Challenges in the Era of Globalization - iaabd

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Proceedings of the 12th Annual Conference © 2011 IAABD the UN Secretary General called for its creation in April 2001 (Lambert and Stuyft, 2002). In this regard, the setting up of the Global Fund represents a great leap forward towards combating tuberculosis in poor and developing countries. The Global Fund to fight AIDS, Tuberculosis, and Malaria was created to increase funds to combat these three devastating diseases (Brugha et al, 2004). The Global Fund is an independent organisation, governed by a board of 18 voting and five non-voting members and supported by a secretariat of about 70 staff in Geneva (Brugha et al, 2004). By the end of 2005, after 3 years of full operation, the Global Fund had already made US$4·4 billion in commitments, accounting for about a tenth of all donations for development assistance for health in that period (Michaud, 2006). The Global Fund had approved 322 grants in 128 countries and has already disbursed US$1·8 billion (Lu et. al, 2006). In terms of the criteria considered before funding is advanced, the Global Fund considers two main factors. These factors are income per person and disease burden (Lu et al, 2006). Some authors argue that for the global fund to be effective in fighting malaria, TB and AIDs, grant recipients must have certain absorptive capacities. These absorptive capacities are needed for poor countries to effectively utilize such resources to increase delivery of their health programmes (Lu et al, 2006). In terms of necessary absorptive capacities, Lu et al (2006) found that grant characteristics such as size of commitment, lag time between signature and first disbursement, and funding round had significant effects on grant implementation. They also found that enhanced political stability was associated with high use of grants. Interestingly, these absorptive capacities are likely to be absent in the poorest countries who need access to funds most to fight these three major diseases. Over the past seven years, funding for tuberculosis control has come from the Government of Ghana (GOG) and the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). The funds provided by the Global Fund have increased significantly over these years. Ghana received the first round of funds from the Global Fund in 2003 to fight AIDS and Tuberculosis. Ghana received an amount of US$ 5.69 million which was to be distributed over five years. These Funds were to be used in Kumasi and Accra. By the provision of the fifth round of funds the Enablers Package covered all ten regions in the country (Auer et al, 2009). Ghana also received US$ 31.7 million in round five which was to last for another five years. One of the main reasons why Ghana was among the few countries to receive the first set of funds from the Global Fund was due to the high prevalence rates of HIV, Tuberculosis and Malaria as well as the good mix between the private and public sector in health service provision in Ghana. These reasons also accounted for countries such as Tanzania, Sri Lanka and Haiti being early receivers of the Global Fund. However, the fight against TB is far from being won (TB CAP, 2010). Financial as well as human resources are required to transform the fight toward eliminating TB in Ghana. The Global Fund provides this financial assistance that should help in winning the fight against TB. For example as at 2008, the Global Fund provided 60% of the funds (enablers) that went to the National Tuberculosis Programme (NTP). The government of Ghana provided the remaining 40% of the funds. Though these funds were provided they were still insufficient to meet the needs of the NTP. In 2009, the story was not different. The Global Fund provided 80% of the funds that accrued to the NTP whilst the Government of Ghana provided the remaining 20%. The funds provided by the Global Fund are used in part to train and equip health personnel. The funds provided by the Global Fund are supposed to complement those provided by the Government of Ghana. However, it seems that the Global Fund provides the bulk of the funds that are needed by the NTP. Also, it is the Global Fund that provides for the purchase of first line TB drugs which is given free to patients. Second line drugs are not provided for, and are strictly controlled by the Green Light Committee (GLC). The Global Fund supports the World TB Day celebration to create awareness in the community. This shows how crucial the Global Fund has been to managing TB in Ghana. 394
Challenges in the Era of Globalization Edited by Emmanuel Obuah Given that the fight against TB is still on and the fact that the Global Fund has been in operation for sometime it is important to ascertain the impact of the Global Fund in the Management of TB in Ghana. This study examines the impact of the Global Fund on the management of TB in a public hospital in Ghana. For the purposes of this study, the hospital is known as ZTH Hospital. The study also looks at the impact of the Global fund in addressing the key challenges facing the Tuberculosis program at the ZTH Hospital. The rest of this paper is structured as follows; Section 2 gives an overview of the epidemiology of TB in Ghana, Section 3 describes the research methodology employed for the study, Section 4 presents and discusses the findings of the study and finally Section 5 concludes the study. Overview of Tuberculosis in Ghana TB is an airborne infectious disease caused by various strains of mycobacterium, usually mycobacterium tuberculosis in humans. TB usually affects the lungs but can also affect other parts of the body. TB is spread through the air when people who have the diseases cough, sneeze, or spit. Symptoms are usually a chronic cough with blood sputum, fever, night sweats and weight loss. Tuberculosis occurs in all the 10 regions in Ghana. In terms of gender, more men seem to be infected by TB compared to women. The ratio is 2:1 which means more males are infected with TB than females. Ghana has a low detection rate when it comes to TB. The detection rate is about 36%, meaning that out of a hundred people with TB only 36 are detected. Given the low detection rate, other stakeholders such as USAID through the TB CAP are providing support to increase the detection rate to a minimum of 70%. However, of the cases identified, the success rate