Gavi, the Vaccine Alliance appointed Euro Health Group (EHG) to conduct a mid-term evaluation (MTE) 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 used a range of analytical methods such as analysis against the elaborated Gavi 5.0 theory of change (ToC); thematic coding and triangulation of evidence; analysis of key drivers of observed results; analysis against the OECD Development Assistance Committee (DAC) evaluation criteria; and assembled substantial evidence, including review of more than 1,000 Gavi and external documents and 184 key informant interviews (KIIs) – 104 at global level and 80 at country level.
The MTE was built on the findings of three recent independent evaluations commissioned by Gavi: Evaluation of Gavi’s initial response to COVID-19; Evaluation of the operationalisation of Gavi’s strategy through policies, programmatic guidance and use of funding levers; and Evaluation of Gavi’s contribution to reaching zero-dose and missed communities . The MTE also integrated recent Secretariat analysis and reports, including EVOLVE and the 2023 Mid-Term Review (MTR).
FINDINGS AND CONCLUSIONS
The evaluation highlighted seven overarching conclusions relating to Gavi 5.0/5.1 and with implications for Gavi 6.0, including:
Conclusion 1: During the first three years of Gavi 5.0/5.1, a period of exceptional disruption and uncertainty, the Alliance can claim some notable achievements and organisational reforms, including helping countries contain some of the backsliding in routine immunisation (RI) coverage while delivering nearly 2 billion COVID-19 vaccine doses and increasing the breadth of protection .
Conclusion 2: Some, but not all, strategic goal indicators (SG1, SG2, SG3) will be met by 2025, while most SG4 targets will be achieved.
Conclusion 3: Gavi's contribution to the 5.1 strategic goals through 5.0/5.1 programming will not be visible until mid-2025 but likely will make a positive contribution. The contribution from Gavi 4.0 (2016–2020) appears strong; but recalibrating 5.0 strategic priorities has had limited impact.
Conclusion 4: Gavi is making concerted efforts to achieve the 5.1 goals. Maintaining progress requires tackling how the Alliance influences country immunisation programming, while respecting country ownership. It also requires accelerating and deepening the ongoing, much-needed internal reforms to streamline Gavi's systems and processes.
Conclusion 5: Resilient and strong health systems are essential for vaccine programme sustainability.
Conclusion 6: Notwithstanding increased momentum towards 5.1 goals, there are serious concerns around transition and sustainability, as some countries may again backslide during a time of increasing global social, political and economic fragility.
Conclusion 7: The EHG agreed with the Gavi analysis of the barriers to vaccine uptake during 6.0, including conflict, climate change and natural disasters, vaccine hesitancy, weak health systems, and economic disruption. The extent to which the Alliance can overcome them depends crucially on the success of current efforts to deal with long-standing barriers to operational efficiency and effectiveness.
Last updated: 11 Jun 2024