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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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
Tested for effects of ISS expenditures using the logistic transformation of DTP3 coverage rates as the dependent variable

8. 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%

9. 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?

10. 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
findings and recommendations will be considered in future GAVI policies

11. Thank you