Evaluating Global Health Partnerships: A Case Study of a Gavi HPV Vaccine Application Process in Uganda

Document Type : Original Article


1 Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda

2 PATH Seattle, WA, USA

3 Makerere University School of Public Health, Kampala, Uganda

4 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

5 The INDEPTH Network, Maternal, Newborn and Child Health Working Group, Accra, Ghana

6 George Washington University, Washington, DC, USA

7 Management Sciences for Health, Arlington, VA, USA


Global health partnerships have grown rapidly in number and scope, yet there has been less emphasis on their evaluation. Gavi, the Vaccine Alliance, is one such public-private partnership; in Gavi-eligible countries partnerships are dynamic networks of immunization actors who work together to support all stages and aspects of Gavi support. This paper describes a conceptual framework – the partnership framework – and analytic approach for evaluating the perceptions of partnerships’ added value as well as the results from an application to one case in Uganda.
We used a mixed-methods case study design embedded in the Gavi Full Country Evaluations (FCE) to test the partnership framework on Uganda’s human papillomavirus (HPV) vaccine application partnership. Data from document review, interviews, and social network surveys enabled the testing of the relationships between partnership framework domains (context, structure, practices, performance, and outcomes). Topic guides were based on the framework domains and network surveys identified working together relationships, professional trust, and perceptions of the effectiveness, efficiency, and legitimacy of the partnership’s role in this process.
Data from seven in-depth interviews, 11 network surveys and document review were analyzed according to the partnership framework, confirming relationships between the framework domains. Trust was an important contributor to the perceived effectiveness of the process. The network was structured around the EPI program, who was considered the leader of this process. While the structure and composition of the network was largely viewed as supporting an effective and legitimate process, the absence of the Ministry of Education (MoE) may have had downstream consequences if this study’s results had not been shared with the Ministry of Health (MoH) and acted upon. The partnership was not perceived to have increased the efficiency of the process, perhaps as a result of unclear or absent guidelines around roles and responsibilities.
The health and functioning of global health partnerships can be evaluated using the framework and approach presented here. Network theory and methods added value to the conceptual and analytic processes and we recommend applying this approach to other global health partnerships to ensure that they are meeting the complex challenges they were designed to address.


Commentaries Published on this Paper

  • Passed the Age of Puberty: Organizational Networks as a Way to Get Things Done in the Health Field; Comment on “Evaluating Global Health Partnerships: A Case Study of a Gavi HPV Vaccine Application Process in Uganda”

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  • All Health Partnerships, Great and Small: Comparing Mandated With Emergent Health Partnerships; Comment on “Evaluating Global Health Partnerships: A Case Study of a Gavi HPV Vaccine Application Process in Uganda”

