MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Some informants felt that local NGOs benefited greatly from GHI funding and partnerships with international NGOs that had more resources and experience to share: Discussion Local NGOs, they benefited from the experience of international NGOs. They learnt from them. It is like small soccer teams. When a small soccer team from the village plays with a big experienced team, it does have the fear to lose the game, however the small team learns from the big one. For sure local NGOs have learnt a lot; we have noticed that in the area of how they now work, plan, and how they organize themselves. This strengthens both the Rwandan society and the health system. And we strengthen more the lower level institutions, it is very important for us. Rwanda is an example of how, with strong coordination at the national level, the money from GHIs can strengthen health systems. Specific examples of the linkage between the stewardship of the Rwandan government and the utilization of GHIs that were demonstrated by the qualitative analysis are: the unified procurement system CAMERWA with medications beyond targeted diseases funded by Global Fund with technical capacity building by PEPFAR. Both GHIs were called upon to contribute to the national insurance system of “mutuelle de santé” which increased access for targeted and non-targeted diseases. The national plan to spread and decentralize services across the country was supported by both of the main GHIs in Rwanda. Lastly, the Rwandan government successfully coordinates even international NGOs to work within the national framework through the PEPFAR steering committee that was created by the government. This strong national framework with donor collaboration with the clear intent of designing a health system as a national priority and, in that context to deliver equitable, well distributed HIV care, is a critical lesson to both national governments, international NGOs and donors. This approach highlights the importance of government oversight and planning and stewardship in the long-term success of such projects. 158
References [1] World Population Prospects: The 2008 Revision Population Database [online database]. New York; United Nations Population Division. 11 April 2009. [2] Country Brief: Rwanda. World Bank, 2009 (http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/RWANDAEXTN/0,,menuPK: 368714~pagePK:141132~piPK:141107~theSitePK:368651,00.html; accessed 7 April 2009). [3] Rwanda Decentralization Assessment. United States Agency for International Development, 2002 ( http://pdf.usaid.gov/pdf_docs/Pnacr570.pdf; accessed 12 April 2009). [4] Sekabaraga C. Rwanda Primary Health Care and Decentralization of Health System. In: International conference on primary health care and health systems in Africa: towards the achievement of health millennium development goals. Ouagadougou, Burkina Faso, 2008. [5] World Development Indicators Online [online database]. World Bank. 8 April 2009. [6] United Nations Development Programme Rwanda. Turning Vision 2020 into Reality: From Recovery to Sustainable Human Development. National Human Development Report, 2007. [7] United Nations Development Programme. Human Development Report 2007/2008: Fighting Climate Change: Human Solidarity in a Divided World. New York: Palgrave Macmillan, 2007. [8] Development Economics LDB Database [database]. Rwanda at a Glance 2008. The World Bank. 19 April 2009. [9] Republic of Rwanda. Rwanda Service Provision Assessment Survey 2007. Kigali, National Institute of Statistics, Ministry of Finance and Economic Planning, 2007. [10] World Health Statistics 2008 [database]. World Health Organization. 19 April 2009. [11] Country Situation: Rwanda. Geneva, Switzerland, UNAIDS, 2008 (http://data.unaids.org/pub/FactSheet/2008/sa08_rwa_en.pdf; accessed 19 April 2009). 159
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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
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PEPFAR* Year Amount Disbursed (in U
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Primary data collection - facility
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The Global Fund has strengthened th
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Background The Republic of Kenya li
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Results Leadership and Governance D
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Informants noted that a general lac
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time periods. Informants believed t
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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 146 and 147: without substantial emphasis on pre
Page 148 and 149: References [1] The World Bank Group
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 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
Page 196 and 197: GHIs created an opportunity to cond
Page 198 and 199: Ukraine: Effects of the Global Fund
Page 200 and 201: GAVI (in US$) Disease Priority Amou
Page 202 and 203: government and nongovernmental prov
Page 204 and 205: • The introduction of new service
Page 206 and 207: References [1] Data are from the Mi
Page 208 and 209: The health system struggles with a
Page 210 and 211: Objectives and Methodology This stu
Page 212 and 213: Nonetheless, efforts to recruit and
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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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