Gavi

Gavi

Board meeting
6-7 June 2018
www.gavi.org
MTR Update
BOARD MEETING
Marie -Ange Saraka -Yao
28 -29 November 2018 , Geneva, Switzerland
Reach every child
Board meeting
6-7 June 2018
2018 MTR - 200 of our partners will convene for a high -level
event to review progress & shape the future of our model
Mid -Term Review Report Event Programme Attendees
Board meeting
28 -29 November 2018

Gavi

Gavi

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Board -2018 -Mtg -2-Doc A

Section A: Introduction
? This report is an update on progress made in 2018 on imp lementing Gavi?s
gender policy. It covers the programmatic, cor porate, governance,
communications and advocacy dimensions of Gavi?s gender focused work.
? The goal of Gavi?s gender policy is to 1) increase immunisation coverage by
supporting countries overcome gender -related barriers to ac cessing
immunisation services and 2) promote equal access and utilisation for all
girls and boys, women and men to immunisation and related health services
that respond to t heir different health need s.
Section B: Facts and Data
1. Gender Policy at a glance
1.1 Gavi has had a Gender policy since 2008 . It was revised in 2013 , at which
point the Secretariat committed to conduct the next review and u pdate of
the policy in 2019, including an external evaluation.
1.2 The Secretariat has initiat ed the external evaluation process and the
evaluator has been selected. T he main objectives of the evaluation is to
assess the strengths and weaknesses of the 2013 gender policy including
the des ign, objecti ves, goals and theory of change. The evaluation will also
assess the e ffectiveness and efficiency of Gavi?s implementation and
management of gender at th e global and country level , through conducting
country case studies and interviews .
1.3 Final recommendations from the evaluation are expected in early 2019. The
evaluation will provide evidence -based findings which will inform the update
to the g ender policy . The outputs from the external evaluation will be
shared with the Programme and Poli cy Committee (PPC) at its April 2019
meeting and a recommendation on an updated policy will be brought to the
PPC and Board for decisi on in October and November 2019 .
2. Gender and Gavi Programming
2.1 Gavi?s strategic framework for 2016 -2020 calls for an i ncreasing focus on
sustainable coverage and equity of immunisation and includes an indicator
on maternal education status as a proxy for women?s empowerment. This
indicator tracks the differential level of coverage of third dose of d iphtheria -
SUBJECT : ANNUAL REPORT ON IMPLEMENTATION OF THE
GENDER POLICY
Agenda item: A
Category: For Information
Report to the Board
28 -29 November 2018

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Board -2018 -Mtg -2-Doc 18
Report to the Board
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SUBJECT: CLOSING REMARKS AND REVIEW OF BOARD
WORKPLAN
Agenda item: 18
No paper

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Board -2018 -Mtg -2-Doc 17
Report to the Board
28 -29 November 201 8

















SUBJECT: REVIEW OF DECISIONS
Agenda item: 17
No paper

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Board -2017 -Mtg -2-Doc 15

Section A: Introduction
? The purpose of this document is to update the Board on progress in
developing an Accountability Framework for the exceptional support for
Nigeria agreed to by the Board in June 2018.

? We are seeking feedback and guidance on the key elements of the
Account ability F ramework incl uding the overall approach and proposed
indicators.
Section B: Facts and Data
Background and Process
1.1 In June 2018, the Board requested the Secretariat and Alliance partners, in
consultation with the government, to develop an Accounta bility Framework
(AF) by November 2018 . The Board emphasis ed that Gavi support to the
National Strategy for Immunisation and Primary Health Care System
Strengthening (NSIPSS ) will be contingent on Nigeria meeting the
conditions set forth in the Accountabil ity Framework .
1.2 Consultation on the AF only began in early September , after the final
reimbursement was made on 20 Augu st. A working group was established
to conduct an analysis of existing accountability frameworks and a
Taskforce, chaired by WHO , was set -up to develop the NSIPSS
Accountability Framework outline. This has been a highly consultative and
collaborative process, with strong participation from all key stakeholders.
1.3 Additionally to the continuous in -country work, joint missions on vaccines
and health financing were conducted in September by the World Bank, the
Bill & Melinda Gates Foundation and Gavi. Two intensive in -country retreats
with the participation of all stakeholders including Gavi Alliance senior
m anagement led to a draft Accountab ility Framework, which was shared
with the Programme and Policy Committee (PPC) .
1.4 In its deliber ations 1, the y emphasised the importance of clearly defining
which indicators were absolutely non -negotiable requirements

1 Other comments were made, which can be found in the minutes of the PPC discussions
SUBJECT : NIGERIA ACCOUNTABILITY FRAMEWORK
Agenda item: 15
Category: For Guidance
Report to the Board
28 -29 November 2018

