MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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without substantial emphasis on preventive information and interpersonal resources for risk reduction. Responses to questions exploring attitudes towards PLWHA reveal discriminatory attitudes in the general population. Importantly, differences in the prevalence of such attitudes were identified across geographic regions, but not across educational levels. Attitudes were most positive in Iquitos, a city in the Peruvian Amazonia, with a culture generally more open to sexual diversity. According to qualitative findings, health workers’ perceptions about PLWHA vary on the basis of the characteristics of individuals infected. Perceptions of “guilt” or innocence in contracting the disease play a clear role in how PLWHA are treated [14,15]; children and women (i.e., “innocent victims”) tend to be more valued, while transgender people and sex workers are, generally, socially excluded. A review of communication materials prepared for specific target populations of the Global Fund projects showed diverse messages and perspectives. Some materials still present frightening messages about HIV directed to adolescents and young adults, which may produce misinformation and contribute to stigma and social marginalization of PLWHA. Among PLHA responding to the survey, no differences were reported on the quality of care at public clinics based on gender and sexual orientation. Interpretation of this finding, however, is limited by potential differences in expected quality of care based on pre-existing social exclusion (see Table 3) [16,17]. Discussion The Global Fund-funded projects in Peru have defined a new relationship between the public sector and civil society with many positive aspects, although several issues remain to be resolved. Multisectorality implies fairness in decision-making by all actors. The process of instituting multisectorality within Peru’s Global Fund activities is still new, and has meant new challenges overall for the MOH, NGOs, organizations of PLWHA, and vulnerable groups. Generally, the study has revealed a multifaceted process that has changed the ways in which HIV/AIDS work is conducted since the introduction of funds from Global Fund. The Global Fund’s top-down call for a CCM has required multiple sectors as well as both public and private actors to articulate a consistent, national response to the epidemic. This has introduced the opportunity for broader commitment and, to some extent, a more democratic process. The Global Fund-funded projects in Peru have configured a new relationship between the public sector and civil society. However, more work is needed to ensure fairness and genuine inclusivity in decision-making processes [18,19]. <strong>Organization</strong>s of vulnerable populations, while not involved in the CCM originally, have recently been invited to participate. However, their needs are still not considered adequately in the design and implementation of the projects. To achieve equity in input to Peru’s HIV/AIDS strategy, the health sector and other sectors must recognize that the HIV epidemic is a broad social problem, rather than only a health problem. Activities funded by the Global Fund should improve the level of equity in access to project benefits and counter stigma and discrimination directed towards PLWHA and vulnerable groups. It is also clear that other public sectors still find it difficult to understand their role in the response to a problem that is perceived merely as a health problem. A well-defined strategy is needed to mainstream the public response to HIV/AIDS in ways that really strengthen its scope and impact [20]. 140
Within the health sector, the main overall conclusion is that the implementation of Global Fund projects has emphasized the role of non-state organizations, with limited mechanisms for transfer of funds to the MOH. However, the new processes related to implementation of Global Fundfunded projects have demanded a substantially increased time commitment from the NHSS Technical Team, and seem to have led to a loss in their capacity to guide and oversee the health sector components of the national response in more proactive ways. Logistic systems have also experienced problems in meeting project demands, and the NHSS’s capacity to process the substantial amount of information generated has also been limited. Instabilities introduced by the size of HIV/AIDS investments in relation to other health investments must be addressed through appropriate funding mechanisms and through operations research [21]. There is also a need to create mechanisms of accountability within the CCM for the organizations it represents, with regard to the CCM itself and to Peruvian society as a whole [22,23]. Moreover, the CCM must fulfil Global Fund requirements with regard to the adoption of a code to prevent and manage conflicts of interest, as well as the creation of effective mechanisms for monitoring and evaluation [24-26]. 141
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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
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with need. With GHI funding, distri
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I know that within [the organizatio
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Much of the initial enthusiasm abou
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services, or for measures of qualit
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funds and more funding focused on i
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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 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 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
Page 184 and 185: Despite these problems, GHI funding
Page 186 and 187: [19] The Global Fund for Aids Tuber
Page 188 and 189: Official Development Assistance (OD
Page 190 and 191: The study employed both purposive s
Page 192 and 193: Figure 1: Number of Clinicians at S
Page 194 and 195: 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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