Performance Based Reward for Immunization: Experiences from GAVI

Performance Based Reward for Immunization: Experiences from GAVI

By: Rete Trap, Birna Trap, Torsten Wind Hansen, Ebba Holme Hansen
Publication: Southern Med Review4 (1) (April 2011): 40-47. DOI: 10.1093/heapol/czt030



To assess whether linking the Global Alliance for Vaccine and Immunization (GAVI) service support with performance-based interventions has influenced the quality of reporting and of immunization systems. GAVI Service Support (ISS) combines performance assessment, recommendations and implementation support with financial reward.


A retrospective study based on data from Data Quality Audit (DQA), a validated standardized indicator-based performance assessment tool which evaluates reporting consistency, accuracy and the quality of the immunization system. Participants are nine developing countries, sampling 421 health units, 72 districts, which have had two consecutive DQAs in the period 2002 to 2005.


Both the quality of reporting and the immunization system improved following GAVI ISS intervention. Reporting quality was associated with the enhanced overall quality of the immunization system and with immunization coverage. Immunisation coverage improved in eight of the nine countries.


The study indicates that the combined GAVI ISS intervention strategy is effective, resulting in increased immunization coverage, enhanced reporting quality and improved quality of the immunization system set-up at all levels of healthcare. High quality reporting is instrumental in focusing immunization management on setting targets for increased coverage, demonstrated by the correlation between increased reporting quality and immunization coverage. Repeated assessments are recommended to ensure sustainable immunization system improvements.