Abstract
BackgroundGAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time. This paper charts that evolution.MethodsA systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI’s phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries.ResultsSerches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI’s predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes.ConclusionIn its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2521-8) contains supplementary material, which is available to authorized users.
Highlights
Global Alliance for Vaccines and Immunization (GAVI)’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time
The GAVI Board - which governs activities funded by the Alliance - requested that in its phase of operations, GAVI deepen its focus on improving the coverage and equitable distribution of immunization services in GAVI countries1 [1,2,3]
This paper considers equity of outcomes in terms of the following intermediate and final outcomes: (iii).Intermediate outcomes in terms of coverage or utilization of immunization services (iv).Final outcomes in terms of impact on vaccine preventable disease (VPDs)
Summary
GAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time. People (rather than states or institutions) will be at the heart of the sustainable development agenda [4,5,6,7,8,9] This builds on the growing recognition that existing global development goals - with their focus on national averages - have resulted in unequally distributed gains, and at worst have inadvertently exacerbated inequities in access within countries, for child health [10,11,12,13,14]. A growing body of evidence suggests that addressing these inequities could drastically reduce child mortality in low and middle income countries [15, 16]
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