in terms of completion of treatment and cure is very high. Given that a hundred cases are detected, almost 85 people will be cured representing a success rate of about 85%. HIV prevalence in TB patients is less than 1% in the Western Pacific region but 38% in Africa (Corbett et al, 2006). In countries with the highest HIV prevalence, more than 75% of cases of TB are HIV associated. In Africa, TB is often the first manifestation of HIV infection, and it is the leading cause of death among HIV-infected patients. Comparison of HIV prevalence in general populations and TB patients shows that tuberculosis incidence was 8·3 times higher in HIV-positive than HIV-negative African people in 2003. Due to the fact that HIV prevalence in the country has increased, higher TB cases have been recorded across the country. This is because patients who suffer from HIV are also likely to suffer from TB because of the break-down in their immune system. Therefore, the HIV pandemic has accelerated TB infection in the country which previously was not the case due to lower HIV prevalence rates. Methodology This study employed a single case approach. The hospital used in this research is a public hospital in Ghana, which for the sake of confidentiality is referred to as the ZTH Hospital. Two main data sources were employed in this study. These are primary and secondary data sources. The primary data source includes expert interviews. We interviewed experts such as Head of the National TB Control Programme, the Head of Department of Chest Diseases, TB Coordinator, Chest Unit Biomedical Scientists and Laboratory personnel, X’ ray personnel, Pharmacists, Chest Diseases Medical Records officer, Department of Medicine Accountant and other experts at the ZTH Hospital. The secondary data source consists of internal and external sources. Internal documents include annual reports and financial reports. External sources of information were obtained from publications from the Ministry of Health and Ghana Health Service, reports from Tuberculosis Control Assistance Program Ghana (2007-2010), Report on the evaluation of TB Enablers Package in Ghana, the National Tuberculosis Health Sector Strategic Plan for 395
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Table of Contents Challenges in the
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Lennart Bangens, Goteborg, Sweden C
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Local Steering Committee Jacob Musi
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Track 1: Accounting, Finance, and I
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Abstract Challenges in the Era of G
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Abstract Determinants of Bank Lendi
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Empirical Results Challenges in the
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Table 3 Determinants of Competitive
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Research Findings Challenges in the
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Abstract: Study on Africa Governmen
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Abstract Challenges of Oil Revenue
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Abstract Land Based Sources of Poll
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Abstract On the Mitigation of Rever
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Figure 1: Lagos off shore survey po
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Conclusion Challenges in the Era of
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37. Provision of sound education fo
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The cost structure Challenges in th
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Empirical Analysis Challenges in th
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Variable Coefficient Std. Error t-S
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Abstract The Changing Requirements
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The Model, Data and Variable Defini
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Track 8: Gender and Economic Develo
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Empirical results Challenges in the
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Abstract Gender, poverty and sustai
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Figure 1.1: Spread of directorships
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Theoretical Framework Challenges in
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Single 18.1 Masters and above 35.3
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Source: Field survey, 2010 Table 3:
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Track 9: Global Studies and Politic
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Conceptual Definitions Challenges i
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Table 1: A Summary of Operating Ban
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Discussion and Conclusion Challenge
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Abstract What does Globalization me
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7. I see globalization as providing
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Research Methods approach Challenge
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Statement of the Problem Challenges
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Figure 1.Framework for Bank selecti
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Banks in Ghana Challenges in the Er
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References: Challenges in the Era o
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The study seeks to: • examine typ
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Figure 2: Customer Perception of MT
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Relationship Commitment Total 1264.
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Abstract Marketing Nigerian medicin
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References Challenges in the Era of
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Conclusion Dissatisfied 6 3.4 3.6 7
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Abstract Customer satisfaction with
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Discussion Challenges in the Era of
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