MAXIMIZING POSITIVE SYNERGIES - World Health Organization

PEPFAR was perceived as having a more efficient chain of fund disbursement than the Global
Fund. The transfer of Global Fund funds through multiple accounts was reported to take up to a
year before the monies reached the intended programme. Furthermore, due to the performancebased
financing system, subsequent disbursement of approved Global Fund funds can be delayed
while evaluations are reviewed by the relevant ministries and by external auditors before being
sent to Geneva.
The complexity of the Global Fund grant application system was highlighted as an impediment to
efficient programme implementation. Many informants indicated that an excessive amount of
time and effort was spent applying for funds. Several informants criticized the Global Fund grant
application process as complex, stressful, and frustrating for staff, particularly because it occurs
simultaneously with reporting on previous Global Fund grants. Informants also reported that
initially, the Global Fund grant application and general funding procedures were not clear. Due to
poor performance and poor reporting, Kenya did not receive funding from Global Fund Rounds 7
and 8; only 40% of the approved funding from Round 2 was disbursed by the Global Fund for
similar reasons. Some respondents attributed underperformance to Global Fund policies and
procedures being difficult to understand and follow.
Many believed both PEPFAR and the Global Fund could better communicate and disseminate
information on their funding and implementation activities.
Health Workforce
Since the advent of GHIs, health workers have typically moved out of the MOH into GHI-funded
projects due to better compensation packages. Informants suggested that although GHIs have
significantly increased the number of health professionals in Kenya’s health system—through
improved recruitment, training and compensation—internal migration of highly skilled health
workers remains a significant problem.
Several informants criticized PEPFAR for creating competition for staff among NGOs and between
NGO’s and the GoK. Some informants did suggest that PEPFAR has attempted to improve
harmonization of recruitment, training, and compensation across the health system. The Capacity
Project—a PEPFAR funded programme of IntraHealth, a US-based NGO—coordinates its activities
with the GoK to plan human resources, standardize compensation, provide health worker
development, and support health workers once they are in place.
Despite collaborative efforts such as the Capacity Project, many NGOs offered higher salaries to
highly-skilled workers than the government did. Some informants suggested that Kenya has an
excess of skilled health workers who were not motivated to work in government programmes due
to low compensation and programmatic frustrations. Instead these professionals looked to work
for NGOs in Kenya or elsewhere in sub-Saharan Africa.
Like PEPFAR, the Global Fund also increased the number and capacity of staff in Kenya. Some
Global Fund human resource funds were used to pay personnel who were expected to deliver a
comprehensive care package and not just HIV, TB and malaria services. GoK also used Global Fund
funds to train district-level health care workers regardless of their focus. These actions were seen
as strengthening Kenya’s health system.
Although there is a significant need for trained health workers in Kenya, particularly in rural areas,
the government’s ability to recruit and compensate more health workers is limited. Informants
reported that both the Global Fund and PEPFAR had asked the GoK to absorb staff after certain
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