MAXIMIZING POSITIVE SYNERGIES - World Health Organization

World Bank MAP
Title FY Approved/Closing Date Commitment (in US$)
Multisectoral HIV/AIDS Project 2003/2008 40,500,000
Methodology
Qualitative case study
The data collection for the Rwanda case study included semi-structured interviews, observation,
examination of documentary material, and collection of quantitative data. Key informant
interviews used a standard semi-structured interview template that was designed to address how
PEPFAR and the Global Fund funding have interacted with Rwanda’s health system. We addressed
the following elements of the health system: governance, financing, health workforce, monitoring
and evaluation (M&E), health technologies, and communities and civil society WHO considers
these elements to be the building blocks of the health system. To limit the scope of the initial ninemonth
research programme, we limited our embedded units of analysis to HIV and TB
programmes funded by PEPFAR and the Global Fund.
The sample strategy for key informants used purposive sampling. Most key informants had welldefined
roles in the country’s health system as well as significant experience with both PEPFAR
and the Global Fund. The Rwanda study had a sample size of 19; follow up interviews were
completed with five key informants. The sample included people working in the government at
the national level (size = 11), NGO directors from both Rwanda-based and international NGOs (size
= 6), a USAID employee, and one referral hospital director.
Researchers recorded and transcribed interviews to ensure accurate data collection and facilitate
qualitative analysis, conducting six interviews in French and the remainder in English. All
interviews were transcribed in English for analysis. Interviewers took field notes based on their
observations and completed post-interview debriefings. Transcribed interviews were entered into
NVivo8, a qualitative data analysis program (QSR International, Cambridge, MA). A thematic
qualitative analysis approach and an iteratively developed set of codes were used to examine the
data. To further support the authenticity of findings and auditability of analytic processes, we
engaged in inter-rater reliability activities as we created and applied codes; wrote memos about
our analytic decision-making; and conducted participant validation exercises.
To triangulate the data collected in key informant interviews, we collected and reviewed publicly
available documents in each country (i.e. National Health Strategy, PEPFAR or Global Fund Country
Reports).
Quantitative Data
Quantitative data was collected from four health centres in rural Rwanda. Convenience sampling
was used to select facilities from departments that interviewees represented and to select facilities
with different degrees and types of GHI funding and different models of care. A facility analysis
tool was created based on combining the common elements of instruments of the WHO, the
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