MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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A comprehensive, long-term reform of Kyrgyzstan’s health system is in progress. Beginning in 1996, health financing reforms have led to decreased costs, improved quality of care, and increased spending [4,5]. Primary care services were reorganized in Family Group Practices (FGPs), which by 2004 had enrolled approximately 98.5% of the population [5]. This has made Kyrgyzstan the leader in family medicine reform in post-Soviet Central Asia [4]. There is still progress to be made, as out-of-pocket expenditures still account for more than half of total health expenditure [6]. In 2006, external resources made up 6.1% of total expenditure on health [6]. Official development assistance (ODA) to Kyrgyzstan was US$ 311.2 million in 2006 [7]. The country remains highly indebted; it’s total external debt was US$ 2.38 billion, or 84.5% of GDP, in 2006 [1,7]. Table 1 Basic Socioeconomic, Demographic, and Health Indicators (*) (*) Full data sources for all indicators are provided in Annex 1 Indicator Value Year Source Population (thousands) 5,235 2007 World Bank Geographic Size (sq. km) 191,800 2007 World Bank GDP per capita, PPP (constant 2005 international $) 1,894 2007 World Bank Gini index 33 2004 World Bank Government expenditure on health (% general government expenditure) 8.7 2007 WHO NHA Per capita government expenditure on health (current US$) 19 2007 WHO NHA Physician density (per 10,000) 24 2007 WHO SIS Nursing and midwifery density (per 10,000) 58 2006 WHO SIS Maternal mortality ratio (per 100,000 live births) 150 2005 WHO SIS DTP3 coverage (%) 94 2007 WHO SIS Estimated adult HIV (15-49) prevalence (%) 0.1 (
PEPFAR* Year Amount Disbursed (in US$) 2006 1,265,500 2007 1,020,000 2008 721,000 TOTAL: 3,006,500 *Not a PEPFAR focus country; above sums represent total allocations to PEPFAR country programs from bilateral U.S. sources including USAID, Department of Health and Human Services, Department of Labor, and Department of Defense. GAVI Disease Priority Amount Approved (in US$) Hepatitis B vaccine 1,608,000 Vaccine introduction grant 100,000 Injection Safety 178,000 Immunisation services support 256,000 Health systems strengthening 1,155,000 TOTAL: 3,297,199 Methodology The Centre for Health System Development in Kyrgyzstan, with the London School of Hygiene and Tropical Medicine and the Royal College of Surgeons in Ireland, conducted a three-year study between 2006 and 2008 to track GHIs and their impact on the health system in Kyrgyzstan. The data used for this case study draws primarily on the findings reported in 2008. Multiple qualitative and quantitative data collection methods were used. These include: an analysis of policy and programmatic documents and secondary data; in-depth interviews with national and sub-national level key informants; structured surveys with HIV/AIDS service providers and clients; in-depth interviews with clients; and focus groups. The research focused on the effects of two GHIs in Kyrgyzstan – the Global Fund and CAAP—in three regions: Bishkek/Chui (capital and surrounding administrative region), Issyk-Kul (north of the country) and Osh/Jalalabad (south of the country). The following research questions were addressed: The effects of GHIs on the scale-up of HIV/AIDS services: • The levels and types of HIV/AIDS services delivered, including prevention, treatment and support services, with a concern to demonstrate trends over time; • The perceived quality of HIV/AIDS services; • Coordinated service delivery. The effects of GHIs on equitable access to HIV/AIDS services: • Accessibility and patterns of utilisation of HIV/AIDS services; • Institutional, household and community factors that determine the accessibility of HIV/AIDS services. 109
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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
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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 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
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
Page 162 and 163: 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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