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Board -2018 -Mtg -2-Doc 14

Section A: Introduction
? This report requests the Board to approve funding for strengthening yellow
fever diagnostic capacity in Africa , as recommended by the Programme and
Policy Committee (PPC) in October 2018. It is proposed that YF diagnostic
capacity would be strengthened thr ough a diagnostic procurement
mechanism based on Gavi?s existing application, review, and approval
processes. This investment would facilitate implementation of the Gavi -
supported Eliminating YF Epidemics (EYE) strategy and allow more efficient
and effecti ve use of vaccine.
? Timely, reliable identification and confirmation of YF allows more rapid
containment of outbreaks and better prioriti sation of preventive vaccination
efforts in the context of the finite YF vaccine supply. As illustrated during YF
outbre aks in Angola, the Democratic Republic of Congo (DRC) , and Nigeria
over the last few years, major gaps in YF diagnostic laboratory capacity
exist. A key gap is a lack of validated, commercially available YF diagnostic
tests.
? A Gavi Alliance effort to use i ts market shaping capabilities to improve
availability of YF diagnostic tests would be part of a multifaceted approach
to improving YF laboratory capacity that would also address : i) the need for
laboratory technical assistance, ii) quality assurance/quali ty control
assessments, and iii) solutions to critical sample transportation and
laboratory coordination bottlenecks. This approach would be integrated with
broader Gavi efforts to improve the availability and quality of immuni sation
data and strengthen h ealth systems. Efforts to improve YF laboratory
capacity would seek to incorporate count ry co -financing in the medium and
long term , and establish the conditions under which Gavi no longer needs
to provide funding in order to ensure the sustainability of timely, reliable YF
diagnostic capacity.
Section B: Facts and Data
1. Gavi? s engagement with yellow fever control
1.1 In 2015, the Gavi Board authori sed allocating US$ 278 million for YF
vaccine in the Gavi 2016 -2020 budget. In December 2016, the Gavi Board
approved an increase in expenditure on YF vaccine of up to US$ 150 million
SUBJECT : GAVI SUPPORT FOR YELLOW FEVER DIAGNOSTIC
CAPACITY
Agenda item: 14
Category: For Decision
Report to the Board
28 -29 November 2018

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Re port to the Board
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Doc 14 ? Annex A: Implications
Annex A: Implications
Financial implications
? A strategy to strengthen YF diagnostic capacity including diagnostic market
shaping, technical assistance (TA) , quality assurance/quality control
(QA/QC) assessments, sample transportation, and coordination would
require an estimated US$ 13.5 million during 2019 -2021.
? This estimate includes approximately US$ 8.2 million for the procurement
and distribution of laboratory reagents, supplies, and equipment, of which
US$ 4.6 million would be for 2019 -2020. In addition, approximately
US$ 5.3 million would be needed for TA, QA/QC testing, sample
transportation, and WHO global and regional YF laboratory coordination
during 2019 -2021, of which appro ximately US$ 3.5 million would be for
2019 -2020. The Gavi Secretariat will seek to absorb the 2019 estimated
costs of approximately US$ 1.7 million for TA, QA/QC testing, sample
transportation, and WHO global and regional YF laboratory coordination
within the existing approved PEF budget .
Risk implications and mitigation
? If the problems with YF diagnostic capacity in Africa are not addressed, there
is a risk that YF outbreaks will be detected late, leading to larger outbreaks
that require more resources, including vaccines, to contain; result in more
morbidity and mortalit y; disrupt routine immunisation more; and have
greater potential to spread to additional countries, as occurred with the
2015 -2016 Angola outbreak, in which international travellers imported
yellow fever into China, the Democratic Republic of Congo, Kenya, and
Mauritania.
? YF serologic tests are unable to distinguish between antibodies formed in
response to YF infection and antibodies formed in response to YF
vaccination, and the latter can persist for relatively long periods of time. An
individual?s vaccin ation history is necessary for interpreting serologic
results, but that information is often not available or is uncertain. As a result,
as vaccination coverage improves there will be an increased risk for false
positive test results that could prompt unne cessary reactive mass
vaccination campaigns that unnecessarily disrupt routine immunisation.
Improving YF laboratory capacity in Africa so that molecular testing for YF
RNA is readily available for appropriately timed specimens would help to
offset this ri sk.
? There is a risk that at least some of the governments of countries at high risk
for YF in Africa, may not provide funding for at least some portion of the
costs of the supplies, equipment, and services supported through this
initiative. Similarly, the re is a risk that countries may not sustain their YF
laboratory capacity after the end of Gavi support.
o Initial discussions with laboratory directors from Nigeria, Cameroon,
Chad, Benin, Togo, Cote d?Ivoire, Mali, and Uganda have been