Findings from two evaluations of GAVI’s support for health systems strengthening (HSS) were published in 2009. An external evaluation by HLSP[24] found insufficient technical support provided to countries applying for GAVI grants, an under-performing Independent Review Committee (IRC), and weaknesses in GAVI’s monitoring of grant activities. The study also found that countries were using GAVI grants for ‘downstream’ short-term HSS fixes rather than ‘upstream’ and long-term structural reform.