GAVI Alliance Board Meeting 30 November - 1 December 2010 Doc #07b ? GAVI Alliance Business Plan
Annex 1, Part 1


GAVI Secretariat 16 November 2010 1

Annex 1 Part I Overview - GAVI Alliance Strategy and
Business Plan 2011 -2015


E xecutive Summary

The GAVI Alliance Strategy 2011- 2015, approved by the GAVI Alliance Board in
June 2010 defines the Alliance?s mission, operati ng principles, strategic goals,
objectives and progress indicators (see Appendix 1 and 2 ).

This GAVI Alliance Business Plan 2011- 2015 describes the actions to be undertaken
to achieve the Strategy. It also lays out the context and challenges for the coming
years. The overview should be read in conjunction with the GAVI Alliance
Business Plan Part II ? strategic goals and cross -cutting issues.

Background

The GAVI Alliance Strategy 2007- 2010 had clear goals around accelerating the
uptake of new and underused vaccines, contributi ng to health systems
strengthening , improving the sustainability of immunisation and capitalising on its
unique partnership model (see Appendix 3) . Progress in these goals has contributed
to achieving the Alliance?s mission to save children?s lives and pr otect people?s
health through access to life- saving interventions. The Strategy was accompanied
by a corresponding ?work plan? which set out the activities of respective partners
organised by outputs. Activities and corresponding budgets were developed o n an
annual basis in 2007 and 2008 and on a bi -annual basis for 2009- 2010.

The results of the Alliance?s efforts are set out in detail in various publications and
documents
1 and documented in the recent second evaluation of GAVI. As a result of
its effor ts, GAVI has immunised over 25 0 million children, increased vaccination
coverage in low -income countries from 66 to 79%
2

(between 2000 and 2009) and
helped avert over 5.4 million future deaths.
There have been areas of continuity in GAVI?s context and internal operations and
areas of change since the last planning cycle in 2007. GAVI remains a public -
private partnership which brings together donors, countries, industry and others, and
which aims to promote immunisation as a highly cost -effective means o f protecting
health and saving lives with 23 million unimmunised children globally the majority of
them in GAVI -eligible countries . GAVI?s mission is unchanged.



1 Phase 1 and 2 evaluation (http://www.gavialliance.org/performance/evaluation/index.php), Progress Reports
(http://www.gavialliance.org/media_centre/publications/progress_reports.php)
2 World Health Organization. WHO/UNICEF estimates of national immunization coverage. 2010 Feb 24 [cited 2010 Feb].
Available fro m:
http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index4.html United Nations,
Department of Economic and Social Affairs, Population Division. World
Population Prospects: the 2008 Revision [CD -ROM edition]. 2009 May.

GAVI Alliance Board Meeting, 30 November - 1 December 2010 Doc #07 c ? GAVI Alliance
Business Plan 2011 -2015
Annex 2- Strategic Goals and
Cross -cutting issues

GAVI Secretariat 16 November 2010 1

Annex 2 Business Plan Part II
Strategic Goals and C ross Cutting -Issues

Summary

Strategic goal 1: Accelerating the uptake of new and underused vaccines

Accelerating the uptake of new and underused vaccines (?the vaccine goal?) is
GAVI?s core business, and has been since it was founded. For this reason, it also
represents the majority of GAVI?s business plan budget.

The first ten years of GAVI?s work focused mostly on yellow fever, HepB and Hib
containing vaccines. In the second decade, GAVI aims to maintain momentum on
these antigens while accelerating introduction of routine meningitis, pneumococcal
and rotavirus vaccines and supporting campaigns against yellow fever and
meningitis. The Alliance will also begin acti vities to prepare for new and underused
vaccines, including HPV, Japanese Encephalitis, Typhoid, and Rubella. If the
Alliance is fully resourced to meet demand, up to 100 new vaccine introductions
across GAVI -eligible countries would occur between 2011 an d 2015. The majority of
these introductions are pneumococcal and rotavirus vaccines - 70 countries in the
strategy period ? 40 of which introduce between 2011 and 2012.

