MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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their budget was comprised of Global Fund funds. CAAP grants have provided funds to 64 governmental and nongovernmental organizations in four Central Asian countries. HIV/AIDS organizations in Kyrgyzstan received a total of US$ 138 000. Many interviewees reported that the distribution of the Global Fund grant reflects the relatively high organizational capacity of service providers based in the capital Bishkek, rather than HIV prevalence rates in different parts of the country. In 2007, 53% of NGOs providing HIV/AIDS services were located in Bishkek/Chui, while the vast majority of PLWHA (62%) lived in southern Kyrgyzstan in and around the city of Osh. Similarly, CAAP-funded services and activities are also concentrated in Bishkek. <strong>Health</strong> Workforce The Global Fund grant has led to substantial increases in staff working for NGOs (focusing on prevention and care/support services), while the number of staff working for government medical services has remained stable. The greatest growth is among NGO volunteer workers and social workers. Specifically, peer-to-peer outreach workers are playing an increasingly important role: they bring knowledge of vulnerable groups and are able to build rapport with clients. The majority of social workers has not, however, received professional education and requires regular training. Shortages of psychologists, psychotherapists and lawyers working in the field of HIV/AIDS persist. The largest increase in staff numbers is observed in the north of Kyrgyzstan: Bishkek city/Chui province. While increases in staff in Osh have also been substantial, the overall number of HIV/AIDS workers lags behind Bishkek/Chui. Table 4 summarises the scale-up of HIV/AIDS-related personnel based on a sample of 24 organizations. Table 3 Personnel categories in 24 surveyed organizations Personnel category Bishkek, Chui Province <strong>Organization</strong> type Osh, Jalalabat Issyk-Kul Government NGOs 2006 2007 2006 2007 2006 2007 2006 2007 2006 2007 Doctors 85 97 27 33 19 17 101 111 30 36 Nurses/paramedics 159 139 33 38 7 9 184 167 15 19 Social workers 25 36 19 42 1 3 2 1 43 80 Outreach workers/ “peer to peer” 72 79 18 6 16 16 19 2 87 99 Volunteers 417 557 53 127 26 26 17 40 479 670 Administrative staff 26 35 11 12 5 7 19 21 23 33 Other 12 19 0 4 4 3 3 7 13 19 Total 796 962 161 262 78 81 345 349 690 956 112
The Global Fund has contributed substantially towards capacity building among HIV/AIDS services in terms of providing training in HIV/AIDS issues and organizational development. Medical workers are trained in donor blood safety, HIV/AIDS diagnostics, ARV treatment (ART) and the prevention of mother-to-child transmission (PMTCT). In 2008, 85% of the survey respondents indicated they had received training, and 62% felt that Global Fund-supported workshops had a positive impact on their skills. Service providers in government and nongovernmental HIV/AIDS organizations do not receive financial incentives for delivering HIV/AIDS services from Global Fund or CAAP grants. Low salaries and uncertainty about wages among government service providers, as well as interruptions in Global Fund funding to sub-recipients, have led to low motivation, a deterioration in service quality (in some cases) and high staff turnover. Staff in NGOs are more motivated to deliver HIV/AIDS services, compared to staff in governmental organizations: 36% of NGO staff and 8% of staff working at governmental medical facilities participating in the survey described themselves as highly motivated to provide services. Monitoring and Evaluation Currently there is no common national monitoring and evaluation (M&E) system for HIV/AIDSrelated programmes and services, although there are some efforts to develop one. The Global Fund, the CAAP, and other donors do not employ a common system for monitoring the activities they finance. Community/Civil Society Reflecting the increasing GHI funding, the research confirms that there has been an increase in client numbers for a range of HIV/AIDS-related interventions, including: information/education, VCT, harm reduction (needle/syringe exchange and substitution therapy) and ART. Coverage of vulnerable groups, including PLWHA, young people, injecting drug users (IDUs), commercial sex workers (CSWs), men who have sex with men (MSM) and prisoners/ex-prisoners, has increased since the inception of the Global Fund (Table 5). New groups, including young people from rural areas and street children, are now receiving interventions. Table 4 Number of clients of surveyed organizations: 2004-2006 (N=24) Previous target groups 2004 2005 2006 Youth 2,527 7,159 21,941 IDUs* 2,982 4,969 8,225 CSWs 2,491 2,549 2,620 MSM** 6,500 7,200 7,500 PLWHA*** **** **** 324 Prisoners No data 3,325 6,500 113
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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
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References [1] China at a glance. W
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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 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
Page 164 and 165: Some informants felt that local NGO
Page 166 and 167: 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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