Health Systems

Resources: availability of essential drugs, procedures, vaccines and technology

Created in 2000, Gavi is an international organisation - a global Vaccine Alliance, bringing together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. Their commitment to health system strengthening provides the opportunity to use vaccination as a case study for the importance of health systems in improving the health of populations, and much of the information in this section comes from the Gavi website.

The problem: Health systems in the poorest countries are still not reaching almost one in five children with a full course of basic vaccines.

These remaining pockets of under-immunised children are often the hardest to reach. Many live in urban slums or in remote rural areas, unregistered with health clinics and beyond the reach of health workers. Others are born into marginalised communities where parents may be unaware of the benefits of vaccination.

Vaccinating a child in a health clinic is just the final destination of a complex journey that spans a sequence of essential steps, from training health workers and maintaining the cold chain to collecting data and raising awareness of the benefits of vaccination.

All of these activities have to be in place if vaccines are to be delivered even to the poorest and hard-to-reach communities. Importantly, they also provide a platform for delivering other essential primary healthcare services.

Gavi has thus identified the following Strategic Focus Areas:

• data;
  • three key areas:
    • Immunisation delivery,coverage and equity: strengthening the quality of immunisation coverage data to help address bottlenecks.
    • Vaccine-preventable disease (VPD) surveillance: helping countries to strengthen their surveillance systems and use disease data to target and improve immunisation programmes. VPD surveillance systems are also a vital part of ensuring global health security and outbreak preparedness.
    • Vaccine safety surveillance and response: establishing and improving data systems to detect adverse events and implement effective response and communication strategies.
• supply chain;
  • The immunisation supply chain encompasses all the people, activities, infrastructure, resources and planning necessary to ensure that vaccines stay safe and effective and reach the children who need them. Strong supply chains are a prerequisite to improving immunisation coverage and equity, and they contribute to reduced child mortality
  • Improving the supply chain is a long-term undertaking, which complements Gavi’s broader health system strengthening efforts. It does this by supporting countries to deliver vaccines in an equitable and timely manner as part of a comprehensive package of primary healthcare services.

• in-country leadership, management and coordination of immunisation programmes;
  • Achieving (our) goal of sustainably improving coverage and equity requires strong leadership, management and coordination of immunisation programmes
  • ...have identified a range of challenges in the area of leadership, management and coordination of immunisation programmes. In the past, this area has received limited attention and investment.
  • Gavi provides different types of support to strengthen EPI (Expanded Program on Immunization) teams, national coordination forums, and technical advisory groups. These are applied and adjusted based on each country’s specific context, needs and requests for support.
• demand promotion and community engagement.
  • Ensuring sustainable demand for immunisation is only possible when caregivers and communities trust the safety and efficacy of vaccines, as well as the quality and reliability of immunisation services. They also need to have the necessary information, access and motivation to complete the recommended immunisation schedule on time
  • The Vaccine Alliance has developed a demand promotion strategy that encourages countries to embrace a range of evidence-informed approaches that are targeted and tailored to the local context. These include social and behaviour change communication, political will and advocacy, health workforce capacity development, social mobilisation and community engagement activities.

Relevance to other areas

Essential medicines are those that satisfy the priority health care needs of the population. The Essential medicines and health products website describes the programme of WHO and is worth exploring.

In 2018, WHO also developed a list of essential diagnostic tests to improve diagnosis and treatment outcomes.

Strong health systems are vital for both medicines and diagnostic testing.

Let's not forget broader areas of service delivery - look at the WHO site Health systems service delivery where we see how "WHO is supporting countries in implementing people-centred and integrated health services by way of developing policy options, reform strategies, evidence-based guidelines and best practices that can be tailored to various country settings".