Countries take the decisions to introduce vaccines, and are responsible for
managing the introduction of the vaccine. The GAVI secretariat and the members of
the Alliance ? primarily the multilateral partners and the AVI technical assistance
consortium ? can draw upon their comparative advantages and resources to help
countries:

? Improv e decision -making on vaccines , by strengthening decision making
bodies, providing impact information about specific vaccine introduction,
development of policy standards and reporting systems and producing key
scientific data. and to monitor of the results ;

? Strengthen vaccine introduction, by supporting, primarily through technical
assistance and training, cold chain capacity, supply plan management,
programme administration, monitoring and reporting, waste disposal,
surveillance systems and advocacy and s ocial mobilisation.

The programme objectives and deliverables under the vaccine goal identify the key
activities which will support this, which agency is responsible, and what budget is
available.

Funding for partner agencies is requested in those area s where the Alliance
activities necessitate additional effort as a consequence of supporting activities
funded by GAVI:

? WHO: develops global policy on immunisation recommendations, standards,
global reporting on disease burden and immunisation programmes. Provides

GAVI Alliance Board Meeting, 30 November - 1 December 2010 Doc 07d ?GAVI Alliance Business P lan 2011 -2015
Annex 3
Annex 3 - GAVI Alliance Strategy 2011 -2015



As a public -private partnership including civil society, the GAVI Alliance pla ys a catalytic role providing funding to countries and demonstrates ?added -
value? by:
1. Advocating for immunisation in the context of a broader set of cost -effective public health interventions
2. Contributing to achieving the Millennium Development Goals (MDG s)
3. Supporting national priorities, integrated delivery, budget processes and decision -making
4. Focusing on innovation, efficiency, equity, performance and results
5. Maximising cooperation and accountability among partners through the Secretariat
6. [Ensuring g ender equity in all areas of engagement]

Mission Indicators:
I. Under five mortality rate II. Number of future deaths averted III. Number of children fully immunised
SG1 Ac celerate the uptake and
use of underused and new
vaccines
SG2 Co ntribute to strengthening
the capacity of integrated health
systems to deliver immunisation

SG3 Increase the predictability of
global financing and improve the
sustainability of national financing
for immunisation


To save children?s lives and protect people?s health by
increasing access to immunisa tion in poor countries
I. Country introductions of underused and new vaccines - Number of GAVI supp orted countries introducing underused and new vaccines
II. Coverage of underused and new vaccines ? Coverage of underused and new vaccines in GAVI supported countries

1. Increase evidence based decision -
making by countries
2. Strengthen country introduction to
help meet demand


I. Drop -out rate ? Drop out between DTP1 and DTP3 coverage
II. DTP3 coverage ? % of surviving infants receiving 3 doses of DTP - containing vaccine
III. Equity in immunisation coverage ? % of GAVI supported countries where DTP3 coverage in the lowest wealth quin tile is +/ - 20% points of the coverage in the highest wealth quintile

I. Resource mobilisation ? Resources mobilised as a % of resources needed to finance forecasted coun try demand for vaccine support
II. Country investments in vaccines per child ? Average government expenditure on vaccines per surviving infant
III. Fulfilment of co -financing commitments - % of countries that meet their co -financing commitments in a timely manne r
1. Contribute to the resolving of the
major constr aints to delivering
immunisation
2. Increase equity in access to
services , including gender equity
3. Strengthen civil society engagement
in the health sector

1. Increase and sustain allocation of national resources to immunisation
2. Increase donor commitments and private contributions to GAVI
3. Mobilise resources via innovative financing mechanisms


Mission
Operating
Principles

Cross -cutting

Strategic Goals

Goal -level
Indicators
Strategic
Objectives



SG4 Shape vaccine markets
[for poor countries]

I. Reduction in vaccine price - Change in weighted average price per dose for pentavalent and rotavirus vaccines II. Suppliers in t he market ? Number of manufacturers with a pre -qualified vaccine, and active supply, in the market



