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What is PEF?
The Partners’ Engagement Framework, PEF for short, is a new model that we introduced in 2016 to be able to deliver on our strategic vision for 2016–2020 – to dramatically improve immunisation coverage and equity in the world’s poorest countries. This is a vision which is extremely compelling but also very daunting, and we needed to look differently at the role Alliance partners have to play in achieving it.
PEF aims to clarify the role of each Alliance partner and seeks to leverage their comparative strengths to improve coverage and equity.
What are the key principles of PEF?
PEF is based on four key principles: country-focused approach, differentiation, transparency, and accountability.
The first, and most important, is a country-focused approach. Previously, countries’ needs for technical assistance were determined in the headquarters of our partner organisations, rather than by the countries themselves. This meant that a lot of the resources we were giving to our core partners, like WHO and UNICEF, were consumed at the global and regional levels.
By contrast, the new PEF model brings a bottom-up approach to technical assistance planning. Now more than 50 per cent of our budgets are used for technical support at country level. In addition, through PEF, we are working with a broader range of partners that include Civil Society Organisations (CSOs) and local institutions to support the Expanded Programme on Immunization (EPI) in areas of their comparative advantage.
How are these needs determined?
The beauty of this model is that technical assistance needs are identified and expressed through a process we call joint appraisal, which brings together multiple country-level stakeholders. The joint appraisal reviews the immunisation programme holistically, identifies challenges and bottlenecks and then determines what kind of technical assistance the country needs to strengthen the performance of the EPI.
This process is entirely driven by the EPI and the country leadership – a huge paradigm shift compared with our previous model.
What impact is this having on the ground?
In addition to financial resources, human resources dedicated to immunisation are also being moved to the national level. WHO and UNICEF are increasingly staffing their country offices – with more than 200 full-time country office staff now funded under PEF – giving us more boots on the ground.
These country representatives are able to respond quickly to country needs and work very closely with the EPI to accelerate coverage and equity of immunisation – the central focus of our strategy.
How has PEF affected transparency and accountability?
Transparency is another core principle of PEF. In the past, the funding that was allocated to partners was not sufficiently visible - it was difficult to determine what it was spent on, for what purpose and with what outcome. Under the new model, everything is transparent. Partners and countries know exactly who is doing what, how much funding is allocated to each partner, what the expected deliverables are and how they are progressing.
This has ushered in a level of transparency that didn’t exist before – and which, to my knowledge, doesn’t exist in any other global initiatives. As each country’s EPI programme has a complete understanding of who is receiving what and for what purpose, they can hold every partner to account for outcomes that are promised and expected.
This leads me to the third principle, which is accountability. For every technical assistance component funded under PEF, there are very systematic milestones that are determined in consultation with each country.
How are the milestones monitored?
The milestones are reported biannually on a dedicated portal, in full view of the country and partners. This has laid a solid foundation for all-round accountability. They are also becoming the basis of more meaningful reviews of performance – allowing us to understand what is working and what is not.
Has this affected the way partners are funded?
PEF has enabled us to move away from incremental funding to partners, whereby our funding increased by a set percentage every year. Instead it is the country needs, the comparative advantage of each partner and their performance that collectively determine the amount allocated.
Do all countries receive the same level of support?
This brings me to the fourth and last principle: differentiation. PEF is built around the premise that one size does not fit all. The countries we support are all different in terms of the challenges they face, and therefore we divide them into three tiers.
The first tier is a set of 10 countries which together account for more than 70% of the children who do not get a full course of basic vaccines. If we really want to move the needle on reaching the unreached it is absolutely imperative that these countries start to make progress, so that is where we provide the most intensive technical support.
The second tier consists of 10 countries which are not necessarily large, but very fragile and face deep challenges. In this group we have countries like Somalia, Haiti and the Central African Republic, which require focused technical assistance from partners.
Tier three contains the rest of the Gavi-supported countries, which also need tailored support but not at the same scale.