MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Quality of services The majority of stakeholders and service providers indicated that the Global Fund and CAAP grants supported improvements in the quality of HIV/AIDS services in Kyrgyzstan; moreover, most clients said that they were satisfied with the quality of services (85% of clients participating in the survey in 2007). These initiatives enabled service providers to enhance service quality due to: increased staff numbers; better training; and improved provision of key commodities. However, the study shows that there is room to improve quality in a number of areas including: effective and confidential VCT services; appropriate information materials for population groups in rural areas, particularly in the relatively high-prevalence south of Kyrgyzstan; and staff training for substitution therapy. Access to HIV/AIDS services The client survey suggests that clients experience multiple problems accessing Global Fund and CAAP-financed HIV/AIDS services. The stigmatization of HIV/AIDS was the most important barrier to using services; using an HIV/AIDS-related service carried the risk of clients becoming known as HIV-positive, a drug user or sex worker. Indeed, in mid-2007, a hospital outbreak of HIV among children in the south of the country revealed a range of needs and problems in the field of HIV/AIDS services delivery and showed that stigma remains high among the population. An important related problem is the criminalization of injecting drug use, since police frequently intercept drug users or sex workers, sometimes when they attempt to use an HIV/AIDS-related service. Other significant access barriers from clients’ perspectives include shortages of medicines and other commodities; costs of transport and out-of-pocket expenses; and limited knowledge about HIV/AIDS services and eligibility to use them. Discussion The Global Fund grant in Kyrgyzstan has financed substantial scale-up of HIV/AIDS services, including prevention, testing, treatment, care and support. However, barriers to access remain. In particular, the stigmatization of PLWHA, the criminalization of drug use, and limited provision of information about HIV/AIDS services to target groups have undermined efforts to scale-up HIV/AIDS services. Though organizations providing HIV/AIDS services appear to be collaborating more effectively following the introduction of the Global Fund and CAAP grants, cooperation is frequently based on informal personal relationships and agreements rather than formalized procedures. GHIs have led to an increase in the number of organizations from different sectors involved in HIV/AIDS-related activities. Global Fund requirements concerning national coordination led to improvements in the national coordination structure and participation (2005-2006). Experiences at the national and sub-national level in Kyrgyzstan suggest that the effective functioning of multisectoral coordination councils depends on several factors: 1. An effective secretariat with sufficient resources; 2. A national coordination structure that is sufficiently focused to engender high levels of engagement from all parties; 114
3. Political commitment to HIV/AIDS among decision-makers at the highest government level; 4. Regular technical assistance for sub-national councils on the coordination of HIV/AIDS activities; 5. Regular communication between secretariats of sub-national coordination councils and the country coordination council. The Global Fund grant has supported the strengthening of the health workforce among NGO subrecipients delivering HIV/AIDS programmes; there has been a substantial scale-up in the number of NGO workers. The Global Fund and СААР have also made an important contribution towards building the capacity of HIV/AIDS service organizations in Kyrgyzstan in terms of financing staff training. However, the GHIs have not funded staff incentives, which have a strong influence on motivation, staff turnover and the quality of care. 115
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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
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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 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
Page 168 and 169: 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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