Gavi, the Vaccine Alliance appointed IPSOS to conduct an evaluation of Gavi’s contribution to reaching zero-dose and missed communities (ZD evaluation) to inform the Gavi Board, Gavi Secretariat and Vaccine Alliance partners how their work is contributing to immunising children in the lowest-income and most marginalised communities in Gavi-eligible countries. The evaluation aims to inform programmatic improvements during Gavi’s 2021–2025 strategic period (Gavi 5.0/5.1) and the development of Gavi 6.0 (2026–2030 strategic period). This first annual report covers Phase 1 (Year 1) of the evaluation, during which the aim is to establish an in-depth baseline in eight case study countries, against which work in future years can be compared.

EVALUATION OBJECTIVES AND METHODS 

The evaluation looks back to Gavi 4.0 (2016–2020) for lessons learnt, and forward to Gavi 6.0 to guide the design of the next phase. This report covers Phase 1 of a three-stage evaluation, and provides a baseline in eight case study countries against which change will be tracked in Phases 2 and 3. The evaluation has four specific objectives, of which Objective 1 was expected to have the strongest evidence in Phase 1:

• O1: Evaluate the relevance and coherence of the ZD agenda, Gavi's vision for leaving no one behind by reaching zero-dose children and missed communities with immunisation, in Gavi 5.0/5.1 ;
• O2: Assess the operationalisation of the ZD agenda through the Gavi 5.0/5.1 funding levers and programmes;
• O3: Estimate the plausible contribution of pro-equity grants initiated under Gavi 4.0 with continued implementation in Gavi 5.0/5.1, and grants initiated under Gavi 5.0/5.1, to achieving Gavi's targets related to reaching ZD and missed communities; and
• O4: Generate lessons learnt on the implementation of the ZD agenda to inform course correction and development of the Gavi 6.0 strategy.

The expected use case is to contribute to strategic and programmatic decision-making regarding course correction for Gavi 5.0/5.1 and development of Gavi 6.0 in relation to the ZD agenda, and to feed into the Mid-Term Evaluation (MTE) of Gavi's 2021–2025 strategy to help explain performance. The MTE is an evaluation by the centralised evaluation team to provide the Gavi Board and the Gavi Secretariat with an independent, objective assessment of the implementation of Gavi's 2021–2025 strategy (Gavi 5.0/5.1), with a focus on whether the design of Gavi 5.0 was appropriate, coherent and implemented effectively. The MTE is intended to support course correction of Gavi 5.0/5.1 and inform the development of Gavi's 2026–2030 strategy (Gavi 6.0).

EVALUATION METHODS

The evaluation uses mixed methods and is theory-driven. The evaluators test causal links between Gavi funding levers, outputs and vaccination outcomes; and assess the assumptions in the Theory of Change (ToC). Methods include desk review of Gavi documentation and published papers, secondary data analysis of vaccination statistics and Gavi internal information, key informant interviews with global stakeholders, country case studies, including interviews with national stakeholders; and an online survey with Gavi Senior Country Managers.

FINDINGS AND CONCLUSIONS 

First, IPSOS presents findings on evaluation Objective 3 (assessing the contribution of grants to ZD outcomes ), enabling comparison with subsequent findings on Gavi 5.0/5.1, as Objective 3 focuses this year on Gavi 4.0 grants only. Findings on Objective 1 examine the relevance and coherence of the new Gavi 5.0/5.1 ZD approach. Findings on Objective 2 assess the operationalisation of new grants to date. Finally, strategic, operational, and evaluation insights and implications are presented after the findings below.

Strategic implications for Gavi 6.0 development process

• Simplify funding levers and guidance. From 2027, when the Equity Accelerator Fund (EAF) expires, consider simplification of grant levers into one overall health system strengthening (HSS) input to deliver immunisation outcomes while adopting other means to ensure all funds contribute to strategic objective 2: the Equity goals. Update guidance in light of simplified funding levers to make it less complex and more user-friendly, and ensure its flexibility to different country segments.
• Make a stronger case for Gavi to work through broader HSS, primary health care (PHC) and Universal Health Coverage (UHC) processes by leveraging pooled funding and other development harmonisation opportunities. Use Gavi 6.0 to make a clearer case for working more closely with other global health partners to support immunisation outcomes and target ZD and marginalised communities more effectively.
• Clarify relationships with and expected outcomes from non-traditional partners. To increase contribution to demand generation, community engagement and gender, use the Gavi 6.0 strategy to develop the vision for the role of civil society organisations (CSOs), to go beyond a set of new contractual relationships and include clear guidance on appetite for fiduciary and operational risks.
• Develop a more nuanced approach to difficult resource allocation choices. Under Gavi 6.0, develop a clearer framework for Secretariat country teams and national stakeholders on how best to make difficult resource allocation choices, including how to balance equity with public health effectiveness and resource allocative efficiency.

Operational implications for ongoing grant implementation

• Intensify focus and resource allocation to implementation, disbursement and grant absorption. EVOLVE has highlighted multiple opportunities to streamline processes, and it isrecommended to expedite these as soon as possible in order to deliver transformational change in achieving ZD outcomes. In addition, it is recommended to  reinstate the full joint appraisal (JA) process as a mechanism for shared oversight of grant implementation.
• Support Gavi Secretariat country teams to operationalise their grants more effectively and efficiently. Operationalise differentiation by learning from and using the extensive evidence being generated to streamline processes; and sufficiently resourcecountry teams to manage grants that are flexible to local contexts, including measures of progress against specific milestones and outcomes in terms of grant differentiation.
• Invest in internal data systems for grant oversight and accountability. To improve data on grant disbursement, absorption or the implementation of supported interventions, and thereby permit oversight of and accountability for progress against intended goals, prioritise improvements in use of central management information systems, alongside reinstatement of the full JA process.
• Clarify expectations for non-state partners' role in reducing ZD children and missed communities. To improve focus on demand generation, sustained subnational advocacy, community engagement and gender, enhance operationalisation of Gavi's Civil Society and Community Engagement (CSCE) approach – with clearer outcomes to be delivered by non-state entities; and clarity on how to contract most effectively, and how to manage operational and fiduciary risks .

Documents

• Final report: Evaluation of Gavi’s contribution to reaching zero-dose and missed communities
• Policy brief
• The Evaluation Advisory Committee summary assessment
• The Evaluation Management Response summary

Country case studies reports

• Afghanistan
• Cambodia
• Côte d'Ivoire
• Djibouti
• Ethiopia
• India
• Pakistan
• South Sudan