Since December 2005 the GAVI Alliance (GAVI) Health Systems Strengthening (HSS) window has offered predictable funding to developing countries, based on a combined population and economic formula. This is intended to assist them to address system constraints to improved immunization coverage and health care delivery, needed to meet the Millennium Development Goals. The application process invites countries to prioritize specific system constraints not adequately addressed by other donors, and allows them to allocate their eligible funds accordingly. This article presents an analysis of the first four rounds of countries' funding applications. These requested funding for a variety of health system initiatives that reflected country-specific requirements, and were not limited to improving immunization coverage. Analyses identified a dominance of operational-level health service provision activities, and an absence of interventions related to demand and financing. While the proposed activities are only now being implemented, the results of this study provide evidence that the open application process employed by the HSS window has led to a shift in analysis and planning-from the programmatic to the systemic-in the countries whose applications have been approved. However, the proposed responses to identified constraints are dominated by short-term operational responses, rather than more complex, longer term approaches to health system strengthening.

Summaryobjectives To analyse the first four rounds of country applications to the GAVI Alliance Health Systems Strengthening (GAVI-HSS) funding window; to provide valuable insight into how countries prioritize, articulate and propose solutions for health system constraints through the GAVI-HSS application process and to examine the extent to which this process embodies alignment and harmonization, Principles of the Paris Declaration.methods The study applied multiple criteria to analyse 48 funding applications from 40 countries, submitted in the first four rounds, focusing on the country analysis of health systems constraints, coordination mechanisms, alignment with national and sector planning processes, inclusiveness of the planning processes and stakeholder engagement.results The applications showed diversity in the health systems constraints identified and the activities proposed. Requirements of GAVI for sector oversight and coordination, and the management of the application process through the Ministry of Health's Planning Department, resulted in strong alignment with government policy and planning processes and good levels of stakeholder inclusion and local technical support (TS).conclusion Health Systems Strengthening initiatives for global health partnerships (GHPs) can provide a link between the programmatic and the systemic, influencing policy alignment and harmonization of processes. The applications strengthened in-country coordination and planning, with countries using existing health sector assessments to identify system constraints, and to propose. Analyses also produced evidence of broad stakeholder inclusiveness, a good degree of proposal alignment with national health plans and policy documents, and engagement of a largely domestic TS network. While the effectiveness of the proposed interventions cannot be determined from this data, the findings provide support for the GAVI-HSS initiative as implementation continues and evaluation begins.

Through Desa Siaga (Alert Village) Program, Lumajang has been succeeded to decrease MMR. However, so far the researcher has not found any study which explored the implementation of Desa Siaga development in high-risk pregnancy care; therefore investigating the high-risk pregnant women's experience in preventing childbirth complication is important. This study aimed to document the perception and expectation among high-risk pregnant women on the "Alert Village" program. This was a qualitative study carried out in Lumajang district, East Java. The primary informants were high-risk pregnant women. The secondary informants included local communities, health workers, and maternal health programmers. The data was collected by in-depth interview, direct observation, and document review. The data analyzed with Colaizzi's technique. Most pregnant women perceived that the introduction of the "Alert Village" program had brought about improvement in the provision of women health care. The health personnel monitored high-risk pregnant women more intensely. The quality of the antenatal care and delivery care was improved, and they were more accessible to pregnant women. The communities had more power and control over their resources. They collected fund from the community members to help support pregnant women to cover the costs associated with antenatal and delivery care. Transportation showed improvement, and it eased referral system. The "Alert Village" has improved the quality and quantity of antenatal and delivery care to high-risk pregnant women. It empowers the communities to have control over their health problems. Continuing actions need to be taken to maintain and improve these initiatives Keywords: desa siaga, alert village program, high-risk pregnant women, antenatal care, delivery care