That vacuum is already being filled by American diplomacy, as in Zaire at present, and in the steadily strengthening proposals to set up regional African peace forces backed by American support.
In its guidelines for health systems strengthening proposals, GAVI encourages countries to use local evidence regarding barriers to immunisation to support their proposals.
A few topics were present in a great majority of health systems strengthening proposals: 'development of staff skills', 'health information', 'training in management and planning', and 'supplies management'.
Although each of the six topics in this theme area featured in a high proportion of health systems strengthening proposals (range: 32%to7373%), no relevant reviews of high or moderate quality were found for any of them.
The high frequency of reviews of high geographic and thematic relevance reflected the focus of the search strategy, which included terms related to the main topics and geographical scope of health systems strengthening proposals.
Nation-wide household surveys were scarcely cited in the health systems strengthening proposals even though they provide data not only on immunisation coverage but also on household and system characteristics that may be related to the uptake of vaccination.
One of the most striking examples is the topic most frequently included in the health systems strengthening proposals we studied: 'health information systems', a topic that appeared in 39 proposals, but for which no reviews of at least moderate quality could be found.
Finally, in matching the availability of nation-wide surveys with their use in the health systems strengthening proposals, we found that in 39 of the 44 countries that submitted proposals there had been a nation-wide household surveys (DHS or MICS) that could have been used to support descriptions of the immunisation status of the population and/or specific barriers to immunisation.
From 44 health systems strengthening proposals submitted to GAVI in 2007 and 2008, we analysed the topics identified, the coverage of these topics by existing systematic reviews and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals.
We recognise, though, that topics found in health systems strengthening proposals could be influenced by factors other than their importance to the countries, such as the complexity of the topics or interventions to address them, or the amount of funding requested for different kinds of interventions from other funding bodies.