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  1. World Health Organization Maximizing Positive Synergies Collaborative Group. An assessment of interactions between global health initiatives and country health systems. Lancet. 2009;373(9681):2137-2169. doi:10.1016/S0140-6736(09)60919-3
  2. Reinicke WH, Deng F, Witte JM, et al. Critical Choices: the United Nations, Networks, and the Future of Global Governance. Ottawa: International Development Research Centre (IDRC); 2000.
  3. United Nations. Goal 17 - United Nations Partnerships for SDGs platform. Partnerships for SDGs. https://sustainabledevelopment.un.org/partnerships/goal17/. Accessed July 13, 2016.
  4. Buse K, Harmer AM. Seven habits of highly effective global public–private health partnerships: Practice and potential. Soc Sci Med. 2007;64(2):259-271. doi:10.1016/j.socscimed.2006.09.001
  5. GAVI Alliance. The GAVI Alliance Strategy 2011-2015 and Business. http://www.unicef.org/immunization/files/GAVI_Strategy.pdf. Accessed August 21, 2015.
  6. Naimoli JF. Global health partnerships in practice: taking stock of the GAVI Alliance’s new investment in health systems strengthening. Int J Health Plann Manage. 2009;24(1):3-25. doi:10.1002/hpm.969
  7. Shearer JC, Stack ML, Richmond MR, Bear AP, Hajjeh RA, Bishai DM. Accelerating policy decisions to adopt Haemophilus influenzae type b vaccine: a global, multivariable analysis. PLoS Med. 2010;7(3):e1000249. doi:10.1371/journal.pmed.1000249
  8. Lee LA, Franzel L, Atwell J, et al. The estimated mortality impact of vaccinations forecast to be administered during 2011–2020 in 73 countries supported by the GAVI Alliance. Vaccine. 2013;31(Suppl 2):B61-B72.
  9. Abt Associates Inc. Evaluation of the GAVI Phase 1 Performance (2000-2005). Cambridge, USA: Abt Associates Inc; 2008.
  10. CEPA LLP, Applied Strategies. Second GAVI Evaluation. http://www.gavi.org/library/gavi-documents/evaluations/second-gavi-evaluation-2006-2010/. Published 2010.
  11. McKinsey and Company. Strengthening technical support: GAVI Alliance. New York, NY: McKinsey and Company; 2008.
  12. Gupta A, de Chaisemartin A, Goldstein C, Murray-Lopez M. Report to the Board: A new Gavi engagement framework for implementing the 2016-2020 strategy. Gavi, the Vaccine Alliance; 2015.
  13. Institute of Health Metrics and Evaluation (IHME). Gavi Full Country Evaluation: 2014 Annual Dissemination Report. Seattle, WA: IHME; 2014.
  14. Gavi, the Vaccine Alliance. A New Gavi Engagement Framework for Implementing the 2016-2020 Strategy: Report to the Board. Geneva: Gavi; 2015.
  15. Full country evaluations. Gavi, the Vaccine Alliance website. http://www.gavi.org/results/evaluations/full-country-evaluations/. Accessed August 21, 2015. Published 2015.
  16. Brinkerhoff JM. Assessing and improving partnership relationships and outcomes: a proposed framework. Eval Program Plann. 2002;25(3):215-231. doi:10.1016/s0149-7189(02)00017-4
  17. Brinkerhoff DW, Brinkerhoff JM. Public–private partnerships: perspectives on purposes, publicness, and good governance. Public Adm Dev. 2011;31(1):2-14. doi:10.1002/pad.584
  18. Provan KG, Milward HB. A preliminary theory of interorganizational network effectiveness: a comparative study of four community mental health systems. Adm Sci Q. 1995;40(1):1-33.
  19. Provan KG, Kenis P. Modes of Network Governance: Structure, Management, and Effectiveness. J Public Adm Res Theory. 2008;18(2):229-252. doi:10.1093/jopart/mum015
  20. Popp J, Milward, MacKean HB, MacKean G, Casebeer A, Lindstrom R. Inter-Organizational Networks: A Review of the Literature to Inform Practice. Calgary: IBM Center for the Business of Government; 2014.
  21. Sandstrom A, Carlsson L. The performance of policy networks: the relation between network structure and network performance. Policy Stud J. 2008;36(4):497-524. doi:10.1111/j.1541-0072.2008.00281.x
  22. World Bank. Sourcebook for Evaluating Global and Regional Partnership Programs: Indicative Principles and Standards. Washington, DC : World Bank; 2007. https://openknowledge.worldbank.org/handle/10986/6601. Accessed August 21, 2015.
  23. Brinkerhoff JM. Partnership as a means to good governance: towards an evaluation framework. In: Glasbergen P, Biermann F, eds. Partnerships, Governance and Sustainable Development: Reflections on Theory and Practice. Cheltenham, UK: Edward Elgar; 2007:68.
  24. Bovaird T. Public–private partnerships: from contested concepts to prevalent practice. Int Rev Adm Sci. 2004;70(2):199-215. doi:10.1177/0020852304044250
  25. Romzek BS, Johnston JM. State social services contracting: Exploring the determinants of effective contract accountability. Public Adm Rev. 2005;65(4):436-449. doi:10.1111/j.1540-6210.2005.00470.x
  26. Brinkerhoff DW, Brinkerhoff JM. Partnerships between international donors and non-governmental development organizations: opportunities and constraints. Int Rev Adm Sci. 2004;70(2):253-270. doi:10.1177/0020852304044254
