Board -2017 -Mtg -1-Doc 03 1
Report to the Board
14 -15 June 2017

Section A: Introduction
? Th is update has been developed at the request of the Board to provide
regular and systematic, data driven, reporting on progress made against
implementing Gavi?s strategy. The first update was shared with the Board
in December of last year. This edition builds on the previous report and
includes updated dashboards with r esults from the first year of
implementing the 2016 -2020 Strategy . Coverage data for 2016 is still not
available and will be updated after WHO -UNICEF estimates are released in
July . Therefore, a number of indicators have not changed since the last
report. Discussions are underway among Alliance partners on how to
improve the generation, reporting and use of coverage data.
? The Alliance Accountability Framework, which informs this update, is a new,
ambitio us, approach to measure progress and increase accountability in the
Alliance. As we monitor progress of delivering the 2016 -2020 Strategy, w e
are learn ing more about the utility and relevance of indicators and the
availability of data . Going forward, we plan to review this and potentially
refine some indicators , based on lessons learned . At the recent Programme
and Policy Committee (PPC) meeting , members suggested that areas for
simplification and streamlining be explored, whilst maintaining rich and
detail ed reporting. Areas of learning are highlighted throughout the report
and feedback is sought on h ow this report could be made more useful for
the Board.
Section B: 2016 -2020 Strategy : Implementation and progress
Progress against Gavi?s mission aspiration
Discusses Mission Progress Indicators and Disease Dashboard Indicators


SUBJECT : 2016 -2020 S TRATEGY: IMPLEMENTATION AND
PROGRESS
Agenda item: 03
Category: For Information 2016?2020 INDICATORS MISSION PROGRESS
2015 2017201820192020
TARGETS
2016
Children immunised 300 million > 65 million 1
Future deaths av erted 5-6 million > 1.2 million 2
Under-fiv e mortality rate 58 per 1,00010% reduction in rate from 2015 baseline by 2020 64 per 1,000 3
Future disability -ad justed life years (DALYs) av erted 250 million > 56 million 4
Vaccines sustained after Gav i support ends 100% 100% 5
Projected on track, based on assumed continued improvement over last report (latest available data shown ) 2015 2017201820192020 2016 On track, based on data available year to date

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Board -2017 -Mtg -1-Doc 04
Report to the Board
14 -15 June 2017


7 June 2017
Dear Board members ,
We are 18 months into the 2016 -20 20 strategy and our focus is on implementing,
learning and adjusting our approach to support countries to achieve our
ambitious coverage , equity and sustainability goals . The agenda at this meeting
reflects that with few er major decisions and more of a focus on reviewing
progress and lessons learned, and adapting where needed . We will be
reflecting on implementation of the Partners? Engagement Framework (PEF) ,
progress and challenges in country programmes including the lessons we can
draw from Pakistan?s recent experience , aligning on updates to our risk appetite
statement and discussing an extension to our support for inactivated polio
vaccine (IPV) given programmatic developments.
Following positive feedback at the last Board meeting, the Update on Gavi?s
2016 -2020 Strategy, Indicator s and KPIs is now a standing item on the Board
agenda. It provides a systematic overview of key areas of progress and
challenges as we implement our strategy (the end of year report will be more
complete as it will include updated coverage data , which the World Health
Organization ( WHO ) and UNICEF publish in July). The Board also discussed at
our last meeting the desir e for more strategic discussion of higher -le vel
and longer -term issues . I have sought to use this report to frame two issues
that I think are particularly timely: our initial thinking on how we might engage
differently with countries during and after transition (in follow -up to the April Board
Retreat) and how we balance risks and country ownership given our growing
understanding of weaknesses in some countries? systems . The report also
provides an update on key developments in the global landscape, reports back
on previous Board decisions which are not otherwise addressed in the Board
agenda , and provides an update on the Alliance?s performance and operations. I
will expand on some of these issues in my presentation at the meeting.
In response to Board requests, we have continued to make Board papers
more concise and strategic and have rolled out the BoardEff ect platform to
facilitate easier access to materials. We ar e organising technical briefings for
Board members on the day before the meeting to allow for more informal
presentation and discussion of issues that are relevant to the Board but not on
Report of the Chief Executive Officer

