MAXIMIZING POSITIVE SYNERGIES - World Health Organization

of respondents aware of treated nets rose from 70% to 97.3%, and the number of households
owning a bednet rose from one third (33.6%) to half (56.1%) [12].
Information
Although all key informants felt that monitoring and evaluation were strengthened through GHIs,
national programmes were unable to provide researchers with district-level data. This lack of data
availability shows an existing weakness in the M&E system for GHIs too, and focuses attention on
the quality of the data published at national level.
One of the most disappointing, yet instructive, research outcomes was the poor performance of
the country monitoring and evaluation system. Few data trends could be gathered from
Ziguinchor (2004-2008), no significant data trends could be discerned for Mbao (2007-2008), and
no data trends at all for Fatick (only 2008 data were available). This prevented researchers from
analysing the relationship between median income or regional disease prevalence on the
performance of GHIs. The results of this study are therefore mostly based on the qualitative
interviews, the data gathered during those interviews and the extensive review of the literature
performed by the MPS team.
Discussion
The outcome of the quantitative data collection process at district level was disappointing: only
one of the three focus Health Districts, Ziguinchor, provided data which allowed some trend
analysis on selected MPS project indicators. Nonetheless, the qualitative interviews of a diverse
range of individuals involved in GHIs at all levels of the health system, as well as the extensive
literature search on GHIs and health systems in Senegal, yielded a wealth of information on how
GHIs and health systems interact in this country.
In Senegal, the interaction between the GHIs and the health system included an important effort
to ensure national ownership of projects and programmes funded through GHIs (particularly by
the Global Fund); and improvements in equity of access through subsidies and the expansion of
service coverage. Here, the strengths of the GHIs balance the weaknesses of the health system,
providing funding that is relatively independent of changes in political administration and linking
funding to performance. An adequate performance assessment, however, requires a sound M&E
system, which the MPS research highlighted as a weak component of the health system in
Senegal.
Some outcomes of the interaction between GHIs and health systems were less positive. While
GHIs have encouraged task shifting, it would be desirable to promote the training and recruitment
of physicians in Senegal. Efficiency requires quality and the Senegal MPS team advocates for the
development of a health system where clients can access physicians’ expertise if they wish to.
Efficiency also calls for maximizing the use of opportunities of synergistic funding, and the Senegal
MPS team proposes that GHIs create better links with other global priority issues (such as the
environment), for which substantive funding has been earmarked and for which the linkages with
health are clear.
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