MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Information
Many respondents agreed that both the Global Fund and PEPFAR improved M&E systems. However,
informants indicated that reporting and performance-based financing structures in Kenya remain
weak. Many informants reported that both PEPFAR’s and the Global Fund’s reporting structures were
too extensive and time consuming. PEPFAR, the Global Fund, and the government each required
different information and indicators in their reports, and respondents believed that a better
harmonization of systems was needed.
PEPFAR requires specific data to be routinely collected. Respondents felt that this necessitated a high
level of staff training to adequately evaluate and report on multiple indicators. Respondents reported
that the M&E requirements were time-consuming. Some respondents commended PEPFAR’s effort to
help organizations understand the importance of monitoring their programme’s progress using
appropriate data. A few informants hoped that training health workers to conduct quality M&E would
benefit the health system overall.
A number of interviewees cited challenges with Global Fund indicators. In particular, they noted that
indicators needed to be better aligned with country constraints because limitations in infrastructure
hindered the effective tracking of some indicators. Additionally, the Global Fund has, at times, added
indicators that were not in the original grant application forcing the GoK to set up separate monitoring
systems for such indicators. A few respondents blamed reporting issues on a lack of communication
between the Global Fund and the government. Informants reported that poor M&E systems
contributed to the Global Fund’s decision to withhold approved disbursements. Some respondents
suggested strengthening accountability throughout the reporting process as a way to improve the
reporting system. It was clear that performance-based funding makes effective and timely reporting
imperative.
Discussion
Informants reported that PEPFAR and the Global Fund had an overall positive effect on Kenya’s health
system. PEPFAR significantly increased the number of people living with HIV/AIDS on ARVs and created
or strengthened the systems providing this treatment. Specifically, informants identified PEPFAR’s
governance, procurement systems, and M&E systems as key drivers of its achievements. Global Fund
funding had perceived positive effects, particularly in malaria and TB control, as well as on HIV
treatment and prevention. Specifically, informants identified Global Fund’s funding coordination with
government priorities as a key driver of its positive effects.
While acknowledging PEPFAR and Global Fund’s overall positive effect on Kenya’s health system, many
informants identified additional opportunities for maximizing these effects and minimizing negative
effects. PEPFAR’s lack of coordination with government decision-making processes and the constraints
it places 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.
Informants thought that PEPFAR’s and the Global Fund’s impacts on Kenya’s health system were closely
related to the differences in how they disbursed their funding. PEPFAR was viewed unfavourably for
not working closely with the government, but it was viewed favourably for being able to achieve
significant results quickly by disbursing funds efficiently to implementing organizations. The Global
Fund, which was viewed favourably for disbursing funds through government bodies, was felt to have
inefficient procedures for grant approval and reporting that diminished its potential positive impact.
Most informants had concerns about the long-term viability of GHI-sponsored programmes without
lasting commitments from the GHIs. Strengthening Kenya’s health system was deemed essential to
achieving sustainable positive effects from GHI funding.
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