Abstract
BackgroundThe GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. Our objectives were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers to immunisation.MethodsFrom 44 health systems strengthening proposals submitted to GAVI in 2007 and 2008, we analysed the topics identified, the coverage of these topics by existing systematic reviews and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals.ResultsThirty topics were identified and grouped into three thematic areas: health workforce (10 topics); organisation and management (14); and supply, distribution and maintenance (6). We found 51 potentially relevant systematic reviews, although for the topic that appeared most frequently in the proposals ('Health information systems') no review was identified. Thematic and geographic relevance were generally categorised as "high" in 33 (65%) and 25 (49%) reviews, respectively, but few reviews were categorised as "highly relevant for policy" (7 reviews, 14%). With regard to methodological quality, 14 reviews (27%) were categorised as "high".The number of topics that were addressed by at least one high quality systematic review was: seven of the 10 topics in the 'health workforce' thematic area; six of the 14 topics in the area of 'organisation and management'; and none of the topics in the thematic area of 'supply, distribution and maintenance'. Only twelve of the 39 countries with available national surveys referred to them in their proposals.ConclusionRelevant, high quality research summaries were found for few of the topics identified by managers. Few proposals used national surveys evidence to identify barriers to vaccination. Researchers generating or adapting evidence about health systems need to be more responsive to managers' needs. Use of available evidence from local or national surveys should be strongly encouraged.
Highlights
The GAVI Alliance was created in 2000 to increase access to vaccines
Global health initiatives often focus on a disease or on health outcomes to help programmes be effective
The “Expanded Programme on Immunisation” (EPI), which was launched in the late 1970s, has been linked with other interventions or integrated into wider primary health care services
Summary
The GAVI Alliance was created in 2000 to increase access to vaccines. GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. Global health initiatives often focus on a disease (such as TB) or on health outcomes (such as cure rates) to help programmes be effective. This can unwittingly overburden already weak health systems[1]. Vaccination coverage went up initially, but in the late 1990s immunisation coverage stagnated. Some critics accused GAVI of being too centred on immunisation at the expense of strengthening health systems[3]
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