MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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References [1] The World Bank Group. Kenya Data-at-a-Glance. Washington, DC, World Bank, 2008 (http://devdata.worldbank.org/AAG/ken_aag.pdf; accessed 20 May 2009). [2] Report on the Global AIDS Epidemic 2008. Geneva, UNAIDS, 2008. [3] World Development Indicators 2008. Washington, DC, World Bank (proprietary online database, accessed 12 November 2008). [4] Siringi S. Kenya government promises to increase doctors' salaries to curb brain drain. Lancet, 2001, 358: 9278:307. [5] Kimalu PK, Nafula NN, Manda DK, Bedi A, Mwabu G, Kimenyi MS. A Review of the Health Sector in Kenya. Kenya Institute for Public Policy Research and Analysis Working Paper. Nairobi, 2004. [6] Government of Kenya National Coordinating Agency for Population and Development, Ministry of Health, Central Bureau of Statistics, and ORC Macro. Kenya Service Provision Assessment Survey 2004. Nairobi, National Coordinating Agency for Population and Development, Ministry of Health, Central Bureau of Statistics, and ORC Macro, 2005. [7] World Health Organization Statistical Information System (WHOSIS). Geneva, WHO, 2008 (http://www.who.int/whosis/en/; accessed 27 February 2009). [8] Zumla A, Malon P, Henderson J, et al. The impact of the human immunodeficiency virus (HIV) infection epidemic on tuberculosis. Postgraduate Medical Journal, 2000;76:259-268. [9] World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing. Geneva, WHO, 2008. [10] Stop TB Partnership. Tuberculosis in countries online database. Country profile: Kenya. Geneva, Stop TB Partnership, 2009. (http://www.stoptb.org/countries/GlobalReport2009/ken.pdf; accessed 21 May 2009). [11] PEPFAR Country Profile: Kenya. Washington, DC, United States Department of State, Office of the Global AIDS Coordinator (http://www.state.gov/s/gac/countries/fc/kenya/; accessed May 30, 2008). 106
Kyrgyzstan: Tracking global HIV/AIDS initiatives and their impact on the health system Abstract Gulgun Murzalieva 17 , Julia Aleshkina 15 , Arnol Samiev 15 , Neil Spicer 18 , Gill Walt 16 This study examines the effects of two HIV/AIDS-focused GHIs – the Global Fund and the World Bank Central Asian AIDS Project (CAAP) – in three regions of Kyrgyzstan: Bishkek/Chui, Issyk-Kul and Osh/Jalalabad. The Global Fund is the biggest GHI for HIV/AIDS in the country, and contributed more than US$ 17 million between 2004 and 2008. The research finds that these GHIs have contributed to substantial scale-up of HIV/AIDS services, including information/education programmes, voluntary counselling and testing (VCT), harm reduction programmes and antiretroviral therapy (ART). However, stigma and discrimination are major barriers to people seeking to access these services. Most HIV/AIDS services are provided by non-governmental organizations (NGOs), many of which depend on GHIs for a high proportion of overall funding. GHI support has led to substantial increases in staff working for NGOs, especially social workers and peer-to-peer outreach workers, and has contributed towards developing staff and organizational capacity. GHIs have also strengthened national coordination mechanisms, which now play a significant role in HIV/AIDS-related decision-making. While coordination and cooperation between government and NGO HIV/AIDS services has improved, especially in terms of referrals between services, Kyrgyzstan continues to face several problems concerning the engagement of key actors; information sharing and the devolution of decision-making powers to sub-national coordination structures remain problematic. Background Kyrgyzstan is a landlocked, mountainous country bordering Kazakhstan, Uzbekistan, Tajikistan, and China. It is home to 5.2 million people and averaged a 0.9% annual population growth rate between 2001 and 2007 [1]. Kyrgyzstan ranked 122 nd out of 179 countries on the UN Human Development Index in 2006 [2]. The country has faced economic problems in its transition from a command economy to a market economy. Whilst Kyrgyzstan possesses oil and gas resources, it imports the bulk of what it needs. Economic challenges are particularly acute in the southern region of the country, where agriculture remains the main industry, unemployment is very high, and poverty is widespread [3]. 17 Centre for Health System Development, Kyrgyzstan 18 London School of Hygiene and Tropical Medicine, Department of Public Health and Policy Acknowledgement: The research for this study summary was funded by The Open Society Institute, New York. The study summary was produced with the support of the GHIN Network (www.ghinet.org). 107
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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
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China: The Impact of the Global Fun
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Table 2 Global Health Initiative In
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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 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 148 and 149: References [1] The World Bank Group
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
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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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