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GAVI: Preliminary notes

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  • Holden Karnofsky
    Our current top priorities on research are (1) creating a database of which charity does what (for as many charities as possible); (2) investigating the most
    Message 1 of 1 , Nov 3, 2008
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      Our current top priorities on research are (1) creating a database of which charity does what (for as many charities as possible); (2) investigating the most promising charities we find to see if we can get all the way to a recommendation on them.  Today I spent a bit over 2 hours looking at the GAVI Alliance, an extremely large initiative focusing on providing funding to developing-world countries specifically for immunization programs.  Preliminary, I think it is an extraordinarily transparent organization that has more thorough self-documentation (by a lot) than either of our current recommended charities in developing-world aid.

      I focused on trying to get a picture of their activities and what they report; I'm leaving actual review of the evaluation documents for later.  Note that DCP2 and Copenhagen Consensus both list immunization as one of the most cost-effective interventions; it is in our list of top-priority "straightforward" interventions, and we estimate that it is likely to be as cost-effective as anything else we've seen in terms of DALYs or LYS or lives saved per dollar.

      I had no trouble finding a detailed breakdown of how much is getting spent, on what sort of program, in what country.  Further, it appears that every single country's grant proposals, annual progress reports, and Data Quality Audit reports (less frequent reports that try to assess a country's self-reported data reliability from the outside) are posted online.  I downloaded all the materials for the Congo, which is receiving support under all 4 of GAVI's programs (including two new ones).  I'm hoping that I will be able to get an extremely concrete sense of what the programs involve and what is reported from these docs.  (I already list general descriptions for each program, but most are unclear to me.)

      More detailed notes follow.


      What they do


      Overall finances and dashboard

      Financial structure very confusing.  From http://www.gavialliance.org/media_centre/faqs/index.php :

      The GAVI Alliance is supported by the GAVI Secretariat in Geneva and Washington, DC, by four affiliated charitable entities: The GAVI Fund (the financing arm of the Alliance: tasks include asset management and investment, financial control, auditing and accounting), IFFIm (the International Finance Facility for Immunisation Company – a multilateral development institution designed to accelerate the availability of funds), The GAVI Fund Affiliate (assigns donor pledges to IFFIm for eventual GAVI programme disbursement), and the GAVI Foundation (provides certain contracting and administrative services to the GAVI Alliance Secretariat in Geneva). The GAVI Secretariat and GAVI Fund operate under the single leadership of the Executive Secretary and CEO. Each of the affiliated entities plays a specific and unique role to help support Alliance programmes and has its own Board. 

      2007GAVIReport.PDF pg 76-79 has the breakdown of funds across countries and projects.

      Immunisation Services Support – ISS


      Investment phase: $20 for each child to be immunized in the next year, over and above the baseline of last year.  Disbursed over time (25% in year of approval, then 25%, then 50%).

      Reward phase: $20 for each additional child who was actually vaccinated.

      Data Quality Audit required.

      Map: http://www.gavialliance.org/performance/commitments/iss/index.php.  Program has been running since 2000 and has reached most eligible countries since 2003.

      Injection Safety Support – INS


      "GAVI will contribute to the provision of auto-disable syringes, reconstitution syringes and safety boxes in quantities sufficient to vaccinate all women, and infants less than one year old, targeted in national immunisation schedules with the following vaccines: [list of vaccines] … Countries that can demonstrate secure and sufficient support to maintain use of autodisable syringes and safety boxes may apply instead for grants towards injection-safety activities."  This sounds more like restricted funds but I'm not sure. 

      Map: http://www.gavialliance.org/performance/commitments/ins/index.php.  Funding has been available since 2001 and reaching most eligible countries since 2003.


      New and underused vaccines support – NVS


      "GAVI provides support to developing countries to introduce the following vaccines and associated vaccine technology. GAVI's support aims to accelerate their uptake and to improve vaccine supply security."

      Maps available.  Hep B wide coverage.  Hib narrower, until 2007.  Ditto pentavalent vaccine.  Yellow fever just in a few countries (central Africa).  Pneumococcal is totally new and only 3 countries have been approved for it.  Ditto with Rotavirus (though difft countries).

      Health System Strengthening – HSS


      Funds for health system strengthening – accountability setup unclear.  PDF contains "good examples" of proposals.

      Map: http://www.gavialliance.org/performance/commitments/hss/index.php

      Funding by year:


      It appears that the first funds along these lines were 2007, and the latest year for which annual reports are available is 2006.  So we'd have to ask them how they evaluate this program.  We can at least look at a couple of proposals though.

      Civil Society Organisation support – CSO


      Unclear just what this is.  From the word doc, looks like direct grants to NGOs (though they apply thru the country … ?)  Two types of support, one (support for implementation of health system strengthening plan) being implemented only in 10 "pilot countries."  (General support available everywhere.)

      It seems that this sort of support is very new and has only been approved for one country (DRC).  See http://www.gavialliance.org/performance/commitments/hss/index.php and the 2007 overall report, which doesn't even have a line item for it.

      Does it work?  (I have downloaded these documents but not yet examined them – will probably do this on Thursday on the bus ride to Boston)

      Overall evaluation report – ISS


      Overall data quality audit

      This is to  check the quality of data provided by countries in their annual reports.  http://www.gavialliance.org/resources/DQAeval_WHObull_July2005.pdf

      Other overall evaluations

      See http://www.gavialliance.org/performance/evaluation/index.php.  Overall report is pending; evaluation of INS has just begun the RFP process. 

      Case Study – Democratic Republic of Congo

      I picked this one because it is the only one to receive support under all four headings, even though only the older stuff (ISS, INS, and some NVS – yellow fever and tetra) is old enough to expect it to be in the annual report.  All of the proposals are online, along with annual reports for 2002-2006 and a 2005 data quality audit report. 



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