MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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The study employed both purposive sampling and snowball sampling. The study team selected participants based on their roles and experiences in implementing projects/programmes supported by GHIs in Uganda. The study aimed to interview as diverse a range of individuals as possible, asking the interviewees identified through purposive sampling to nominate other people they knew who would willingly participate in the study. The evaluation was cross-sectional, employing both quantitative and qualitative methods (administered structured questionnaires and conducted key informant interviews). It involved review of documents relevant to GHI implementing partners in Uganda. Information from these documents was used to complement findings from the other data collection methods. The evaluation involved in-depth interviews with identified key informants. Interviews with the key informants were conducted according to the key informant guide so that the interviews yielded data responsive to the evaluation objectives. Key informants were also guided to provide perspectives and perceptions on implementation of GHIs. Interviews were recorded following consent of the informant, and field notes were taken. Authority to conduct the study at identified health facilities in Uganda was sought from the Uganda National Council for Science and Technology (UNCST). Lower level permission and consent was sought from the management of the respective health facilities participating in the study. Researchers also sought the consent of the interviewees who completed forms signifying their consent to participate in the study and provide required data. Participants were informed about their freedom to refrain from the study. Participants were given an opportunity to ask questions and/or seek clarification. Participants were also informed of guaranteed confidentiality; this included altering personal details captured on audio tapes during transcription to ensure that Key Informants were not directly linked to their comments. Table 3: Increase in ANC Attendance in relation to availability of HIV counseling services at UPHOLD Sites in Uganda Baseline 2004 2005 2006 Number % Change Number % Change Targeted (Counseling) 1198 14958 1148.5% 30268 102.4% Non-Targeted (ANC) 1745 22001 1160.8% 42509 93.2% Table 4: Availability of TB Management Services at Surveyed Health Facilities Available TB Services % Facilities before GHI % Facilities Currently TB Diagnosis 85.7% 97.1% TB Treatment 88.6% 94.3% DOTS 65.7% 85.7% MDRTB Treatment 14.3% 40.0% 184
Results Leadership and Governance GHIs have stimulated development of various health policies geared towards improving health status. GHIs also improved the participation of communities in health care programmes. Funds provided by GHIs have improved workforce motivation and strengthened programmes for staff retention and coordination at national and district levels. However, there was duplication of work due to poor or inconsistent coordination and monitoring of programmes. Health Workforce Generally there was an improvement in human resources for health both in terms of numbers of staff and skills following GHI implementation. Key informants at the health facilities surveyed associated this change with GHIs. On the positive side, many cadres of health workers were trained by GHI-funded programmes (lab staff, HIV/AIDS counsellors, provision of antiretroviral therapy [ART], etc). However, trainings were criticized for being disruptive to service delivery (taking health workers out of station for long periods, thus creating service delivery gaps at facilities). GHIs were also criticized for attracting health workers to GHI-funded programmes and denying the public health sector much needed human resources for health. All the key informants reported that they had lost doctors to GHI-funded projects. Table 5: Numbers and Changes in Personnel Cadres at Surveyed Health Facilities No. Before GHI No. Currently % Change Surgeons / Obstetricians 19 28 47.3 Medical Doctors (Specialists) 16 22 37.5 Medical Doctors (Non-Specialists) 34 24 (29.4) Non-Doctor Clinicians 30 56 86.7 Nurses (All Categories) 1037 1466 41.4 Laboratory Personnel (All categories) 74 115 55.4 Pharmacy Personnel (All categories) 33 67 103.0 Counsellors (all categories) 175 428 144.6 Community Health Workers 290 441 52.1 Lay Service Providers 72 68 (5.5) Other service providers 193 498 158.0 There was general increase in the number of health workers at all the facilities that were surveyed, with a 145% increase in the number of counsellors and a103% increase in the number of pharmacy personnel of all categories. Other service providers increased by 158%. There was however a reduction in the number of non-specialist medical doctors by nearly 30% and the number of lay service providers reduced by 6%. For the rest of the health workforce the increases were over 35%. 185
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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
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Some negative effects are also attr
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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 186 and 187: [19] The Global Fund for Aids Tuber
Page 188 and 189: Official Development Assistance (OD
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
Page 236 and 237: HRH Intervention Categories GAVI: C
Page 238 and 239: 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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