MAXIMIZING POSITIVE SYNERGIES - World Health Organization

medical staff to higher-paying administrative positions at the Global Fund, exacerbating the
human resource shortage. As one informant reported:
Doctors and nurses have quit the patient’s bedside in a scramble for ‘AIDS’
money, as cynics like to call it. These medical people leave the mainstream
clinical work to take up administrative jobs in Global Fund coordination offices.
This has escalated the scarcity of medical professionals even further.
In addition to the movement of clinical staff to administrative Global Fund positions, PEPFAR was
also seen as pulling human resources out of the public sector and into NGOs, as the latter were
often able to offer higher salaries. While many informants viewed this as a negative consequence
of PEPFAR’s funding system, others commented that overall it increased human resources within
Rwanda, as it prevented practitioners from seeking jobs abroad.
GHI funding impact on workforce capacity
GHIs have built significant capacity through their investments in training. In particular,
respondents saw great potential in the willingness of GHIs to recognize community health workers
as an important cadre of human resources for health. One informant stated, “If they reinforce
community health workers, everything will be achieved.” Since community health workers are
rarely limited to addressing HIV at the community level, capacity building within this population
was seen as a form of health system strengthening, as it could increase access to services for the
general population.
Data showed PEPFAR increased employment opportunities and built capacity in the Rwandan
workforce, but not in the public sector given that it funded NGOs. In contrast, the Global Fund
contributed to capacity building of all personnel. Global Fund funding could be used for measures
that would sustainably enhance the workforce, such as investing in nursing schools.
Quantitative analysis demonstrated increases in the number of doctors (non-specialized), nursing
staff, non-degree laboratory technicians, non-degree pharmacists, and community health workers.
Altogether, facilities in Rwanda had no doctors before GHI funding, and 1.45 after, all of whom
were non-specialist practitioners.
GHI impact on human resource strategies
GHIs have helped with the human resource shortages by contributing to salaries for doctors and
nurses. Global Fund monies were used to increase salaries in rural areas, leading physicians to
accept jobs and remain in areas where positions had previously not been able to be filled.
Retention also increased in the public sector overall and the number of health practitioners
seeking opportunities abroad fell.
In addition, the GHI’s decision to support the GoR’s performance-based financing system has
enabled payment structures that are more effective and that provide incentives to health care
professionals. However, despite these changes, informants often stated that the government
could not compete with the salaries that NGOs offered. Some described NGO salaries as
“destabilizing” to a market where there were so few doctors and nurses.
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