MAXIMIZING POSITIVE SYNERGIES - World Health Organization

More documents

Recommendations

Info

The Global Fund has strengthened the role of Civil Society Organizations in disease control programmes Global Fund policies ensure that CSOs are directly involved in the consultative process for country proposals. Further, Global Fund’s policy of ‘dual track’ funding ensures that CSOs are part of the implementation process as well. Key informants in all the states studied were of the view that CSOs had contributed towards increasing the quality and coverage of TB and HIV/AIDS services in India. In both these programmes, CSOs actively participate in service delivery like running TB labs, providing care to patients, and helping the programme reach vulnerable and difficult to reach groups by engaging with them. The engagement of CSOs in provision of health services has a long history and existed long before the Global Fund’s arrival. However, the Global Fund has definitely institutionalized their involvement and provided them a legitimate space for influencing the design and implementation of Global Fund- supported programmes. Equally important, this engagement has made CSOs a partner in the national disease control programmes of TB and HIV/AIDS, a position which they did not previously have. Quantitative Findings Health Management Information Systems (HMIS) data collected from the sampled health facilities and interviews with facility staff in Andhra Pradesh and Manipur indicated that, in general, the presence of Global Fund funding appears to have increased availability and uptake of health services at the sampled health facilities. Notably, Multi-drug Resistant Tuberculosis (MDRTB) drugs became available only after Global Fund funding started. Temporal trends also suggest that uptake of certain TB services (e.g. TB suspects evaluated) increased when Global Fund funding was present, though trends in new patients started on DOTS does not follow this trend. HIV/AIDS services also appear to have increased with Global Fund funding – both testing and counselling witnessed impressive increases at most health facilities. It is important to note that these findings are based on a small number of health facilities which are not representative of the health facilities in either of the two states. In addition, causal inferences should not be drawn from the information presented here since several factors not connected with Global Fund funding could be responsible for the observed trends. For instance, the National Rural Health Mission has made considerable resources available for strengthening service delivery in the public health system. 94
Discussion Global Fund- supported programmes have been critical for making TB and HIV/AIDS services available to the population and are the health system’s primary means of controlling these diseases. In particular, Global Fund funds contributed importantly to the expansion of ART services in India. Global Fund proposals have consciously required applicants to detail how their disease specific strategies can strengthen health systems. Further, the latest round of Global Fund funding to India includes the Nursing Council of India as a primary recipient. This should provide much needed support to strengthen the position of nurses in India and the health system. Both the RNTCP and especially the NACP have a great potential for strengthening health systems in several ways. First, they place health workers at health facilities, especially at the periphery, who function as a resource for the entire health facility and not just for their specific programme. Key functions of health facilities like lab services can also be strengthened by sharing supplies and resources with labs meant for general patients or providing services for non-programme specific patients. Furthermore, the presence of these well run programmes at health facilities improves patient perceptions of public health facilities and also creates demand for better quality services. The Global Fund has also contributed in important ways to strengthen the presence, voice and capacity of civil society organizations to participate in national health programmes. While there is tremendous potential for Global Fund-supported disease control programmes to strengthen health systems, these synergies did not take place at all health facilities. Programmes like the RNTCP seem