MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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the US Centers for Disease Control and Prevention (CDC), Rotary International and other major bilateral and private donors. Initial success of the PEI in Pakistan was remarkable. The number of laboratory confirmed cases of poliomyelitis countrywide declined from 1155 in 1997 to 28 in 2005—the lowest ever recorded for a year. A very sensitive nationwide reporting system was built up to assure the detection of all remaining polio cases. The system captures all children under 15 with acute onset flaccid paralysis (AFP) and includes subsequent laboratory testing of stool specimens [17]. However, since 2008, there has been a marked resurgence of polio cases, both in aggregate terms and in relation to geographic spread (Figures 1 and 2). In 2008, eight cases were reported in Punjab, the largest Pakistani province in the country, home to more than 60% of the country’s population. No cases had been reported there in 2007. The determinants of this failure are discussed in a subsequent section. Figure 1: Number of confirmed cases of poliomyelitis in Pakistan (1997-2006) Figure 2. Number of districts with confirmed poliomyelitis cases in Pakistan (1997-2006) Source for Figures 1 and 2: National Surveillance Cell, Expanded Programme on Immunization, Ministry of Health, Government of Pakistan, Islamabad 128
Impact of the PEI on the health system Notwithstanding the failure to achieve the polio eradication goal, the Polio Eradication Initiative, as a GHI, has had a positive impact on Pakistan’s health system in several areas. Funding for the PEI represents the largest-ever allocation for a disease-specific programme in Pakistan. Official Development Assistance (ODA) accounts for a major proportion of the funds for Pakistan’s PEI. Donors contribute an average of US$ 40 million annually towards the initiative. A significant proportion of polio resources are not delivered through conventional channels and are therefore not accounted for when calculating health expenditure. PEI financing is the result of effective coordination between multilateral and bilateral agencies and the government. Key stakeholders in financing the PEI include WHO, UNICEF, the World Bank, the UK Department for International Development (DFID) and USAID. WHO supports AFP surveillance activities and the operational costs of the SIAs. UNICEF supports social mobilization and vaccine procurement, whereas the World Bank, Japan’s International Cooperation Agency (JICA) and USAID provide funds for vaccine procurement. The most significant contribution of the PEI at the outcome level is a major reduction of wild poliovirus transmission, moving towards the ultimate goal of eradication. An important spin-off effect is the establishment of the Polio Surveillance system, which is sensitive enough to detect every case of polio. This is an active surveillance system where each case is actively searched out in the community; as such it can only be used for diseases marked for elimination or in outbreak and emergency situations. However, many of the components and attributes of the system are also features of other surveillance systems. These include: active surveillance visits at health facilities, laboratory specimen collection, transport and laboratory testing, channels of data reporting, analysis and dissemination, use of indicators to measure surveillance quality, and training and capacity-building of staff, among others. These attributes are of relevance to broader capacity building in the wake of the threat posed by emerging infections in Pakistan, for example with the entrenchment of avian flu. Recent developments around avian flu include evidence of cases in the “poultry belt” of the Northwestern Frontier Province (NWFP) and a documented chain of humanto-human transmission, which was luckily un-sustained [18]. To date, however, resources of the PEI have not contributed to strengthening other health information systems, nor have they been strategically used to consolidate country capacity for generating and utilizing evidence. Pakistan’s PEI has also supported the creation of a grassroots workforce, which has capacity to deliver services door-to-door throughout the country. The creation of this capability, by itself, constitutes a significant outreach capacity—one that can be leveraged for episodic nation-wide activities. However, effective harnessing of this capability is dependent on the capacity of monitoring and oversight agencies, which is where the actual gap lies. The incentive structures created for this workforce have been criticized as undermining the functioning of routine immunization. However, gaps in the performance of the routine immunization programme may be more directly attributable to issues inherent to Pakistan’s health system, as described below; in comparison, the role played by incentive structures is marginal. In addition, the availability of expanded resources through the PEI has improved infrastructure in terms of cold chain equipment and transport. 129
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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
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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 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
Page 182 and 183: 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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