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Board -2017 -Mtg -1-Doc 05

Section A: Introduction
? This report requests the Gavi Alliance Board ("Board") that it approve a fee
budget for vaccines and c old chain equipment procurement functions to be
performed by UNICEF in 2018 .
? It also informs the Board of a ctual expenditure and resources for 2016 and
the upda ted outlook for 2017 . The overall Financial Forecast for 2016 -20
that was reviewed by the Board in December 2016, will be updated and
presented to the Board in November 2017.
Section B: Budget for 2018 procurement fees; update on resources and
expe nditure
Budget request for 2018 procurement fees
1.1 Procurement activities are governed by a MoU between Gavi and UNICEF
(signed in 2016) covering the period 2016 -2020. UNICEF has provided an
early indication of procurement fees for 2018 and an overview of what the se
fees relate to (see Appendix 2). The Board is requested to now approve a
budget for UNICEF for 2018 procurement fees for vaccines and cold chain
equipment now , because 2018 procurement ac tivity will commence in Q4
2017, before the November 2017 Board meeting.
1.2 The current MoU sets out the procurement fees for 2016 and 2017 for both
vaccine and cold chain equipment. Fees for procurement of vaccines are
based on volume estimates and a retrospective fee adjustment mechanism
as set out in the MoU. UN ICEF is requesting a 2018 vaccine procurement
fee of US$ 19.0 million , which is US$ 0.6 million less than for 2017 . The
Secretariat considers this fee request reasonable.
1.3 For procurement of cold chain equipment , UNICEF is requesting approval
of a procureme nt fee of US$ 2.4 million in 2018 . An increase to this amount
may be requested in November 2017 based on updated demand estimates
at that time , informed by projected country applications and approvals in the
interim. UNICEF notes that these preliminary est imates may require
discussion of an upwards adjustment to as much as US $ 4.6 m illion .

SUBJECT : FINANCIAL UPDATE
Agenda item: 05
Category: For Decision
Report to the Board
14 -15 June 2017

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Board -2017 -Mtg -1-Doc 06

Section A: Overview
The purpose o f this report is to inform the Board o n the progress of implementation
of the Partners? Engagement Framework (PEF).

The PEF seeks to leverage the comparative strengths of Alliance partners to boost
immunisation outcomes in countries. US$ 132 1 million was provided to partner s
towards this purpose in 2016 . 84 % of th ese resources are allocated to WHO and
UNICEF. Additionally, the World Bank, Centr es for Disease Control and Prevention
(CDC) and 15 expanded partners including JSI, AMP, CHAI, Aspen Institute and
Civil Society Orga nisations (CSOs ) are engaged in providing technical assistance
and support to countries to improve coverage, equity and sustainability of
immunisation.

Introduced in pursuit of Gavi?s new strategic vision for 2016 -2020, PEF ushers in
a new way of plannin g, funding, operationalising and monitoring technical
assistance provided by partners. With its new country -centric approach and
emphasis on transparency and accountability, PEF is triggering Alliance -wide
changes in mindsets, behaviours, incentives, proce sses and structures.

There is improved communication between the Gavi Secretariat and partners,
better clarity and appreciation of each other?s roles and joint efforts to understand
challenges and devise solutions/strategic approaches. A strong country lens is
being applied to planning and oversight activities at regional and global level
recognising that country level outcomes are pivotal to success.

The new way of working together is permeating all critical Alliance processes and
forums including Joint Appraisals (JAs), the High Level Review Panel (HLRP),
Regional Working Groups (RWGs) and is now paving the way for the Country
Engagement Framework (CEF) .
Section B: Progress Update
There are three key mechanisms under PEF through which partners receive
funding: targeted coun try assistance, foundational support and special
investments in strategic focus areas.

