MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Results Leadership and Governance Data showed that GHI governance was an important determinant of impact. PEPFAR’s leadership and management structures were cited as integral to the rapid increase in the number of people on antiretrovirals (ARVs) in Kenya. The Global Fund leadership and management structures were perceived as presenting persistent challenges to achieving the full potential of its funding. Informants indicated that it was relatively easy to communicate and problem-solve with PEPFAR representatives, due to the established relationships with US government (USG) agencies in Kenya and the resultant familiarity with their organizational structures. Access to PEPFAR leadership, however, was somewhat hindered by its location in the US Embassy compound and the associated security protocols. Respondents indicated that unclear mandates and poorly delineated roles and responsibilities of the USG agencies—US Agency for International Development (USAID), the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Walter Reed Medical Research Institute, Department of Defense (DOD), Department of State and Peace Corps—created interagency tension and competition that led to inefficiencies. However, informants also reported that these agencies’ scope of work was better defined and clarified over the past year, and that this may help reduce tensions. Unlike PEPFAR, the Global Fund does not have in-country representatives. All concerns must be raised with the main in-country governance mechanism, the Country Coordinating Mechanism (CCM), or by contacting the country portfolio manager in Geneva. Additionally, any programmatic changes after the initial grant approval must be directed to Geneva for review, which causes delays in implementation and reporting. Although informants believed that the Global Fund country portfolio manager in Geneva was accessible and receptive, they indicated that Global Fund-funded programmes would significantly benefit if portfolio managers were located in Kenya. The Global Fund CCM elicited both positive and negative assessments from respondents. Some informants lauded the creation of the CCM as a country-led team that brought together different stakeholders in the health system and enabled donor resources to be better aligned with national health priorities. Others felt CCM members did not adequately represent the different sectors within the health system and that the government representation was disproportionately large. They suggested that the CCM was a parallel system that was imposed by the Global Fund and that it did not fit with the pre-existing national structures, since it only coordinated activities around three diseases rather than across the entire health system. Civil society organization (CSO) representatives to the CCM were elected democratically, however the CCM chair and vice chair were not elected. Informants indicated that there were tensions within the CCM, including a lack of trust between CSO and government representatives. Many CCM members were members of the Global Fund sub-recipient organizations. Several informants criticized CCM members who worked to benefit their own sectors exclusively or who attempted to obtain Global Fund funds for their own programmes. Informants believed that this conflict of interest hindered the transparent functioning of the CCM and the overall effectiveness of the Global Fund in Kenya. Respondents criticized the CCM leadership for heavy infighting and irregularities in reporting. Several respondents indicated that the CCM was not a legal entity and, as a result, had unclear accountability. 100
Table 2 Global Health Initiative Investments (*) Global Fund Round & Disease Priority Approved (in US$) Disbursed (in US$) Round 1, HIV/AIDS 220,875 220,875 Round 1, HIV/AIDS 2,650,813 2,650,813 Round 2, HIV/AIDS 106,786,807 68,006,881 Round 2, Malaria 27,700,377 4,640,447 Round 2, TB 8,761,405 3,299,522 Round 4, Malaria 162,173,085 76,103,617 Round 5, TB 13,499,895 3,511,242 Round 6, TB 4,206,357 1,710,684 Round 7, HIV/AIDS 46,663,557 16,538,950 TOTAL: 372,663,171 176,683,031 PEPFAR Year Amount Disbursed (in US$) 2004 92,474,390 2005 142,937,153 2006 208,269,879 2007 368,129,182 2008 534,794,604 TOTAL: 1,346,605,208 GAVI Disease Priority Amount Approved (in US$) Pentavalent vaccine 171,060,000 Yellow fever vaccine 325,000 Vaccine introduction grant 100,000 Injection Safety 1,245,000 Immunization services support 8,460,680 Health systems strengthening 9,903,000 TOTAL: 190,093,357 World Bank MAP Title FY Approved/Closing Date Commitment (in US$) HIV/AIDS Disaster Response Project 2001/2005 50,000,000 Total War Against HIV and AIDS (TOWA) Project 2007/2011 80,000,000 TOTAL: 130,000,000 101
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Table of Contents Key Acronyms Intr
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Policy analysis of the impact of Gl
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OIs Opportunistic infections OVC Or
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core section of the document then p
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Figure 1: Analytic framework for MP
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studies. MPS researchers have linke
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Burundi: Building a health system t
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at between US$ 14.5 and US$ 18.5 pe
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collaborations with European school
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epresent only US$ 1.75 per month pe
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Service Delivery The decentralizati
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Long term HSS will require governme
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Cameroon: Evaluation of the Nationa
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Table 1 Basic Socioeconomic, Demogr
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of treatment interruptions (>two da
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side effects) were associated with
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Prevention behaviours Nearly half (
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References [1] The World Bank Group
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Out-of-pocket payments account for
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as well as the number of community
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Table 1: Characteristics of facilit
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Table 4: Estimated changes in human
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Central African Republic: Impact of
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Objectives and Methodology In this
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Financing There was a general appre
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NGOs and Civil Society The overall
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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 100 and 101: The Global Fund has strengthened th
Page 102 and 103: References [1] The World Bank Group
Page 104 and 105: Background The Republic of Kenya li
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
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PEPFAR’s funding practices were l
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medical staff to higher-paying admi
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system (CPDS), in which many stakeh
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needing medical transport. Both GHI
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Some informants felt that local NGO
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Senegal: The effects of Global Heal
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Table 1: Basic Health System and Ep
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case study. Data analysis was condu
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of respondents aware of treated net
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South Africa: The effects of Global
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Table 2 Global Health Initiative In
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of South Africa (GHI2, ND6). 26 Don
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NDOH to disburse external funds in
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The lack of effective monitoring an
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Despite these problems, GHI funding
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[19] The Global Fund for Aids Tuber
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Official Development Assistance (OD
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The study employed both purposive s
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Figure 1: Number of Clinicians at S
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There were very significant increas
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GHIs created an opportunity to cond
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Ukraine: Effects of the Global Fund
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GAVI (in US$) Disease Priority Amou
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government and nongovernmental prov
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• The introduction of new service
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References [1] Data are from the Mi
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The health system struggles with a
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Objectives and Methodology This stu
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Nonetheless, efforts to recruit and
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References [1] The World Bank Group
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average annual population growth of
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2006 149,022,153 2007 216,012,780 2
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isks duplication of services but al
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centres have only one qualified hea
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Policy analysis of the impact of Gl
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countries” [6]. The TRP apply sev
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PEPFAR I & II The newest PEPFAR leg
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Types of fundable HRH interventions
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Global Fund In two country applicat
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TABLE 3: Selected Countries: MPS Ca
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HRH Intervention Categories GAVI: C
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HRH Intervention Categories GLOBAL
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HRH Intervention Categories PEPFAR
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Conclusion: Directions for future r
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GHIs and health systems. Civil soci
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Annex 01: Data sources for tables i
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Annex 02: Contributing Institutions
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