1. Make vaccines more affordable 2. Ensure sufficient supply 3. Create market security and stability 4. Catalyse introduc tion of appropriate vaccines [1. Ensure adequate supply to meet demand ] [2. Minimise costs of vaccine s to GAVI and countries ]
Monitoring and Evaluation
Advocacy , Co mmunication and Public Policy

Annex 4 Risk Matrix - GAVI Alliance Board Meeting, 30 November - 1 December 2010
Level of risk High
Medium
Low
Risk category Main risk Likelihood
of riskPotential for
negative
impact
Specific risk
Risk mitigation strategy/activity in the business plan Strategic
goalProgramme
objective/
Residual
risk (post
mitigation
actions)
Predictability of donor
commitments
Re-designed replenishment mechanism, increased emphasis on
multi-year agreements and pledges
SG3 321
Size and diversity of the
funding base
Increased efforts to expand the funding base, specifically targeting
key members of the G20, innovative finance mechanisms and,
new private and corporate partnerships
SG3 322
Donor relations/
perceptions
Enhanced donor relations and improved donor communications.
Formalised and more active donor support network (e.g., Friends
of GAVI)
SG3, ACPP 321, 322, AC111
Economic and
financial market
risks
Low Medium Credit ratings, currency
fluctuation, interest
rates etc.
Long-range financial planning and forecasting. Robust financial
management strategies and policies
Financial
admin
Internal financial
management
Low
Medium-term
liquidity risks (2-3
years) Low
MediumCash flow Rigorous internal financial management policies and controls (inc.
cash flow reserve policies, regular internal audits) Financial
admin Internal financial
management
Low
Cash-based
Programme risks
High High Health system
strengthening grants,
CSO grants, IRIS
Programme
Dedicated infrastructure for the management of cash-based grants
(incl. TAP, FMAs etc.). Joint partnership with the World Bank,
Global Fund and WHO in the Health Systems Funding Platform
(incl. joint assessments and annual reviews, and a surveillance
platform).
SG2 211, 212 High
Applications, reviews
and disbursement
process risksDedicated country communications capacity, evidence based
decision making, direct support with GAVI applications (vaccines
and HSS). Independent Review Committee technical reviews and
recommendations around country applications. Alignment of GAVI
funding with country planning and budgeting cycles. SG1, SG2 111, 112, 113, 121,
211, 212
Forecasting and
planning
Specialised demand and supply forecasting across all vaccines
(current and future)
SG1, SG4 111, 112, 121, 122,
123, 411
Country capability and
infrastructure
Specialised in-country training and capability building.
Implementation of proven country systems, structures and
processes for vaccine introduction (incl. vaccine policies and
regulations) SG1 111, 112, 121, 122,
123
Programme
performance
Routine assessments and reviews (e.g., APRs, EVMs, pre and
post-Programme evaluations), routine Programme monitoring
SG1, ME 112, 121, ME111
High
Medium
Funding risk
Country introduction
risks
High
Low
High
Medium
Financial risk
Operating risks

GAVI Alliance Board Meeting, 30 November - 1 December 2010 Doc #07 f ? GAVI Alliance
Business Plan 2011 -2015
Annex 5 - Chair?s Summary
1


Annex 5 SG2 Time Limited Task Team : CHAIR?S SUMMARY


As requested by the PPC the Task Team (TT) has review ed the proposed
objectives/ deliverables/ activities in strategic goal 2 (?Contribute to strengthening
the capacity of integrated health systems to d eliver immunisation?) of the 2011 -
2015 B usines s P lan to ensure they are appropriate for delivery on strategic goal
2. The Task Team has , within the tight timeframe , strategically discussed GAVI?s
role and proposed activities relating to health systems str engthening in the
Business Plan , as well as suggested some adjustments to activities, objectives
and deliverables.

Spec ific deliverables :
? Submission of revisions as necessary to the objectives, deliverables,
activities and budget of strategic goal 2 (se e attachment) ;
? Input to the board paper on the business plan with respect to the SG2
section (this paper to be submitted as an annex ).