1 US $ 22 million is provided to the UNICEF Supply Division as procurement fees for vaccines and
cold chain equipment
SUBJECT : PARTNERS? ENGAGEMENT FRAMEWORK
Agenda item: 06
Category: For Information
Report to the Board
14 -15 June 2017

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Re port to the Board



Annex A: Accelerating the equitable uptake and coverage of vaccines: Update on Gavi supported Vaccine
Programmes
Anne x A: Accelerating the equitable uptake and coverage of vaccines : Update on
Gavi supported Vaccine Programmes
1. Introduction
Gavi anticipates approximately 270 1 new vaccine introductions between
2016 and 20 20, a greater number than in any previous strategic period, with
a particularly high number expected in 2018. Over 4 0% of the se
introductions will be for non -routine programmes (e.g. Supplementary
Immunisation Activ ities , catch -up campaigns) . Over this strategic period,
Gavi expects to support 152 programme types.



1 This tally assumes that introductions for routine immunisation and multi -cohort campaigns for HPV
are counted as one event for a given country. NB: based on an alternate approach, the total
number of introductions, as reported to the PPC in May 2017, is more than 300 events 2 The count of 15 includes HPV (RI and MAC), IPV, JE, MSD, Meningitis A, MR, Pneumococcal,
Rotavirus, Yellow Fever and Pentavalent (10) routine programs and HPV demo, JE campaign,
Measles SIA/follow up, Meningitis A mini -catch -up, MR campaign.

Annex E: Update on the progress achieved in the Strategic Focus Areas

Annex B: Increase effectiveness and efficiency of immunisation delivery as an
integrated part of strengthened health systems: Update on Health Systems
Strengthening efforts
The Secretariat is undertaking several streams of work related to the HSIS portfolio,
including the Country Engagement Framework (CEF , see Doc 03b to May 2017 PPC )
and CCEOP ( see Doc 02f ). The information below provides an update on HSS grant
financia l disbursements and new approvals, as well as recent analyses conducted on
HSS intermediate results. The HSS results reported in 2016, for 2015 implementation,
are noteworthy as they represent the first year of reporting through the grant
performance frame work, allowing the Alliance to better look across the HSS portfolio
at performance by grant category or region, view alignment between programmatic
and financial reporting, and better inform decision making and country specific
recommendations during the J A and HLRP.
1. HSS Portfolio
1.1 Total HSS approvals equal US $ 1.33 billion (2007 -2017), of which
US$ 1.06 billion have been disbursed (80%) by February 2017.
1.2 As of February 2017, 34 countries have an HSS or PBF approval for 2016 or
earlier that is pending disbursement ( For additional details on balancing risk
assurances with timely and predictable HSS disbursements, please see
Alliance update on Country Programmes ). Two countries, Kenya and Zambia,
have recently requested Gavi to disburse HSS funds directly to CSOs. To
accommodate these requests and manage fiduciary risk, the Secretariat is
developing appropriate mechanisms and tripartite agreements with each
government and the CSOs, and will monitor these type of demands and their
implications to revert to the PPC and Board as appropriate.
1.3 Since the last PPC update, the November IRC recommended four HSS grants
for approval (Burkina Faso, Cote d?Ivoire, Mauritania, and Somalia). The IRC
noted the continued alignment of HSS grants to National Health Plans and
improved engagement of the Ministry of Health and health partners in the
country dialogue, highlighting this as a positive result of the Joint Appraisal
process and strengthened relationships in country. The IRC provided
suggestions to further strengthen s ynergies between HSS and CCEOP
proposals and recommended identifying locally relevant and innovative
solutions for building capacity and sustainability of health systems, especially
for countries approaching transition.
2. Using grant performance results to i nform decision making
2.1 In 2016, the Gavi Secretariat focused on introducing and setting up grant
performance frameworks as well as on encouraging programmatic reporting
compliance with countries. Reporting compliance has been high, with 80% of

Annex C: Improve sustainability of national immunisation programmes: Update on Co -financing Performance

