Challenges in the Era of Globalization - iaabd

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Proceedings of the 12th Annual Conference © 2011 IAABD Figure 3: Disbursement of Global Fund at the ZTH Hospital, 2009-2010 The Global Fund also provides support to the ZTH Hospital to improve its service delivery. Hence the hospital has achieved zero default rates as at the third quarter of 2010. Due to the provision of these funds, treatment success has improved as attested by most of the experts. According to the experts, the Global Fund has increased awareness on TB, increased reporting rates to hospitals, reduced the default rate amongst patients and increased success rates of treatment. Table 2 shows the TB success and mortality rates between 2007 and 2009. We infer that the funds provided by the Global Fund have contributed to stabilizing the success rates that have been chalked over the past few years. Table 2: Cohort Analysis Year 2007 2008 2009 (3 quarter) Cured 172 136 94 Completed 366 402 241 Default 12 35 7 Failure 6 2 4 Died 199 197 140 Trans our 11 55 40 Not evaluated 12 3 0 Total 778 830 526 Success 69.1% 64.8% 63.7% Mortality 25.5% 23.7% 26.6% Source: Chest Department, ZTH Hospital Details of funds received by ZTH Hospital and how the amount has been spent are provided in figure 2 and figure 3 respectively. The trend analysis shows that the funds provided to ZTH Hospital have been dwindling over time, though the funds provided to the hospital remain substantial. The allocation and expenditure is based on NTP activity classification for the period the money is given out. Out of the total funds released by NTP to the hospital chest diseases unit, 63% went into enablers to TB patients, 18% went into enablers to CBTC volunteer providers, 10% went into training for treatment monitors, 5% went into regional quarterly review meetings and 4% went into the World TB Day celebration. 398
Challenges in the Era of Globalization Edited by Emmanuel Obuah The objectives of the Global Fund are to achieve higher cure rates, increase treatment success rate, reduce mortality rate, increase TB case detection and notification rate and reduce TB patient default rates. The findings of this study however show that, the mortality has not reduced much over the period, 2007 – 2009 (see Table 1), though fund inflows have been substantial, in excess of GHC 50,000. Treatment success rate at ZTH Hospital is on the average above 60%, but failed to rise because mortality rates have not fallen. Interviews with the experts suggest that the case detection rates have been improving because of some of the incentives provided under the enablers package from the Global Fund. 5. Conclusions What are the key lessons so far from the operation of the Global Fund at the ZTH Hospital? The Global Fund has come in to aid the management of TB in the country. One of the lessons learnt is that the Global Fund should not be viewed as a replacement for funding from the Government of Ghana. If the Global Fund is viewed as a replacement then government’s commitment towards fighting TB is likely to be reduced and in that case the fight against TB is likely to be lost. According to the experts, monitoring and evaluation is key to winning the fight against TB since that can lead to better success outcomes. Also, it is essential to keep proper records so that accurate information can be produced. A good information base can enable volunteers to trace patients and administer the required treatment. Policies can also be better formulated if the records available are accurate. It is important to have state of the art laboratory equipment since poor diagnostic tools are likely to lead to late or low case detection of TB. Timely release of funds motivates staff to work and give off their best in helping TB patients get the treatment that they need. It also helps in the provision of free feeding which leads to more people reporting to health facilities. In addition, those who cannot afford it are provided transportation to the Direct Observation Treatment Centers. These factors contribute to patients reporting to facilities and increasing the detection and success rates over time. The Global Fund has contributed to the management of TB in the country. However, more needs to be done and it is important that the lessons learnt so far are taken into account to ensure even greater success outcomes in the future. Provision of funds in a timely manner is essential to sustain the gains made so far. It is essential that all parties stay committed to providing the necessary resources that will be needed in the fight against TB. Provision of state of the art equipment will also help in the early detection of TB cases early. References Auer, C., Bonney, A.A., Mensah, G, Vanotoo, L. and Hesse, A. (2009). A Report on The Evaluation of TB Enablers’ Package in Ghana. Brugha, R., Donoghue, M., Starling, M., Ssengooba, F. Fernandes, B. and Walt, G. (2004). “The Global Fund: Managing Great Expectations.” Lancet, 364(9428), 95-100. Corbett, L.E., Marston, B., Churchyard, G.J., and De Cock, K.M. (2006). “Tuberculosis in Sub-Sahara Africa: Opportunities, Challenges, and Change in the Era of Anti-Retroviral Treatment.” Lancet, 367(9514), 926-37. Drager, S., Gedik, G., and Dal Poz, M.R (2006). “Health Workforce Issues and the Global Fund to Fight AIDS, Tuberculosis and Malaria: An Analytical Review.” Human Resources for Health, 4:23 doi:10.1186/1478-4491-4-23. Floyd, K., Blanc, L., Raviglione, M., and Lee, J-W. (2002). “Resources Required for Global Tuberculosis Control.” Science, 295(5562), 2040-2041. 399
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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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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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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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Abstract The Changing Requirements
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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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Single 18.1 Masters and above 35.3
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Source: Field survey, 2010 Table 3:
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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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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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Relationship Commitment Total 1264.
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Conclusion Dissatisfied 6 3.4 3.6 7
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