1. Overall p olicy -related issues

While some priority areas in the Business Plan are well addressed ( e.g. financial
managemen t) the TT confirmed the PPC ?s and the External Advisory Group?s
concern that SG2 , as previously configured , did not provide the necessary
confidence that GAVI will be successful in reaching its SG2 goals and related
strategic objectives .

a. There are valid reasons for this : all of the Strategic Objectives (2.1; 2.2; 2.3)
are w ork in progress - this includes IRIS, the CSO component and the HSFP .
Additionally, the HSFP is being implemented with other multilateral partners
(the Global Fund, the World Bank, and facilitated by WHO) . So, this part of
the GAVI Business Plan needs to be aligned with a broader plan of work,
which aims to make global financing for health systems more streamlined and
more outcome focused. This speaks to the need for a flexible approach to
SG2 in 2011 that allow s partners and countries to move ahead . Involvement
of the Board (or a mandated body) to review progress and adjust as
necessary will be needed .

b. The Task Team agrees that country eligibility thresholds for the cash -based
grants need to be revisited so that they get better aligned with country needs .
There needs to be more complementarity between HSS/HSFP ( ?general
service delivery support ? in which resources are directed to the underlying
operational components of health system s) and IRIS/ISS (in which resources
are spent on incentives aiming to directly support the improvement of
immunization coverage as part of integrated services). Specifically, the
current eligibility and filters for both HSS (40 LIC countries) and for IRIS (14
countries with DTP3 coverage below 70%) might need to be broadened.

GAVI Alliance Board Meeting, 30 November -1 December 2010 Doc #07g ? GAVI Alliance Business Plan
Budget

FOR DECISION

GAVI Secretariat, 16 November 2010 1

At its meeting in June, the GAVI Alliance Board adopted a new strateg y for 2011 -
2015, and asked the S ecretariat to produce a Business Plan. The annual GAVI
Alliance Business Plan Budget finances the operations of the Secretariat and
programmatic activit ie s conducted by the GAVI Alliance multilateral partners . It
also includes the cost of AVI technical assistance consortium 1

, procurement
costs and investment case costs. As such, it combines the previous work plan
and administrative budget. The only cost s not included are those for vaccines
and cash grants provided to countries .
The Board is asked to approve:
? Business Plan B udget of US$ 126 million for 2011, of which US$100.4
million is for Programme Implementation, and US$25 million is for Mission
Suppor t. Together these make up the programmatic activities supported
by the GAVI Alliance other than for vaccine s and cash grants , and the
budget for the Secretariat.
? Capital Expenditure budget of US$ 1.8 million for 2011.
? Provision al Business Plan Budget of U S$ 126 million for 2012, with a
proviso that a detailed budget be presented to the Executive Committee in
early 2011 for guidance and further recommendation to the Board.

Following review by the PPC and AFC and upon taking account of their
guidance, the Executive Committee has recommended that the Board approve
this Budget.

GAVI 2011 Business Plan Budget

1. Executive Summary

1.1 For 2011, the GAVI budget structure is chang ing in response to thinking from
the strategy development process . In the past, budget approval was sought
for two separate budgets: for a Secretar iat Administrative plan and for a two-
year Work Plan . For 2011, an all -inclusive ?Business Plan? Budget is being
presented.

1.2 The business plan places emphasis on strategic priorities w hich ensure
delivery on the GAVI strategy. These include:
a) Continuing to accelerate the uptake of underused and new vaccines ;
b) Mobilising the resources to meet demand for new vaccines ;
c) Reducing vaccine input costs [while ensuring secur e supply] ;
d) Ensuring ad equate country financing and delivery of introduced vaccines;
e) Continuing to improve aid effectiveness .
1 AVI TAC = AVI Technical Assistance Consortium

GAVI Alliance Board Meeting, 30 November
? 1 December 2010 Doc #09a ? Audit and Tax Engagement Ltrs

FOR DECISION

GAVI Secretariat, 16 November 2010 The Board is responsible for appointing GAVI?s independent auditor. At its meeting
on 29 November 2010 , the Audit and Finance Committee will review the
engagement letters for KPMG?s reappointment and consider recommending to the
Board that it:
? Appoint KPMG SA/AG as independent auditor of the GAVI Alliance for 2010
? Appoint KPMG LLP to provide US tax services for the GAVI Alliance for
20 10
? Approve the 2010 audit and tax engagement letters with KPMG SA/AG and
KPMG LLP .

