Table 1.

Design elements of a prospective, mixed-methods, comprehensive, process-focused evaluation

Element	The FCE approach
Overarching objectives	Phase 1 (2013–16): to understand and quantify the barriers to and drivers of immunization programme improvement, including Gavi’s contributions Phase 2 (2017–18): to evaluate the new policies, programmes and processes implemented by the Gavi strategy for the 2016–2020 period with a focus on identifying the drivers of equitable coverage and Gavi’s contribution to observed changes
Time frame	Prospective
Knowledge paradigm and disciplines	Mixed paradigms (positivist and relativist) and multidisciplinary [implementation science, evaluation, epidemiology, biostatistics, public health, social science (policy science, organizational science, health services research), economics]
Methods	Multiple, mixed methods driven by the EQ or phenomenon of interest
Scope	All aspects of the results chain and all levels of intervention (from global policies and process to national and subnational implementation) related to Gavi investments and national immunization programmes
Data sources	Multiple data sources, often triangulated to answer a single question. An emphasis on fit-for-purpose data collection tailored to specific EQs
Analytic approach	Multiple analytic approaches based on fit with EQ and evidence needs. Methods and analytic approaches were increasingly purposively mixed over time as we improved question framing to allow mixing.
Generalizability and comparability	Use of ToCs and conceptual frameworks support comparability across multiple countries
Evaluators and participants	Evaluators were staff of national universities or research institutions, and global research institutions at global level. Evaluators shifted from independent arms-length evaluators to, in some cases, participant-observers of EPI processes and decisions. Global and national immunization stakeholders participated in the design of the evaluation and selection of EQs.
Dissemination and feedback loops	Over time, the consortium implemented regular dissemination and feedback to key national-level stakeholders (e.g. active participation during EPI meetings, quarterly policy briefs), including specific and targeted recommendations
Governance	Commissioned by the Evaluation Advisory Committee, a sub-committee of the Gavi Board composed of independent evaluation advisors. Funded by Gavi, and managed by the evaluation team at the Gavi Secretariat.