The Vaccine Delivery team at the Bill and Melinda Gates Foundation (BMGF) requested a synthesis of country-specific Gavi documents to gain a more granular understanding of the work that is happening in Gavi-eligible countries to strengthen immunization systems and increase or sustain vaccine coverage. The objective of the project was to construct a comprehensive and easily digestible summary of where work is taking place and where there are gaps. This information was further synthesized by vaccine-relevant domains to provide insight into common themes and challenges across countries. The project was conducted in two distinct phases, wherein the methodological approach from Phase 1 was slightly adjusted for Phase 2 based on interim discussions with the BMGF team.
To accomplish the goals during both phase 1 and 2, we conducted a review of publicly available country-level Gavi documents, including country multi-year plans, health systems strengthening grant proposals, Gavi joint appraisal reports, targeted country assistance plans, and other relevant data sources where applicable. During both phases, information was extracted from source documents based on a codebook that mirrored the Vaccine Delivery Team’s amphitheater, which lays out vaccine system activities by various domains. In Phase 1, information from source documents was coded and extracted using the qualitative analysis software Dedoose. For Phase 2, documents were reviewed manually; in addition, the codebook was adapted to capture more nuanced information related to vaccine demand, outreach activities, and workforce. To synthesize the country summaries, we used the Vaccine Delivery team’s country segmentation as our basis of comparison. Country segments were developed by the Vaccine Delivery team based on current vaccine coverage metrics and level of conflict. Information from both phases was used to inform a high-level synthesis of domain-specific findings across different country segments. Based on presentations of our results from Phases 1 and 2, the Vaccine Delivery team may be interested in future work related to evaluation of the country segmentation scheme.