MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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international standards. The Under Five Mortality Rate has declined from 117 per 1,000 live births in 1986-90 to 94 in 2002-06, and an upward trend in child immunization has been reported— increasing from 35% in 1990-91 to 47% in 2006-07. Nevertheless, rates of improvements in health outcomes have been slow, particularly in comparison with other countries in the region [15]. Table 1. Pakistan’s Key Health indicators (2005-2006) Health Indicators Life expectancy (years)* 63.8 a Dependency ratio (percent)* 68.7 a Crude Birth Rate (per 1,000)* 26.1 b Crude Death Rate (per 1,000)* 8.2 b Total Fertility Rate (children per woman) 4.1 c Contraceptive Prevalence Rate (percent) 39.0 c Pregnant women receiving at least one ante-natal consultation (percent) 61.0 c Women who receive care from Skilled Birth Attendants (percent) 39.0 c Neonatal Mortality Rate (per 1,000) 54 c Infant Mortality Rate (per 1,000) 78 c Under-Five Mortality Rate (per 1,000) 94 c Fully immunized children (percent) 47 c Tuberculosis Case Detection Rate 62 d Tuberculosis Case Detection Rate for new Sputum Smear Positive Cases 49 d Tuberculosis Treatment Success Rate 84 d Confirmed number of polio cases (as of May 13, 2009) 12 e Prevalence of viral hepatitis in the general population (percent) 7.4 f Prevalence of smoking (over 18 years of age, percent) 15.75 g Prevalence of leisure time physical inactivity (over 18 years of age, percent) 91.5 g Prevalence of overweight and obesity (over 18 years of age, percent) 38.5 g Prevalence of central obesity (over 18 years of age, percent) 48.35 g Prevalence of high blood pressure (over 18 years of age, percent) 13.7 h Prevalence of diabetes (percent) 7.65 i Doctor-population ratio 1326 g Nurse-population ratio 22,662 g Dentist-population ratio 3,039 g Households with toilets systems (percent) 74 j Households with government garbage disposal services (percent) 37 j *estimations a. Federal Bureau of Statistics, Pakistan. Pakistan Demographic Survey, 1998-2003 b. Federal Bureau of Statistics, Pakistan. Pakistan Population Census, 1998 c. National Institute of Population studies and Macro International Inc. Pakistan Demographic and Health Survey, 2006-07 d. National TB Control Programme, Ministry of Health, Pakistan e. National Expanded Programme on Immunization, Ministry of Health, Pakistan f. Pakistan Medical Research Council, Ministry of Health, Pakistan; Unpublished data g. Heartfile, Ministry of Health and Federal Bureau of Statistics. Gateway Paper II: Health Indicators of Pakistan, 2007 h. Pakistan Medical Research Council. National Health Survey of Pakistan, 1994 i. Diabetic Association of Karachi and WHO surveys, 1994-1998 j. Social Audit of Governance and Delivery of Public services Pakistan, 2005 126
Pakistan also suffers from a number of other health challenges, particularly in relation to polio eradication and the prevention and control of non-communicable diseases, viral hepatitis and HIV/AIDS. Pakistan’s key health indicators have been summarized in Table 1. Health is an inter-sectoral responsibility. A number of factors are therefore responsible for poor health status of the country’s population; these include broader issues implicit in the social determinants, low public investments in the health sector and poor performance of the health system. The latter is the result of interplay between insufficient state funding for health, a regulatory environment which enables the private sector to operate unchecked and unregulated in the delivery of social services, and the overall lack of transparency in governance [16]. Political factors, conflict and disaster further worsen the situation, particularly with reference to the case study that is described below. Objective and methodology The objective of the case study was to analyse the impact of the Polio Eradication Initiative (PEI)— a part of the Global Polio Eradication Initiative—on health systems in Pakistan. However, the study also ended up documenting the impact of the health system on polio eradication. Qualitative methods were used for the study. These included a review of academic and grey literature and semi-structured interviews and focus group discussions with key informants. A Medline search was conducted with the search terms “polio eradication” and “PEI Pakistan” in combination with search terms “health systems”, “information systems”, “workforce”, “service delivery”, “financing”, “supply chains” and “governance”. In order to review grey literature, the same search terms were entered into Google. Semi-structured in-depth interviews varied in length. These were conducted with managers at various levels within the public and private sectors. A total of 27 interviews were conducted; the professional profile of the interviewees ranged from government clerical staff and equivalent private sector employees to Chief Executive Officers and former cabinet members. Gender, culture, language and social considerations were taken into account when planning interviews. The Principal Investigator also conducted focus group discussions with 5 to 10 people on particular issues. A total of five focus group discussions were held. Results and analysis The PEI in Pakistan: background The PEI was launched in Pakistan in 1994, fifteen years after the launch of the Expanded Programme for Immunization (EPI); the latter is mandated to undertake routine immunization activities. Since 2000, the PEI has followed the successful approach of the western hemisphere— supplementing routine polio immunization with huge country-wide campaigns several times a year to deliver drops of Oral Polio Vaccine (OPV) to every child under the age of five years. Over the last nine years, 88 rounds of SIAs have been conducted with nationwide outreach, with the help of contributions from the Global Polio Eradication Initiative—a global partnership of WHO, UNICEF, 127
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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
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References [1] Human Development Re
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In 2003, the government launched th
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Objectives and Methodology The data
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Health Workforce Ghana is challenge
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Discussion GHIs are critical for ra
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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 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
Page 170 and 171: case study. Data analysis was condu
Page 172 and 173: of respondents aware of treated net
Page 174 and 175: South Africa: The effects of Global
Page 176 and 177: Table 2 Global Health Initiative In
Page 178 and 179: of South Africa (GHI2, ND6). 26 Don
Page 180 and 181: 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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