Sharpening the World Bank Group’s ability to deliver results for country clients has been the focus of a lot of attention and effort during the current change process. But to better deliver those results – and to help achieve the Bank’s twin goals – more effort needs to be put into strengthening and improving an area that is not getting the attention it deserves- the Bank’s global programs and partnerships.

IEG’s review of the Bank Group’s partnership with the GAVI Alliance highlights the challenges the Bank faces in ensuring that its contributions to major global partnership programs maximize results for its country clients.

GAVI is one of the Bank’s fastest growing and most complex partnerships. GAVI supports childhood vaccination in low-income countries, disbursing on average $735 million annually between 2007-13. It is also one of the new multilateral ‘vertical funds’ in the health sector. The Bank Group has historically been a vital partner, helping to create GAVI in 2000 and setting up innovative financial instruments on GAVI’s behalf. For example, the Bank helped create the International Finance Facility for Immunization that raised $4.5 billion for GAVI. The Bank also helped create the Advanced Market Commitment for pneumococcal vaccine.

GAVI’s secretariat, by design, does not have a country presence and relies on national health authorities and partners such as WHO and UNICEF to make sure that GAVI-financed vaccines reach all children. Although lean, this model has certain gaps. Who makes sure there is a dialogue with Ministries of Finance on how to finance immunization once GAVI withdraws? Who is responsible for boosting immunization rates for low income and remote populations?

IEG’s review finds that the Bank Group missed opportunities to contribute analytical work, policy dialogue, and donor coordination around immunization that could have addressed gaps in GAVI’s model and improved results. In fact, in recent years, the Bank has largely disengaged from GAVI-supported national immunization programs - even as it continued to do innovative financial work on behalf of GAVI globally.

Direct Bank financing for immunization has become largely restricted to polio; broader immunization-related lending was just 5 percent of total health lending in 2012. And the Bank has largely ceased doing analytical work on getting vaccination programs into national budgets.

Tajikistan, for instance, has a capable Ministry of Health but no budget line for distributing the vaccines it receives from GAVI, a situation Bank staff were largely unaware of and so had not raised the issue with the Ministry of Finance.

There are signs that the Bank Group has started to reengage with GAVI and that provides an opportunity to recalibrate the partnership by providing a clearer definition of roles and responsibilities. IEG’s evaluation recommends that there should be a flexible division of labor that allows the Bank to pursue policy dialogue and conduct analytical work tailored to country contexts with a focus on countries with low immunization coverage. Key themes for the Bank to focus on are:

  • Ensuring governments create budget lines for vaccination programs
  • Equity of coverage
  • More effective donor coordination.

Looking beyond GAVI, the review highlights that inertia, disengagement, and missed opportunities for stronger development results have occurred in other large and vital partnerships. To prevent that from happening again, the Bank Group needs to be able to track and document how its partnerships are performing and to identify what it is contributing to them. Routine oversight and monitoring of the Bank’s contributions to partnerships should be geared to optimizing their value to country programs and client countries.

Staff may also need more support. Training for staff representing the Bank on boards of partnership programs and clear terms of reference would equip them to better represent the organization.

The new World Bank Group strategy argues that addressing complex development challenges requires partnering with private, public, multilateral, and civil society actors. Our evaluation suggests that these partnerships could often deliver better value for money.

Comments

Submitted by Lyjohn on Fri, 07/24/2015 - 05:56

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New vaccine demleopvent and introduction should be congratulated private sector manufacturers need reasured that there will be a demand for and profitability in their products. Unfortunately the systems costs of new vacine introduction can be 30-50% of the vaccine cost istelf (GAVI board papers and analysis 2005-2008), that can leave the countries with a substantial long term mortage. before deciding on new vaccine introduction and spending time and resources for advocacyu for relatively expensive technologies, more lives could be saved with less investment by turning to boring old early and exclusive breast feeding, links with water and sanitation, integrated approaches to demand side of primary health care. More complex than the magic bullet' of vaccines but more cost effective?

Submitted by Rasmus Heltberg on Fri, 07/31/2015 - 05:06

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Thanks for your comment. To me, it is not a question of either vaccines or other basic public health interventions like those you mention: public health systems should be able to do both. In fact, there are synergies since vaccinations often bring families into contact with the health system and this way can trigger other preventative services.

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