MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Table 2 Global <strong>Health</strong> Initiative Investments Global Fund Round & Disease Priority Approved (in US$) Disbursed (in US$) Round 1, HIV/TB 62,476,536 49,771,823 Round 1, HIV/TB 20,226,665 20,226,665 Round 2, HIV/TB 24,400,220 12,579,554 Round 3, HIV/AIDS 66,501,629 62,190,178 Round 6, HIV/AIDS 55,071,906 24,927,005 TOTAL: 228,676,956 169,695,225 PEPFAR Year Amount Allocated (in US$) 2004 89,272,988 2005 148,187,427 2006 221,539,430 2007 397,777,008 2008 590,897,685 TOTAL: 1,447,674,538 Objectives and Methodology Little is known about how the shift from traditional funding mechanisms towards global approaches has impacted on health systems in recipient countries, nor how donor harmonization initiatives have interplayed with GHIs at country level. The study therefore seeks to understand how GHIs operate in South Africa and their outcomes in terms of the functioning of South Africa’s health system. This study is part of a multi‐country study being conducted in five African countries (Angola, Burundi, Lesotho, Mozambique and South Africa), with support from three European institutions in Ireland, Belgium and Portugal. Additional support was received from the WHO Maximizing Positive Synergies Group and Harvard University. The study was descriptive in nature and used a qualitative research methodology, which enabled the research team to uncover any unforeseen concerns of the study population and obtain a deeper understanding of the subject under study. Data were collected through document analysis and individual interviews after obtaining ethics approval from the University of Western Cape Senate Research and Ethics Committee. Three levels of data collection are planned to reflect national, provincial and facility-level diversity. Data presented in this paper reflect work done at national level. Individual interviews were conducted with 15 participants at national level. Participants were purposefully selected from among key staff involved in GHIs at national level as well as amongst in‐country staff of donors and recipient nongovernmental organizations (NGOs). Senior government officials and policy makers at the National Department of <strong>Health</strong> (NDOH) headquarters were interviewed. An attempt was made to maintain a balance across the different categories. 170
The collection of information from different categories of respondents from diverse organizations helped the team to assess whether there was consensus on the issues raised. The interviews followed a question guide, with the scope of the questions focused on participants’ experiences and views. The interviews lasted between 45 and 90 minutes, differing slightly as the interviewer probed according to what was said by each interviewee. The interviews addressed both what had been implemented with GHI support but also stakeholder perspectives on likely implications for the broader health care system. The purpose of the interview and the freedom to participate or withdraw if they so chose, were verbally explained to each participant. Most interviews were carried out at the interviewees’ offices while others were telephone interviews. All interviews were in English. Some of the interviews were tape recorded, but where this was not possible detailed notes were taken. The interview format was refined periodically in order to probe and explore leads on key issues that were not clear. Data analysis was an ongoing process using interpretive description as described by Thorne and others [13]. Audio taped interviews were transcribed and analysed, with key themes identified through this process. The consistency and reliability of the analysis process was improved through the involvement of more than one analyst [14]. Results Leadership, Governance and Coordination South Africa’s position as a middle-income country with some of the highest HIV prevalence rates in the world places it in the unique position of being able to fund its own health care system, while receiving large amounts of external funding for HIV-specific services. Current GHI and donor activity largely focuses on HIV/AIDS, though reliance on the state to coordinate and monitor activities has had varied results. Most funding centres on HIV‐related areas such as home based care, training and support of community health workers, supporting the rollout and scale‐up of ART services, and the funding of community‐based HIV prevention organizations. Many clinically based interventions are operationalized in conjunction with or through national and provincial departments of health. State health‐related policy guidelines in South Africa are generally strong, with strategic plans regularly crafted to cover various areas [11]. Government policies currently include amongst others: the HIV and AIDS and STI Strategic Plan 2007‐2011; the National Infection Prevention and Control Policy for TB, MDRTB and XDRTB; and the Comprehensive HIV and AIDS Care, Management and Treatment Plan for South Africa. In addition to specific health‐related policies, state planning follows the principles of the Reconstruction and Development Program (RDP) and other macro‐economic strategies. South Africa’s federal governance system gives provinces the ability to interpret national policy according to their own priorities, with funding from the national level allocated according to need. Post-apartheid restructuring of the public health sector has focused significantly on promoting equity. Donors are also expected to follow state guidelines, and many do seek to align with government priorities and policies. However, the imperative of addressing focal diseases, along with local political conditions, has led to most donor‐funded projects being concentrated in specific regions 171
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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
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References [1] Kyrgyzstan at a glan
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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 172 and 173: of respondents aware of treated net
Page 174 and 175: South Africa: The effects of Global
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
Page 222 and 223: centres have only one qualified hea
Page 224 and 225: 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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