MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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[19] The Global Fund for Aids Tuberculosis and Malaria. Portfolio of Grants - South Africa & the Global Fund to Fight AIDS, Tuberculosis and Malaria (http://www.theglobalfund.org/programs/portfolio/?lang=e&countryID=SAF; accessed 19 May 2009). [20] Maharaj R. Annual LSDI report. Durban, MRC, 2007. [21] Garrett L. The Challenge of Global Health. New York/Washington, DC, Council on Foreign Relations, 2007. [22] Garrib A, Stoops N, McKenzie A, Dlamini L, Govender T, Rohde J, Herbst K. An evaluation of the District Health Information System in rural South Africa. S Afr Med J 2008, 98:549-522. [23] Hanfield J, Musheke M. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia. BioMed Central. 2009, 7:8-11. [24] Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravangchai P, Jacobs M, Kurowski C, Michael S, Pablos Mendez A, Sewankambo N, Solimano G, Stillwell B, De Waal A, Wibulpolprasert, S. Human resources for health: overcoming the crisis. Lancet, 2004, 364: 1984-90. [25] TAC. Key HIV Statistics (http://www.tac.org.za/community; accessed 6 March 2009. 180
Uganda: Expanding Targeted Services Into Primary Health Care* Abstract Dr. Bernard Michael Etukoit1, Mr. Richard Wanyama1 1 The AIDS Support Organization Several GHIs have funded programmes in Uganda since 2000, most recently the Global Fund and PEPFAR. Overall, the GHIs have demonstrated system-wide benefits, but in some instances have negatively impacted health systems. The study explored interactions between GHIs and health systems. The research aim was to generate information to inform health policy and programming from the knowledge, experience and perceptions of personnel at GHI-supported facilities. The study was cross-sectional, employing both quantitative and qualitative methods. GHIs were associated with improved service delivery in most facilities. They improved human resources (HR) numbers and capacity with the exception of a few HR cadres. They led to overall improvements in supply chain management and access to essential commodities (though increased programme activity did in some instances overload supply, leading to stock-outs). Leaders and governance structures were supported, but coordination remained a challenge. While the increase in funding was significant, overall financing remained erratic. GHIs also raised a need for improved data systems and capacity development/support; without such improvements, reporting requirements led to staff overload. There also was conflict between infrastructure development and programme expansion associated with many GHI-supported interventions. Overall, there were positive synergies between GHI implementation and health systems in Uganda. However, there were some negative outcomes as well. Background Uganda is a landlocked country in East Africa bordered by Sudan in the north, Kenya in the east, the United Republic of Tanzania and Rwanda in the south, and the Democratic Republic of Congo in the west. In 2007 Uganda had an estimated population of 30.9 million people with an average annual population growth of 3.2% per year [1]. Uganda ranked 156 th out of 179 countries on the Human Development Index in 2006 [2]. The HIV/AIDS prevalence rate in Uganda peaked in the 1990s at 25-30% in major urban areas, but stabilized at 5.4% by 2007 [3]. About 940 000 people were living with HIV/AIDS by the end of 2007 [4]. An estimated 51% of households do not have access to medical services in Uganda, with health care delivery especially poor in the northern areas affected by civil war [5]. While 60.89% of the country’s physicians worked in cities in 2004, only 12.82% of the population lived in an urban area [6]. General government expenditure on health as a percentage of total government expenditure increased from 7.3% in 2000 to 10% in 2006 [7]. In 2006, 28.5% of the total health expenditure on health came from external sources [7]. 181
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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
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Objectives and methodology The main
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Discussion The findings of the Mala
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Pakistan: The impact of the Global
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international standards. The Under
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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 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 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
Page 226 and 227: countries” [6]. The TRP apply sev
Page 228 and 229: PEPFAR I & II The newest PEPFAR leg
Page 230 and 231: Types of fundable HRH interventions
Page 232 and 233: Global Fund In two country applicat
Page 234 and 235: 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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