Audit and Tax Engagement Letters

Audit Engagement

1.1 T he majority of GAVI?s overall audit work will be performed on the GAVI
Alliance in Switzerland. To perform the work, KPMG SA/AG (Geneva) has
tabled the enclosed audit engagement letter for the Board?s consideration.

1.2 KPMG ?s proposed fee is US$ 1 93,000 and represents an increase of 8%
versus last year?s audit, fully attributable to the devaluation of the US Dollar.
On a local currency basis, KPMG in Switzerland is keeping its costs flat. The
Secretariat considers this fee reasonable and will suggest that the Audit and
Finance Committee recommend this engagement to the Board.

Tax Engagement

2.1 Although the GAVI Alliance is exempt from taxation, it is still required to file tax returns in the United States and Switzerland . A tax engagement letter has
been provided by KPMG in Washington United States for tax services.

2.2 KPMG has proposed a fee of US$ 8,000 for 2010 and this represents no
increase versus last year. The Secretariat considers this fee reasonable and
will suggest that the Audit and Finance Committee recommend th is
engagement to the Board.

2.3 The Board approved in November 2009 an engagement with KPMG SA/AG to provide Swiss tax consulting services. The engagement was for a fixed price
of $8,000 for the fiscal years 2009 and 2010.

GAVI Alliance Board Meeting, 30 November - 1 December 2010 Doc 10 ? Risk Oversight

FOR INFORMATION

GAVI Secretariat , 16 November 2010 1
This document is being provided for information only. No requests are being made
of the Board.
To support the Board in its oversight role, Internal Audit has evaluated
management's consideration of risk in the preparation of the Business Plan and the
Bud get.
The main conclusions are:
? GAVI's current Risk Register, which has been provided to the Board,
provides a good overview of the key risks and mitigation activities ; Internal
Audit is not aware of any other important risks that should be brought to
the Board?s attention .
? For each of the three risks rated as ?high? (resource mobilisation, cash -
based programme risks, and country sustainability), management has
provided the Board with a good description of the nature of each risk and
how it proposes to (con tinue to) mitigate it through activities described in
the business plan.

Risk Oversight

Introduction / background

Risk management can be defined as follows, as set out in a recent authoritative
paper on the subject 1:

Enterprise risk management is a p rocess, effected by the entity?s board of
directors, management, and other personnel, applied in strategy setting and
across the enterprise, designed to identify potential events that may affect the
entity, and manage risk to be within the risk appetite, t o provide reasonable
assurance regarding the achievement of objectives.

The paper suggests four areas that can contribute to Board oversight with respect to
risk management. Specifically, the Board can undertake to:

? Understand GAVI?s risk philosophy and concur with its risk appetite
? Know the extent to which management has established effective
enterprise risk management within the organisation
? review GAVI?s portfolio of risk and consider it against its risk appetite
? be apprised of the most significant ri sks and whether management is
responding appropriately
1 'Effective Enterprise Risk Oversight ? The Role of the Board of Directors', Committee of Sponsoring
Organisations of the Treadway Commission ('COSO'), September 2009

GAVI Alliance Board Meeting 30 November - 1 December 2010 Doc #05 ? Evaluation Advisory Committee Chair Report

FOR INFORMATION

GAVI Secretariat, 16 November 2010 1

1
This document is being provided for information only. This paper provi des an
update on the activities from the Evaluation Advisory Committee including its views
on the quality and usefulness of the Second GAVI Evaluation .
No requests are being made of t he Board.


