 07, and findings submitted to GAVI Findings to be released by GAVI in the next month should be available on GAVI website www.gavialliance.org findings and recommendations will be considered in future GAVI policies

Thank you