Annex C: Improve sustainability of national immunisation programmes: Update on
Co -financing Performance
1.1 In terms of co -financing performance, 2016 has been the best year since the
beginning of the previous strategic period. Of the 63 1 countries that were
required to fulfil their co -financing requirements by the end of the 2016 calendar
year, 58 fulfilled their co -financing requirements on time, which is the highest
share since 2011 (92%, see graph 1) despite country obligations having
increased five -fold. Only five countries defaulted on their 2016 obligations
(DRC, Ghana, Madagascar, South Sudan and Niger), and one will request an
extension of the waiver granted by the Board for its 2015 co -financing
requirements (Yemen). 2 Two of the countries in default (DRC and Madagascar)
already resolved their arrears.
Graph 1 ? Country co -financing performance

1.2 In 2016, countries financed or co -financed 184 vaccine programmes that were
introduced with Gavi support, which is an 11% increase from 2015 3. The total
amount co -financed on time also increased by 25% from US$ 88 million by the
end of 2015, to US$ 110 million by December 2016. In addition, 14 countries
fully self -financed approximately US$ 20 million in 21 vaccine programmes
which were originally introduce d with Gavi support. This means that 15% of all
1 The figure excludes Yemen which is requesting an extension of the co -financing waiver. 2 Originally also South Sudan was expected to continue the extension of the co -financing waiver but
the country committed to fulfill its obligations. 3 It includes the vaccine programmes in Yemen.

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Report to the Board
Annex D : Update on specific countries
Appendi x D: Update on specific countries (DRC , India, Nigeria, Pakistan and
Syria)
1. Introduction
As requested by the PPC this Annex provides a detailed overview of in -
country operations, strategic issues and challenges encountered in four of
the most complex Gavi eligible countries, DRC, India, Nigeria and Pakistan.
It also provides a short update on the 2016 December Gavi Board approved
time -limited support to Syria . A portfolio overview of performance against
key issues of the PEF 10 countries is provided in the Country Programmes
update to the PPC and Annex E to the Country Programmes update
provide s country summary sheets for these 10 countries.
2. Democratic Republic of Congo (DRC)
2.1 Context

a) The political and security situation in DRC remains uncertain ahead of
elections expected to take place before the end of 2017 and this may
have an impact on the EPI programme.

b) The security situation in Kasai provinces has also worsened. More
than 400 people have been killed, including 2 UN staff in March 2017
and more than 200,000 have been displaced since August 2016.
c) Macroeconomic situation
? In December 2016 DRC's Central Bank announced a reduction in
the country's 2016 GDP growth from 4.3% to 2.5%, and down from
9.5% and 6.9% in 2014 and 2015 respectively, in part due a sharp
decline in global commodity prices.
? As a result, DRC's fiscal space remains constrai ned. The 2016
national budget has been revised and decreased by 22% in May
2016 (from ?7,86 billion to ?6,13 billion) and the 2017 budget
proposes a further 15% cut, with the health budget being reduced
from 9.3% to 6.8% of the total budget. This budget ha s not been
approved (an interim budget has been approved until April 2017).
2.2 Ebola Outbreak
a) As of 14 May 2017, 19 cases have been notified and 3 deaths have
been registered in the Bas Uele province. Of these 2 Zaire -type Ebola
cases have been confirmed by t he national laboratory INRB. A
response plan has been approved by local authorities. At this stage
this does not include plans for using a vaccine to respon d to the
outbreak and there has been no formal request from the DRC
government for rVSV -ZEBOV vaccin e (300,000 doses available) or for

Report to the Board
1
Annex E : Update on the progress achieved in the Strategic Focus Areas

Annex E: Update on the progress achieved in the Strategic Focus Areas
In 2015, six Strategic Focus Areas (SFAs) were identified where cross -cutting
strategies might be able to deliver transformational impact and lead to improved
coverage and more equitable immunisation systems (a new Gavi Engagement
Framework for implementing the 2016 -2020 Strategy, June 2015 Board ). These
included supply chain ; data; demand generation; leadership, mana gement and
coordination; political will; and sustainability. The below provides updates on the
progress achieved to date (note that the supply chain update is addressed in the
strategy progress update ).

