MAXIMIZING POSITIVE SYNERGIES - World Health Organization

The lack of effective monitoring and evaluation systems has meant difficulty in linking resources to
outcomes. In part, data collection is the result of GHIs and their implementing partners’ diverse
and independent information requirements. This has resulted in the duplication of data collection
and also adds to the burden of work, with potentially negative effects on the quality of data
produced. One major HIV-related donor only uses information collected by its own programmes at
district level (ND6), which it has recently begun sharing with the NDOH. One participant reasoned
that if all monitoring and evaluation were put together and everybody held accountable for their
work, actual project outcomes would be different (GHI3).
During the research, NDOH representatives expressed gratitude for donor support in improving
information systems and monitoring and evaluation systems. GHIs and donors have begun
working closely with government to develop health information systems. This involves developing
software, monitoring and evaluation systems, as well as the secondment and training of
information officers and monitoring and evaluation officers, along with supplying computers.
There has been a subsequent noted improvement in the quality of data collected through the
NDOH.
Discussion
The data presented in this paper are preliminary results at national level of an ongoing study on
the effects of GHIs on health systems in South Africa, based on qualitative methods and thus
relying on the perceptions of interviewees. The paper also draws on secondary data from
documents obtained during the data collection process. Data analysis and presentation for this
paper were guided by the WHO building blocks for health systems strengthening framework.
Increasing levels of funds are being spent by international bodies on health in under‐resourced
countries in amounts not previously seen. South Africa is unique in that the amounts coming in are
largely confined to addressing HIV/AIDS and do not dwarf the government’s own contributions to
health. However, the government remains concerned about the sustainability of such externally
financed projects as the money is not contained within its own budget. This reflects global
concerns around the potential long-term effects of such vertical funding on public health systems
in general [21].
Our data suggest that funding specific programmes without building overall capacity in the
recipient country by improving the public health system is not ideal. It is necessary to have a
well‐functioning health care system, align funds with the state, and ensure commitment from all
stakeholders.
The study found that there has historically been some level of competition amongst GHIs, which
view themselves as primarily accountable to their head offices and funding structures. Each GHI
therefore produces separate reports, often based on individual data collection by recipient
organizations. An evaluation of the district health information system in KwaZulu Natal found that
though there was some improvement in the collection of data at primary care level, the quality of
data was still poor and staff were not able to effectively use it [22]. Absent or weak accountability
practices, including poor information systems and weak monitoring and evaluation mechanisms
undermine effective implementation. Parallel reporting systems still exist, with duplication in the
reporting systems of different stakeholders at district level. Strong leadership is therefore needed
to enforce what Garrett describes as “cooperative thinking” and guidance [21]. This is not unique
to South Africa, with other countries in Southern Africa, such as Zambia, reporting coordination of
donor activities as a significant challenge [23].
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