MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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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. 166
References [1] The World Bank Group. Senegal Data-at-a-Glance 2008. [2] United Nations Development Programme. Human Development Reports: Senegal. (http://hdrstats.undp.org/en/2008/countries/country_fact_sheets/cty_fs_SEN.html). [3] The World Bank Group. Senegal at a glance. (http://devdata.worldbank.org/AAG/sen_aag.pdf). [4] The World Bank Group. World Development Indicators (WDI) Online [5] UNAIDS. 2008 Report on the global AIDS epidemic 2008. [6] US Department of State. Background Notes: Senegal (http://www.state.gov/r/pa/ei/bgn/2862.htm). [7] Senegal UNGASS Report 2008 (http://data.unaids.org/pub/Report/2008/senegal_2008_country_progress_report_fr.pdf). [8] UNAIDS, Senegal Country Report 2008 (http://data.unaids.org/pub/Report/2008/senegal_2008_country_progress_report_fr.pdf). [9] WHO Global Summary 2006 (http://www.who.int/vaccinesdocuments/GlobalSummary/GlobalSummary.pdf). [10] Personal Communication, GAVI Focal Point, Ministry of Health, Dakar, Senegal(4/30/2009). [11] Papa Salif Sow. Country Review: Senegal. Chapter 24 of the “A Decade of HAART” Edited by Jose M Zuniga, Alan Whiteside, Amin Ghaziani and John G Bartlett (Oxford University Press). [12] Carol A Baume and M Celeste Marin. Gains in awareness, ownership and use of insecticidetreated nets in Nigeria, Senegal, Uganda and Zambia. Malar J. 2008; 7: 153. (http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2527013&blobtype=pdf). 167
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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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A comprehensive, long-term reform o
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The effects of GHIs on the capacity
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their budget was comprised of Globa
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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 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 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
Page 214 and 215: References [1] The World Bank Group
Page 216 and 217: average annual population growth of
Page 218 and 219: 2006 149,022,153 2007 216,012,780 2
Page 220 and 221: 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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