1. Data
1.1 2016 was the first year of implementing the Data SFA , in which the Alliance
detailed its approach to supporting country data strengthening and Special
Investments at global / regional levels . The Data Strategy is articulated around
three priority areas: Immunisation D elivery, Coverage and Equity (DCE);
Vaccine Safety (Safety) and Vaccine Preventable Disease (VPD) Surveillance .
Building upon the early learning from 2016, 2017 PEF Special Investments in
data will focus on PEF priority countries, incorporate new ways to s upport
country planning and implementation of data strengthening activities, and drive
the ?use? of data. These investments will deliver a complementary series of
guidance documents, tools and methodologies across DCE, Safety and VPD
Surveillance as well a s key capacity building activities in the AFRO region.
Specific updates on Special Investments in the three priority areas are detailed
below.
1.2 In addition to direct investments through PEF, the Data SFA has also had key
achievements in other areas such as through ensuring Data related guidance
is included in Gavi guidelines on PEF, HSS and New Vaccine Support (N VS )
and JAs a s well as enhanced monitoring of country implementation of data
strengthening plans. Being a broad and crosscutting area, the Data Strategy
engages individuals from multiple teams within each partner and this has been
acknowledged as a challenge. To overcome this challenge and facilitate the
Alliance?s work in Data, 2016 also saw the initi al development of a Data SFA
Results framework, a new partner collaboration framework and in 2017 a
partner coordination group will be established to better facilitate planning and
coordination of Gavi support for country data strengthening. The Results
framework and the partner coordination group will be a step change for the Data
strategy and facilitate the identification of transformational approaches for
future investments in the three priority areas .
1.3 DCE update : Early achievements in this area include: coverage estimates for
first dose of rubella and first dose of IPV available for the first time; development
of an EPI module for DHIS2 (District Health Information Software ). This year,
investments in DCE will yield a methodology for triangulation of various data

Re port to the Board

Annex F: Country Summary Sheets
Anne x F: Country Summary Sheets
1.1 The summary sheets are intended to provide a high -level systematic
snapshot of a country?s performance across a number of key thematic areas
(e.g. coverage, supply chain, data quality) . The y provide additional context
and country -specific overviews and highlight main challenges to inform PPC
and Board discussions.
1.2 Each key thematic area is assessed through a ? tra ffic light?. For the traffic
light assessment, a standardised approach has been applied t o assess
countries? p erformance using agreed -upon quantitative and qual itative
criteria. For example, to measure a country?s performance related to equity ,
the country ?s DTP3 coverage differences in wealth, ma ternal education, and
geography are used as standardised proxies to understand the main drivers
of inequities within the country. This quantitative assessment has then been
complemented with a qualitative assessmen t by the country team, building
on broader assessments and work in this area ( e.g. assessing inequities
across marginali sed groups, urban slums, etc. ).
1.3 Wherever possible and to ensure consistency, the Secretariat has used
indicators and data sources that align with the Alliance?s strategic goal
indic ators and existing, agreed -upon performance measurements (e.g.
grant performance framework target achievement, financial reporting
compliance) . Data for these indicators have been retrieved from various
routine source s, including W HO/UNICEF estimates , DHS/MICs surveys,
EVMAs, and other standardised analyses conducted by Secretariat staff.
1.4 As most thematic areas consider performance across several indicators, to
obtain the ev entual traffic light assessment , each indicator has been given
equal weight , and been validated through the qualitative assessment (where
applicable) .
1.5 In addition to provid ing a traffic light assessment for each key thematic area ,
a trend arrow is included to understand if performance in that area is
improving, declining, or stagnating . Where possible, trends are measure d
through quantitative criteria and data ( e.g. coverage) , but some areas rely
on a more qualitative assessment . For example, in a situation where health
workforce shortages are particularly compelling, this could be marked as
red. However, in view of recent efforts towards developing a health
workforce strategy, the trend may show that we are optimistic that this
situation is on a more positive trajectory.
1.6 Going forward , the Secretariat is considering refinements to the
methodology used for the development of the cross portfolio overview and
country summary sheets (e.g. additional metrics to be considered) . Based
on PPC and Board feedback, the Secretariat is evaluating ho w to provide
country specific information and a cross portfolio overview for all remaining
PEF countries , as well as a higher level summary of progress in remaining
countries.

