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Health Policy
Siegfried Modola/IRIN
proposals to GAVI and the Global Fund (table 4). The
health systems component of GAVI includes
requirements for sectoral oversight and coordination,
and for the management of the application process
through the ministry of health’s planning department.
In an analysis of proposals by Galichet and colleagues
(study 1, table 2), 73% of 48 applications that were
reviewed included a national health plan for the period
of proposed funding, or its equivalent. Two countries
used the proposal process to finalise work on their
national health plans, and as a stimulus for planning at
low levels. The nine applications that were submitted
without any planning or strategic documentation were
referred for resubmission. The degree of alignment
with planning processes in a country was good. 68% of
disbursements by the Global Fund in 2007 were for
programme-based approaches, whereas in 62% of
countries Global Fund-supported grants were aligned
with country cycles (study 11, table 2).
However, the country proposals show an uneven
demand for the operational aspects of direct provision of
services rather than for addressing some of the systemic
constraints related to sustainable health service provision.
For example, of the $450 million requested for health
services from the Global Fund, $118 million was for the
support of direct provision of services (treatment,
prevention, and care; study 11, table 2). By contrast,
funding requested for technical capacity building for
service provision amounted to only $50 million (study 11,
table 2). Whether the nature of the demand for health
systems is determined by a country capacity that is
inadequate for identifying and addressing the long-term
systemic needs, or whether it is also determined by real
or perceived constraints about what activities are likely to
be approved through the health systems strengthening
component of GHI funding is not clear and merits
further attention.
Community involvement
GHIs have improved community participation in the
governance of public health. Non-governmental organisations,
faith-based organisations, and other civil
society organisations are directly funded by GHIs and
participate in the planning and provision of health
activities targeted by these initiatives. 14,108,122,123 Nearly
20% of the grant money from the Global Fund for the
seventh round of funding was channelled through nongovernmental
organisations, 124 and non-state organisations
account for 50% of principal recipients or
subrecipients. 125 Non-governmental organisations and
other community-based organisations play a large
implementation part for PEPFAR. In 2005, more than
40% of funding for prime partners and almost 70% of
funding for subpartners was granted to non-governmental
or faith-based organisations. 126 Non-state,
not-for - profit organisations have been effective
recipients of GHI funds and have done better than
government recipients. 126–130
The contribution of GHIs to building capacity outside
the state sector has promoted the decentralisation of
health management but has also raised issues about
subnational coordination. For example, in several African
countries the rapid growth of the non-governmentalorganisation
sector when many of these organisations
had little capacity and were weakly accountable has
caused concern. 109,119,131 Generally, community engagement
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