For a global health alliance to be successful, an appropriate organizational structure receiving adequate resources and support is critical. The GAVI Secretariat is a central office that supports key alliance functions and is located and staffed separately from the various donor organizations. One study of GAVIs governance suggested that the Secretariat structure works well for relatively formal partnerships that have a group of members operating as equals. It is often most appropriate when the partners seek deeper combination gains [and] when a large number of diverse partners are involved (McKinsey 2002, p. 4).
While GAVIs Secretariat was formed during the birth of the alliance, its structure and role have changed over time. The initial Secretariat, hosted by the UNICEF office in Geneva, aimed to be lean and efficient, with only six staff members. With no technical staff, the Secretariat played a limited role in assisting the GAVI board. Instead, the Working Group, consisting of mid-level technical staff from the founding partners, conceptualized and operated GAVI (CEPA 2007). GAVI was created with this skeletal Secretariat because some of its founding partners feared the creation of a new implementing agency. The Secretariats only responsibility was the internal management of the Alliance. All other activities were to be left to the partner organizations. Yet as GAVI grew, the size and the responsibilities of the Secretariat also increased. By 2007, the GAVI Secretariat had 88 staff positions.
GAVIs experience highlights the need to invest in partnership governance. Although GAVI is not an implementing agency, its managing of the grant portfolios, providing technical support to recipient countries, and engaging in advocacy required the development of a substantial Secretariat. Currently, the GAVI Secretariat is responsible for the day-to-day operations of the Alliance, including mobilizing resources for funding programs, coordinating program approval and funding disbursements, legal and financial matters, and administration of the supervisory board. As of January 2009, the Secretariat is independent of UNICEF and Secretariat staff is employed by the new GAVI Foundation, established as a Swiss entity.
While the growth of the GAVI Secretariat may have streamlined decision making and increased accountability, this evolution has presented challenges for the partnership. As the Secretariat internalized its framing of policy issues, there has been concern about whether partners felt the same level of ownership, and commitment to, decisions arrived at this way (Chee et al. 2008).
GAVIs struggle to find the correct balance between optimal decision making with accountability and full partner involvement may offer important lessons for USG. In many ways, the Secretariat model is similar to OGAC. One crucial difference is the accountability structure. The GAVI Secretariat is accountable to the GAVI Board, which includes senior representatives of all founding partners and many other key stakeholders. In contrast, OGAC is responsible to the Secretary of State rather than to representatives of the various USG agencies participating in PEPFAR. Perhaps the most valuable lesson from the GAVI Secretariat is that the administration of complex partnerships appears to merit significant resources, and in some circumstances it may be beneficial to establish an administrative structure separate from participant organizations.