Gavi, the Vaccine Alliance has been shifting focus from disparities in immunisation coverage between countries towards in-country inequalities. Its new 2016–20 strategy embodies this shift with a welcome prioritisation to increase the “equitable use of vaccines”. Save the Children has continued to advocate on this agenda, including calling for equity to be at the centre of Gavi’s new strategy. This is an opportunity to drive positive improvements in child health, ensuring that no child is left behind.
What gets measured gets done
To deliver on this ambition, the new strategy must be matched with strong and robust indicators. As we know, what gets measured gets done. But the window of opportunity to shape this agenda will soon close as the Gavi Board will meet this week to decide on the remaining indicators that will measure delivery of the strategy. Board members have an important responsibility to get it right.
We believe that the indicators that are currently proposed are of varied quality and strength. They don’t all live up to the ambition of the strategy. We urge Board members to consider a number of recommendations:
- align reach of routine coverage with the 90% target of the Global Vaccine Action Plan
- include an explicit health system indicator, such as public health expenditure as a % of GDP
- make the Access, Demand and Service delivery indicator more comprehensive
- measure national expenditure on health alongside investment in routine immunisation
- measure increased/sustained equitable coverage under programmatic sustainability, not just national coverage.
Improved representation from the ‘voice’ of the community
As Gavi moves forward with its new strategy, it should also reconsider representation in its decision-making bodies. Fair and balanced representation is critical to improving accountability to constituencies and recipients of Gavi support.
Governance structures have poor representation from the ultimate beneficiaries of Gavi support – the ‘voice’ of the community – as represented by civil society organisations. They hold only one seat on the Board and no seat on the Executive Committee, despite the critical role they play in supporting delivery of Gavi’s strategy. This is compared with nearly one third of seats held by independent members who don’t represent (and are therefore not accountable to) any organisation or constituency.
Gavi should follow good practice of other international partnerships (eg, IHP+, UNITAID, PMNCH, The Global Fund) by increasing civil society constituency representation in its governance structures. More than a hundred CSOs and CSO platforms from across the globe are calling for action on this agenda, calling for a review of the current board composition and for at a minimum a second civil society seat on the Gavi board. It’s time for the Board to respond to these calls.