Gavi, the Vaccine Alliance, shared insights from the year two evaluation of its efforts to reach zero-dose (ZD) children—infants who have not received even the first dose of the diphtheria, tetanus, and pertussis-containing vaccine (DTP1) by the end of their first year. The evaluation highlighted both barriers and enablers in designing and delivering ZD programmes, offering lessons that are broadly relevant to global health initiatives tackling complex, multi-stakeholder challenges.
One key insight relates to simplifying funding models. Complex funding procedures can slow disbursement and limit absorptive capacity at the country level. Gavi’s testing of pooled funds and streamlined grant processes shows that reducing transaction costs and administrative burdens strengthens country ownership and makes programmes more flexible, especially in fragile and conflict-affected contexts.
Another critical lesson is the importance of building subnational capacity. Limitations in technical skills and financial management at the subnational level consistently hindered ZD delivery. Gavi is adapting by tailoring technical assistance and aligning funding mechanisms to frontline implementers. The broader takeaway is that programmes succeed or fail locally, so investing in planning, financial management, and accountability systems at the local level is essential.
Partnerships also require shared leadership, not just broad coalitions. While Gavi’s network of UN agencies, civil society, private sector partners, and governments brings diverse strengths, alignment among global partners did not always extend to subnational actors. Effective programme delivery depends on clearly defined roles and responsibilities cascading to local leadership and operational levels.
The evaluation further underscored the need for adaptive, real-time monitoring. Compliance-heavy reporting often missed opportunities for learning and timely course correction. Gavi is exploring integrated, learning-oriented monitoring systems that track not just financials but also performance, outcomes, and lessons to improve responsiveness and programme impact.
Finally, innovative models like the Gavi CSO fund manager mechanism provide promising examples of reducing barriers for civil society organisations. By managing grants to national and local CSOs, this approach supports grantees throughout project implementation while maintaining accountability, fostering greater community engagement, demand generation, and service delivery. These lessons collectively offer practical guidance for organisations aiming to address complex health challenges and reach underserved populations effectively.