Report from Chair of Evaluation Advisory Committee to the
Board

1. Introduction

1.1 The GAVI Alliance Board approved the charter for an Evaluation Advisory
Committee in June 2009 and the Executive Committee appointed
members the following month . The Committee is comprised of Board
members (or their delegates ) and independent experts and requires a
majority of independent experts . The purpose of the Committee is to
assist the Board in fulfilling its responsibilities in respect to the oversight of
GAVI?s organisational and programmatic evaluation activities. The
Committee aims to support a ?learning culture? by maximising the utility
and quality of evaluations and helping develop a forward -looking
monitoring and evaluation system to assist in th e Board?s decision -making.

1.2 The Committee?s charter is in Annex 1 .

2. Update on activities

2.1 The Committee convened an in-person meeting in January 2010 , a
teleconference in June 2010 and an in -person meeting in June 2010.
Much of the committee work is d one through email exchange. The
next in -person meeting is scheduled for January 2011 .

2.2 A summary of the Committee?s activities to date follows:

? Second GAVI Evaluation. The GAVI Alliance commissioned the
Second GAVI Evaluation in late 2009 to a consort ium led by
Cambridge Economic Policy Associates. The final reports were
submitted by the evaluators in September . The Committee reviewed
the adjudication process to select the firm and concluded that it was
appropriate . The Committee reviewed the incept ion report , a
preliminary draft of the evaluation report and the final version of the
report . The Committee?s report on the quality and usefulness of the
report is in Annex 2 .

? Monitoring and Evaluation Framework . The Committee reviewed
the draft Monit oring and Evaluation Framework developed by the

GAV I Alliance Board Meeting, 30 November ? 1 December 2010 Doc # 5a ? Management
response to 2 nd GAVI evaluation

FOR INFORMATION

GAVI Secretariat, 16 November 2010

1
This document is being provided for information only. The Board received the
Second GAVI Evaluation in September. This paper provides the Secretariat?s
response to the evaluation, to inform the Board?s discussion of the Report of the
Evaluation Advisory C ommittee. The Secretariat welcomes the evaluation and
substantially agrees with its findings.
No requests are being made of the Board.


Management response to the Second GAVI Evaluation

In March 2009 the Board asked the Secretariat to commission a s econd evaluation
of GAVI covering the period 2006 -2010, and subsequently approved the evaluation?s
terms of reference. Cambridge Economic Policy Associates (CEPA) were selected
to conduct the evaluation through a competitive process and completed the
eval uation in September. The Secretariat provided the evaluation report to the
Board the same month . The Evaluation Advisory Committee has also reviewed the
evaluation and the report of the Chair of the Committee is prov ided to the Board
(document 4a).

The evaluation is a substantial , detailed and robust piece of work which has already
been of great assistance to the Secretariat. Overall, the evaluation affirms GAVI?s
value added and business model. It finds that the Alliance has accelerated the
introducti on of vaccines, attracted additional funding to immunisation, successfully
engaged in organisational and programmatic innovation, and has generated country
ownership ; and in so doing has prevented millions of future deaths .

The evaluation also identified a number of areas for improvement in the next
strategic planning period 2011 -2015. The Secretariat substantially agrees with the
findings of the evaluation , and indeed has been taking account of the emerging
evaluation findings in devel oping GAVI?s five y ear strategy, the busine ss plan which
will implement it, and in new policies . The Board will consider some of these new
policies in Kigali.

This paper provides a response to the evaluation?s main findings. Given the scope
and depth of the findings, ad ditional work to address issues raised will take place in
the coming year, and under the supervision of the new performance management
unit , a detailed plan will be developed .

For ease of reference, this paper follows the order of the evaluation?s execut ive
summar y ( see annex 1 for extracts from the executive summary ).

Cross -cutting issues and methodological limitations
The Secretariat agrees that with the evaluation?s finding that there has been a lack of
comprehensive analysis of data collected to in form monitoring and evaluation of
programmes. The Secretariat has developed a monitoring and evaluation plan

GAVI Alliance Board Meeting , 30 November - 1 December 2010 Doc #11 ? Report of PPC Chair
FOR INFORMATION

GAVI Secretariat, 16 No vember 2010 1

The Programme and Policy Committee (PPC) of the GAVI Alliance Board has held
one meeting since the June 2010 board meeting . This paper provides a brief
summary of issues discussed.
The Board will be requested to approve the PPC?s recommendations with re gard to
co -financing, performance based funding, and the health systems funding platform.

