The GAVI Alliance: how it uses the ‘seven behaviours’
The GAVI Alliance has used the ‘seven behaviours’ on development cooperation to assess and improve its work as a development partner. IHP+ recently interviewed Hind Khatib-Otman, Managing Director of Country Programmes, about how GAVI uses this approach, what difference it has made and what challenges they faced.
GAVI is a public-private partnership focused on saving children’s lives and protecting people’s health by increasing access to immunization in poor countries. GAVI was one of 19 development partners who initially signed the IHP+ Global Compact in 2007, making commitments to improve aid effectiveness and development cooperation.
At an IHP+ meeting in Nairobi, December 2012, participants identified a number of critical areas where international development partners need to change their behaviour in order improve development cooperation. These are known as the seven behaviours.
They include to:
- Support a single national health strategy.
- Record all funds for health in the national budget.
- Harmonize and align with national financial management systems.
- Harmonize and align with national procurement and supply systems.
- Use one information and accountability platform.
- Support south-to-south and triangular cooperation.
- Provide well-coordinated technical assistance.
Q. How has GAVI used the seven behaviours?
After the Nairobi meeting in 2012, GAVI started looking at the seven behaviours. We asked ourselves what can they teach us? It was an opportune moment, because at that time we were changing our business model and revisiting our guidelines. We questioned how the seven behaviours could help us to streamline our funding guidelines for health systems and vaccines.
We carried out an extensive exercise. A committee oversaw the updating of our guidelines and over a period of two months, we examined each of the seven behaviours and explored how we could integrate them into the new model. We had serious facilitated discussions which brought together people from teams across the organization: M&E, Finance, Transparency and Accountability, Policy, Country Programmes, Vaccine Implementation, and Health Systems Strengthening. We also brought in people who were working on IHP+, with knowledge and expertise about aid effectiveness and harmonization. They helped us put things in context and helped us explore how GAVI could pioneer and show results in aid effectiveness and development cooperation.
Q. What changes did you make as a result of using the seven behaviours?
The seven behaviours are very much an integral part of GAVI’s new funding guidelines. The guidelines are out this year partially and in their entirety next year. We have had a major shift of perspective away from starting with vaccines, towards starting with the country. We have changed our reporting, our financial management, our information management and how we communicate. We are not doing extremely well in all the seven behaviours, but in general we are moving towards stronger harmonization and alignment.
Support a single national health strategy:
One of the seven behaviours is to support a single national health strategy. Previously, GAVI did not request for a proposal to be based on a national health strategy and we put a lot of emphasis on the Comprehensive Multi-Year Plan for Immunization. Now all our proposals have to be built on national health strategies. We felt the opportunity was there to work with GAVI’s partners, making sure that partners who know the countries better than us work with the Ministry of Health to update the national health strategy. We also wanted to be able to fund parts of the national health strategy based on the gaps identified by the country.
Record all funds for health in the national budget:
We started talking about budgets and whether they were in line with national priorities. This was useful as many partners were coming to us and saying, ‘Listen you GAVI and the Global Fund are fragmenting the health systems because no body wants to work on any health issue if it is not immunization, aids, TB and malaria, and you top up salaries’. Our Transparency team requested that topping up salaries be part of a national human resource strategy to show how countries are going to sustain it. This is also in our funding guidelines.
Harmonize and align with national financial management systems:
We talked to the Global Fund and the World Bank and they already have systems in place, so we looked at how we could build on their systems and avoid parallel systems. To ensure transparency and accountability, we looked into pooled funding asking for a minimum assurance that GAVI’s money is dispersed towards immunization programmes. We were scared about taking huge risks in working through a harmonized or pooled way. But after our assessment, we understood better how we could track funding without having to create a parallel system.
Harmonize and align with national procurement and supply systems
It is a major challenge to us to fully harmonize vaccine procurement. GAVIs model works on pooled procurement, and this is how we influence the vaccines market. We simply cannot do it any other way to actually ensure that there is a volume of vaccines. We inform countries about the minimum proper procurement practices at country level, (procurement policies and national transparency and accountability). We have given them some additional money through a business plan or money through a grant for them to build their capacity and build a national system.
Use one information and accountability platform:
GAVI has historically used only coverage indicators and it is very difficult in a year to show that a country has increased its coverage from 60-90 percent for example. So we needed something in between to demonstrate that we are on the right track. We decided to introduce intermediate indicators. We used the IHP+ M&E toolkit, and selected indicators most suited for the mission of the organization and which we can draw upon from the proposal submitted by the country. We also have now one database accessed by GAVI, UNICEF and WHO. We can all input data on a specific country, read and access it. This is fantastic because we have established a good base line for the three major partners working on vaccines and immunization.
Support south-to-south and triangular cooperation (and)
Provide well-coordinated technical assistance:
We have not advanced much on these two points, but it is on the agenda. Our Technical Assistance model is very much based on the support from two Alliance partners (WHO and UNICEF), as they provide the technical support through their country offices and bring major expertise into the country. We want to get countries to learn from each other; so how do we enhance a stronger collaboration and enhance learning across the countries? We still have work to do, as we have not done a thorough mapping of the expertise that is available in the countries and assessment of how we can use it.
Q. What challenges did you face?
The area of procurement posed a major challenge as procurement systems and policies are very weak. Through the Financial Management Assessments (FMAs) we can always identify weaknesses and provide recommendations to the country on how best to address them. This has not happened across all the countries and continues to be the most problematic area. GAVI is increasingly involved in joint FMAs with other partners including the World Bank. Based on FMAs, GAVI’s preference is to provide funding to national systems.
Q. What did you learn as an organization?
We learnt that Alliance Partners can adopt flexible approaches to improve our support to countries. Change is difficult but doable. Countries and national ownership is the key to success and it is important for countries to identify their technical support needs early in the process and offer solutions. Another lesson is that you definitely need a champion in the house. It helped that our CEO and the Executive Team endorsed the move towards a new business model focused on stronger alignment with country processes, now an integral part of grant application, management and review.
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