  27. Brinkerhoff JM. Global public policy, partnership, and the case of the World Commission on Dams. Public Adm Rev. 2002;62(3):324-336. doi:10.1111/1540-6210.00182
  28. Brinkerhoff JM. Partnership for International Development: Rhetoric or Results? Portland, OR: Lynne Rienner Publishers; 2002.
  29. Brinkerhoff JM. Donor-funded government—NGO partnership for public service improvement: Cases from India and Pakistan. Volunt Int J Volunt Nonprofit Organ. 2003;14(1):105-122.
  30. DAC Criteria for Evaluating Development Assistance. OECD website. http://www.oecd.org/dac/evaluation/daccriteriaforevaluatingdevelopmentassistance.htm. Accessed February 6, 2016. Published 2015.
  31. Provan KG, Veazie MA, Staten LK, Teufel-Shone NI. The use of network analysis to strengthen community partnerships. Public Adm Rev. 2005;65(4):603-613. doi:10.1111/j.1540-6210.2005.00487.x
  32. Putting countries in charge. Gavi, the Vaccine Alliance website. http://www.gavi.org/about/gavis-business-model/putting-countries-in-charge/. Accessed July 13, 2016.
  33. Knoke D, Yang S. Social Network Analysis. Thousand Oaks, CA: SAGE Publications; 2008. Quantitative Applications in the Social Sciences; vol 2.
  34. Blanchet K, James P. The role of social networks in the governance of health systems: the case of eye care systems in Ghana. Health Policy Plan. 2013;28(2):143-156. doi:10.1093/heapol/czs031
  35. Shearer JC, Dion M, Lavis JN. Exchanging and using research evidence in health policy networks: a statistical network analysis. Implement Sci. 2014;9:126. doi:10.1186/s13012-014-0126-8
  36. Kenis PN, Schneider V. Policy networks and policy analysis: scrutinizing a new analytical toolbox. In: Marin B, Mayntz R, eds. Policy Networks: Empirical Evidence and Theoretical Considerations. Boulder/Colorado, Frankfurt: Westview Press; 1991:25-59.
  37. Yin RK. Case study research: design and methods (Applied Social Research Methods). 4th ed. SAGE Publications; 2009.
  38. PATH, Child Health and Development Center (CDCH), Uganda National Expanded Programme on Immunization (UNEPI). HPV Vaccination in Africa: Lessons Learned From a Pilot Program in Uganda. Kampala, Uganda: PATH; 2011. http://www.path.org/publications/files/RH_hpv_lessons_learned_uganda.pdf
  39. Government of Uganda. Application Form for Country Proposals (HPV vaccine support). Gavi Alliance; 2013.
  40. Lewis JM. Being around and knowing the players: networks of influence in health policy. Soc Sci Med. 2006;62(9):2125-2136. doi:10.1016/j.socscimed.2005.10.004
  41. Borgatti SP, Everett MG, Freeman LC. Ucinet for Windows: Software for Social Network Analysis. Harvard, MA: Analytic Technologies; 2002.
  42. Borgatti, S.P. NetDraw Software for Network Visualization. Lexington, KY: Analytic Technologies; 2002.
  43. Republic of Uganda. Uganda National Expanded Programme on Immunizationn Multi Year Plan 2012-2016. Kampala, Uganda: Republic of Uganda; 2012.
  44. World Health Organization (WHO). Global status report on non communicable disease 2014. Geneva: WHO; 2014. http://www.who.int/nmh/publications/ncd-status-report-2014/en/.
  45. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012: Globocan 2012. Int J Cancer. 2015;136(5):E359-E386. doi:10.1002/ijc.29210
  46. First Lady Launches Cervical Cancer Vaccination in the Country [Internet]. Mrs. Janet K. Museveni website. http://janetmuseveni.org/jmk_cms/index.php/j-d2011/19-updateskaramoja/102-cancervac. Accessed July 11, 2016. Published 2011.
  47. Cervical Cancer Action. 2nd Stop Cervical Cancer in Africa Meeting. Cervical Cancer Action Newsletter. December 2008. http://cervicalcanceraction.org/CCA_news_Dec08_full.html. Accessed July 10, 2016.
  48. Provan K, Fish A, Sydow J. Interorganizational networks at the network level: empirical literature on whole networks. J Manag. 2007;33(3):479-516. doi:10.1177/0149206307302554
  49. Wonodi CB, Privor-Dumm L, Aina M, et al. Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria. Health Policy Plan. 2012;27 (suppl 2):ii27-ii38. doi:10.1093/heapol/czs037
  50. Kamara L, Milstien JB, Patyna M, Lydon P, Levin A, Brenzel L. Strategies for financial sustainability of immunization programs: a review of the strategies from 50 national immunization program financial sustainability plans. Vaccine. 2008;26(51):6717-6726. doi:10.1016/j.vaccine.2008.10.014
  51. Lydon P, Levine R, Makinen M, Brenzel L, Mitchell V, Milstien JB, et al. Introducing new vaccines in the poorest countries: What did we learn from the GAVI experience with financial sustainability? Vaccine. 2008;26(51):6706-6716. doi:10.1016/j.vaccine.2008.10.015
  52. Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan. 2008;23(5):294-307. doi:10.1093/heapol/czn019
  53. Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8(8):e1001079. doi:10.1371/journal.pmed.1001079
  • Receive Date: 25 February 2016
  • Revise Date: 05 October 2016
  • Accept Date: 08 October 2016
  • First Publish Date: 01 June 2017