Report of the Programme and Policy Committee Chair
June ? December 2010

Introduction

1. The Programme & Policy Committee (PPC) serves as the principal advisory bod y to the
board on all GAVI programme areas and leads the development of new policies. It is
staffed by high -level technical experts from partner organisations and constituencies,
with knowledge in areas such as epidemiology, public health, research, health systems
and financing.

2. The Committee is chaired by Gustavo Gonzalez -Canali, the Board member representing
the France/EC/Luxembourg/Germany donor constituency. The Committee has held one
face -to-face meeting since June 2010 .

3. The policies recommended by the PPC for Board approval and key discussion elements
are summarised below . 1

Issues discussed

Co -financing

4. In March 2010 the PPC appointed a time -limited task team to review GAVI?s co -financing
policy. The task team concluded that the current co -financing policy has been
successful in several respects, with good compliance and positive reactions from
countries, there are areas where it needs to be adapted to changed circumstances. As
such, the PPC recommend s that the Board approve the three countr y groups and
associated co -financing levels (Low income group , intermediate group, Graduating
group) to be implemented starting in 2012 . In addition, the PPC noted the following
action items:

4.1 Ensure strong linkages between the supply strategy revision an d the implementation of
the co -financing policy and subsequent review in 2014.

4.2 Ensure clear advocacy and communication efforts with a focus on graduating countries.

1 Full minutes of the meeting have been distributed and are currently under review by the
committee.

GAVI Alliance Board Meeting, 30 November ? 1 December 2010 Doc #1 1a?HSS Decision and
Updates

FOR DECISION

GAVI Secretariat, 16 November 2010 1

At the meeting in June 2010 , the Board made three decision s of relevance to the nature
of the GAVI Alliance ?s co ntinuing role in health systems . The Board endorsed:

1. The inclusion of Strategic Goal 2 ? Contribute to strengthening the capacity of
integrat ed health systems to deliver immunisation? as part of the approval of the
GAVI Alliance Strategy 2011 -2015 ;
2. ?That the maximum share of funding for cash based program me s in a given
proposal round will be 15 -25%; and
3. ?A new HSS resource allocation method wh ereby the maximum potential amount
of funding would be based on an eligible country?s total population and weighted
against a graded gross national income (GNI) scale? . This resource allocation
formula would apply to any Health System s Funding Platform gra nt going forward .

The Board also decided , by a majority vote , to ?retain the no tional U S$ 179 million not yet
expended from the original HSS window subject to availability of funds and in line with
maintaining the appropriate balance between vaccine an d cash programmes? but stated
that the Board ?shall revisit this decision at its November 2010 meeting based on further
advice from the PPC as to what extent the maximum share of funding includes HSFP
funding?.

In Board discussions through 2009 and 20 10 there has been an implicit agreement that
all future GAVI support for health sys tems strengthening (HSS) would be provided as
part of the Health Systems Funding Platform and , wherever possible , existing grants
would be reconfigured to foll ow Platform pr inciples . In that context the June Board
minutes also noted that some countries are GAVI eligible but are not eligible for funding
from the expanded IFFIm funds (i.e. they are low er middle income countries , not low
income countries) but did not at that ti me make a decision .

The PPC at its October 2010 meeting addr essed the ques tion of whether, in the future,
GAVI health system support should be offered only to low income countries and revisited
the decision in relation to the notional allocation of US$ 179 million as requested by the
Board .

The PPC recommends the following decision to be taken by the GAVI Alliance Board

? That HSS support is currently being offered to low income countries (LIC s). Low -
income countries will be funded from the Expanded IFFIm .
? The notional US $ 179 million from the original HSS window be returned to the
balance of expected demand .

In relation to the first decision point , the PPC was in strong agreement that country
eligibility
should aim to be consistent across all GAV I programmes. It stressed that the
recommendation to restrict HSS support at this time to low income countries resulted
from the current financial environment.