more conducive to generating these synergies. It is important to understand why disease control programmes have not been able to contribute more to strengthening health systems. Three factors appear to be important: (1) the explicit intention of the programme to strengthen health systems; (2) the locus of administrative control over programme-specific contractual health workers; and (3) the locus of administrative control over the programme. The RNTCP was designed to work through the existing health system infrastructure and with human resources available in the public health system. Where these are lacking, the programme has an explicit policy of supplementing it, thereby strengthening the capacity of health facilities. The NACP also works through the public health system and there were several instances where resources for the NACP contributed to health services beyond services specific to HIV/AIDS care. Yet, there did not seem to be an emphasis within the programme and by its managers on building connections and contributing to non-HIV/AIDS specific services. While both NACP and RNTCP staff receive salaries directly from the relevant programme, RNTCP employees are supervised by the health facility and district managers since they are typically filling an existing vacancy. NACP staff report to the AIDS control society of their state. This chain of command gives health facility and health system managers little control over NACP staff; consequently, they found it difficult to engage them in work beyond HIV/AIDS. In each state, the Directorate of Health Services is responsible for organizing and managing the delivery of curative and preventive health services through the public health system. The management unit of the RNTCP is housed within the Health Directorate, while the NACP is administered by the State AIDS Control Society (SACS) which is housed outside the state Health Directorate (though in some instances officers from the directorate are also SACS officers). The programme management unit’s location influences the degree to which programme activities and resources contribute to strengthening the health system. Since the Directorate is responsible for the entire health system in a state, close coordination with it enables better alignment of disease control programme activities and resources with those of the health system. 95
Page 2 and 3:
Table of Contents Key Acronyms Intr
Page 4 and 5:
Policy analysis of the impact of Gl
Page 6 and 7:
OIs Opportunistic infections OVC Or
Page 8 and 9:
core section of the document then p
Page 10 and 11:
Figure 1: Analytic framework for MP
Page 12 and 13:
studies. MPS researchers have linke
Page 14 and 15:
Burundi: Building a health system t
Page 16 and 17:
at between US$ 14.5 and US$ 18.5 pe
Page 18 and 19:
collaborations with European school
Page 20 and 21:
epresent only US$ 1.75 per month pe
Page 22 and 23:
Service Delivery The decentralizati
Page 24 and 25:
Long term HSS will require governme
Page 26 and 27:
Cameroon: Evaluation of the Nationa
Page 28 and 29:
Table 1 Basic Socioeconomic, Demogr
Page 30 and 31:
of treatment interruptions (>two da
Page 32 and 33:
side effects) were associated with
Page 34 and 35:
Prevention behaviours Nearly half (
Page 36 and 37:
References [1] The World Bank Group
Page 38 and 39:
Out-of-pocket payments account for
Page 40 and 41:
as well as the number of community
Page 42 and 43:
Table 1: Characteristics of facilit
Page 44 and 45:
Table 4: Estimated changes in human
Page 46 and 47:
Central African Republic: Impact of
Page 48 and 49:
Objectives and Methodology In this
Page 50 and 51: Financing There was a general appre
Page 52 and 53: NGOs and Civil Society The overall
Page 54 and 55: Discussion Interviews with key info
Page 56 and 57: China: The Impact of the Global Fun
Page 58 and 59: Table 2 Global Health Initiative In
Page 60 and 61: In Yunnan and Henan, the epidemic i
Page 62 and 63: funded only from the MOH Pilot Prog
Page 64 and 65: References [1] China at a glance. W
Page 66 and 67: 1994, private spending and emergenc
Page 68 and 69: understanding of their roles and re
Page 70 and 71: References [1] Human Development Re
Page 72 and 73: In 2003, the government launched th
Page 74 and 75: Objectives and Methodology The data
Page 76 and 77: Health Workforce Ghana is challenge
Page 78 and 79: Discussion GHIs are critical for ra
Page 80 and 81: Haiti: Maximizing Positive Synergie
