MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Kenya: The Impact of Global Health Initiatives on
the Health System
Abstract
Joseph Rhatigan *† , Erin Sullivan ‡† , Kileken ole-MoiYoi ‡† , George Kimathi § , Nayana
Dhavan *† , Ephantus Kabiru §
There has been an increasing interest in understanding the effects that GHIs, such as the Global
Fund and PEPFAR, have had on nations’ overall health systems. We sought to evaluate the impact
of these two GHIs on Kenya’s health system.
We conducted semi-structured interviews with 37 key informants from across the health sector
and examined documentary material. Interviews were recorded and transcribed. The data was
then coded and analyzed using qualitative data analysis software.
Informants reported that PEPFAR and the Global Fund had an overall positive effect on Kenya’s
health system. Informants identified PEPFAR’s governance, procurement systems, and monitoring
and evaluation (M&E) systems as key drivers of its achievements. Informants identified the Global
Fund’s ability to coordinate funding with government priorities as a key driver of its positive
effects.
Informants also identified opportunities for maximizing GHIs’ positive effects on the health system
and minimizing negative effects. PEPFAR’s lack of coordination with government decision-making
processes and the constraints it imposes on the use of funding were described in unfavourable
terms. Similarly, the Global Fund’s complex grant funding process and its perceived lack of
oversight and accountability were described unfavourably.
Although GHIs such as the Global Fund and PEPFAR have successfully strengthened the Kenyan
health system, there are opportunities for them to have a greater positive effect.
* Brigham and Women's Hospitals, Department of Global Health Equity
† Global Health Delivery Project
‡ Harvard School of Public Health, François-Xavier Bagnoud Center for Health and Human Rights
§ Kenyatta University, Nairobi
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