START EXAMINES THE CURRENT GLOBAL ARCHITECTURE SUPPORTING HEALTH SYSTEM STRENGTHENING

The Vaccine Delivery team at the Bill & Melinda Gates Foundation (BMGF) requested a landscape analysis of efforts toward strengthening country health systems by several multilateral organizations: Gavi, the World Bank, the Global Fund, and the Global Financing Facility. The landscape analysis included descriptions of programmatic and financial health systems strengthening support, including program elements, eligibility guidelines, funding levels, and details on specific funding envelopes. Further, the team requested an overview of Gavi’s health systems strengthening support over time, encompassing their evolving funding mechanisms and specific challenges, successes, key recommendations from evaluations, and decisions made by the organization. Finally, an annotated bibliography was requested, which included documents referenced and the key points found therein.

To accomplish the first objective, the START team scanned the respective organizational websites for public documents relating to their current and past health systems strengthening efforts. A report was compiled which featured all four organizations. For each, the strategic approach was outlined, followed by the purpose, guidelines, funding type, level of allocation, eligibility, utilization, tracked metrics, and recent/future changes for each funding mechanism. For the second objective, the START team reviewed literature on Gavi provided by the Vaccine Delivery team, supplemented with additional grey and peer-reviewed literature via web searches when information was lacking. A report was created highlighting each of Gavi’s four health systems strengthening phases: Immunization Services Support and Health Systems Strengthening versions 1-3. For each, details were provided on the funding windows, key policy decisions, outcomes from evaluations, and rationale for change to the next phase in Gavi’s evolution. The final deliverable, the annotated bibliography, was generated alongside these two reports as documents were reviewed.