Page 82 and 83: Table 1 Basic Socioeconomic, Demogr
Page 84 and 85: with need. With GHI funding, distri
Page 86 and 87: I know that within [the organizatio
Page 88 and 89: Much of the initial enthusiasm abou
Page 90 and 91: services, or for measures of qualit
Page 92 and 93: funds and more funding focused on i
Page 94 and 95: INDIA: Exploring how disease-specif
Page 96 and 97: PEPFAR* Year Amount Disbursed (in U
Page 98 and 99: Primary data collection - facility
Page 102 and 103: References [1] The World Bank Group
Page 104 and 105: Background The Republic of Kenya li
Page 106 and 107: Results Leadership and Governance D
Page 108 and 109: Informants noted that a general lac
Page 110 and 111: time periods. Informants believed t
Page 114 and 115: A comprehensive, long-term reform o
Page 116 and 117: The effects of GHIs on the capacity
Page 118 and 119: their budget was comprised of Globa
Page 120 and 121: Quality of services The majority of
Page 122 and 123: References [1] Kyrgyzstan at a glan
Page 124 and 125: Commission (NAC) in 2001 as a multi
Page 126 and 127: Objectives and methodology The main
Page 128 and 129: Discussion The findings of the Mala
Page 130 and 131: Pakistan: The impact of the Global
Page 132 and 133: international standards. The Under
Page 134 and 135: the US Centers for Disease Control
Page 136 and 137: Some negative effects are also attr
Page 138 and 139: to country health systems by way of
Page 140 and 141: Peru: Effects of the Implementation
Page 142 and 143: Table 2 Global Health Initiative In
Page 144 and 145: HIV/AIDS, mainly around the Compreh
Page 146 and 147: without substantial emphasis on pre
Page 150 and 151:
Rwanda: The Impact of Global Health
Page 152 and 153:
Rwanda was US$ 584.9 million in 200
Page 154 and 155:
International Health Partnership, t
Page 156 and 157:
PEPFAR’s funding practices were l
Page 158 and 159:
medical staff to higher-paying admi
Page 160 and 161:
system (CPDS), in which many stakeh
Page 162 and 163:
needing medical transport. Both GHI
Page 164 and 165:
Some informants felt that local NGO
Page 166 and 167:
Senegal: The effects of Global Heal
Page 168 and 169:
Table 1: Basic Health System and Ep
Page 170 and 171:
case study. Data analysis was condu
Page 172 and 173:
of respondents aware of treated net
Page 174 and 175:
South Africa: The effects of Global
Page 176 and 177:
Table 2 Global Health Initiative In
Page 178 and 179:
of South Africa (GHI2, ND6). 26 Don
Page 180 and 181:
NDOH to disburse external funds in
Page 182 and 183:
The lack of effective monitoring an
Page 184 and 185:
Despite these problems, GHI funding
Page 186 and 187:
[19] The Global Fund for Aids Tuber
Page 188 and 189:
Official Development Assistance (OD
Page 190 and 191:
The study employed both purposive s
Page 192 and 193:
Figure 1: Number of Clinicians at S
Page 194 and 195:
There were very significant increas
Page 196 and 197:
GHIs created an opportunity to cond
Page 198 and 199:
Ukraine: Effects of the Global Fund
Page 200 and 201:
GAVI (in US$) Disease Priority Amou
Page 202 and 203:
government and nongovernmental prov
Page 204 and 205:
• The introduction of new service
Page 206 and 207:
References [1] Data are from the Mi
Page 208 and 209:
The health system struggles with a
Page 210 and 211:
Objectives and Methodology This stu
Page 212 and 213:
Nonetheless, efforts to recruit and
Page 214 and 215:
References [1] The World Bank Group
Page 216 and 217:
average annual population growth of
Page 218 and 219:
2006 149,022,153 2007 216,012,780 2
Page 220 and 221:
isks duplication of services but al
Page 222 and 223:
centres have only one qualified hea
Page 224 and 225:
Policy analysis of the impact of Gl
Page 226 and 227:
countries” [6]. The TRP apply sev
Page 228 and 229:
PEPFAR I & II The newest PEPFAR leg
Page 230 and 231:
Types of fundable HRH interventions
Page 232 and 233:
Global Fund In two country applicat
Page 234 and 235:
TABLE 3: Selected Countries: MPS Ca
Page 236 and 237:
HRH Intervention Categories GAVI: C
Page 238 and 239:
HRH Intervention Categories GLOBAL
Page 240 and 241:
HRH Intervention Categories PEPFAR
Page 242 and 243:
Conclusion: Directions for future r
Page 244 and 245:
GHIs and health systems. Civil soci
Page 246 and 247:
Annex 01: Data sources for tables i
Page 248 and 249:
Annex 02: Contributing Institutions
show all

MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?