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Board -2017 -Mtg -1-Doc 07a

Report to the Board
14-15 June 2017

Section A: Summary
This update :
o Requests the Board to decide to continue support to Yemen despite the
country?s continuing defaulter status based on a recommendation by the
Programme and Policy Committee (PPC) (see under 1 in Section B) .
o Presents two programmatic challenges that were discussed by the PPC for
further guidance from the Board :
? balancing risk assurance with the need for timely and predictable HSIS
funding, and with ensuring country ownership and sustainability of
programmes (see under 2 in Section B) .
? sustaining progress in introducing pneumococcal and rotavirus
vaccines (see under 3 in Section B) .
o provides a high level cross -portfolio overview of PEF tier 1 countries?
performance (see under 4 in Section B) for the Boa rd?s information and
feedback.
A case study presenting Pakistan?s recent progress towards improving equitable
and sustainable immunisation coverage and describing how Alliance partners have
come together to support the country in reaching more children wit h vaccines is
provided in Doc 07b .
Detailed information on the Alliance?s in -country operations, activities,
achievements and challenges is provided in Annexes A through F. The PPC also
discussed the progress made on the implementation of the Country Enga gement
Framework ( Doc 03b to the May 2017 PPC) .
Section B: Alliance Update on Country Programmes
Improving sustainability of national immunisation programmes and
continued support to Yemen
1.1 As discussed in the Strategy Progress Update, 2016 was a record year in
terms of country co -financing for Gavi -supported programmes. However ,
Yemen is an exception to this trend, ha ving not been able to co -finance due
SUBJECT : COUNTRY PROGRAMMES : STRATEGIC ISSUES
Agenda item: 07a
Category: For Decision

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Board -2017 -Mtg -1-Doc 07b

Section A: Summary
? This case study presents Pakistan?s progress and challenges towards
improving equitable and sustainable immunisation coverage.
? One out of ten under -immunised children within Gavi -eligible countries are
living in Pakistan . Gavi has committed more resources to Pakistan than any
other country , exceeding US$ 1.16 billion .
? Pakistan is an encouraging example of the Alliance partners coming
together and leveraging their inst itutional mandate to support national and
provincial leadership to gain momentum on immunisation in a very
challenging context.
? Through strategic and sustained engagement, with annual high -level joint
Alliance missions mounted by Gavi , Alliance partners have galvanised
po litical commitment and support ed evidence -based decision -making .
? The implementation of the National Immunisation Support Project (NISP)
has created a unique and innovative partnership for routine immunisation.
The national and provincial governments of Pak istan have invested more
than US$ 370 million in their immunisation programmes, with a partial
reimbursement based on results . To support this, resources have been
brought together by the Alliance that include US$ 84 million from Gavi,
US$ 50 million from the World Bank (as a loan with a potential
US $ 25 million buy -down by Bill & Melinda Gates Foundation ) and
US$ 10 million from USAID. The NISP Performance and Results
Framework is shared by all parties and is independently validated.
? These joint interventions and investments are beginning to deliver
significant results. Independent surveys in Punjab, the province that hosts
half of the country?s population, show a 22 % increase in DTP -3 coverage
over the past two years . Administrative d ata from other provinces also
suggest coverage is increasing, though less rapidly.
? Despite this progress, significant challenges remain and continued high -
level and strategic engagement by the Alliance is critical for Pakistan to
reach every child with li fe -saving vaccines in the years to come.
SUBJECT :

CASE STUDY : A LLIANCE PARTNERS JOINING EFFORTS
TOWARDS IMPROVING EQUITABLE AND SUSTAINABLE
IMMUNISATION COVER AGE IN PAKISTAN

Agenda item: 07b
Category: For Information
Report to the Board
14 -15 June 2017