MAXIMIZING POSITIVE SYNERGIES - World Health Organization

district-level health care needs. These funds were also observed to be erratic with little flexibility.
The application requirements were very rigid and there was a general feeling within the public
health sector that GHIs should incorporate their funds into government funding mechanisms.
Discussion
Global Health Initiatives (GHIs) have significantly increased access to a wide range of
HIV/TB/Malaria services of high quality and at no direct cost to the users. There is increased access
to health care services in Uganda as a result of interactions between GHIs and health systems.
There are significant improvements in the areas of TB diagnosis and treatment. The availability of
GHI funding enabled scale up and implementation of the CB-DOTS programme. In the last five
years, during which time GHI funds have been available, access to MDRTB treatment has more
than doubled.
Improvements were also observed in supply chain management for TB drugs and laboratory
reagents. Funding from GHIs also helped to train laboratory technicians and to improve
supervision of health workers providing TB services. Case detection rates for TB in some districts in
Uganda almost doubled. However, most of the funding went to HIV/AIDS, with comparably less
money allocated to TB and malaria.
There was a 10% increased availability of plain X-rays on site; however, ‘access within two hours’
did not change. There was a reduction in fees. Availability of ultrasound services on site increased
by 15%, but ‘access to ultrasound services within two hours’ was reduced and the fee charged for
ultrasound services increased.
There was marked improvement in referral practices for all the variables that were assessed, with a
50% increase in the use of referral forms by community health workers. There was also a great deal
of focus on children, as evidenced by the number of children accessing HIV/TB/malaria services.
There were significant reductions reported in the cost of health care for the targeted conditions,
and to a lesser extent, the non-target conditions.
However, GHIs had limited impact on infrastructural development and the focus of the funding
was limited to the three target diseases. The programmes had both positive and negative impacts
on the health care workforce. Positively, many cadres of health workers were trained (lab staff,
HIV/AIDS counsellors, provision of ART, etc). However, these trainings were criticized for being
“class room type” – taking health workers out of their duty stations for long durations, thus
creating service delivery gaps at public facilities. GHIs were also criticized for attracting health
workers to GHI funded programmes, denying the public health sector the much-needed human
resources for health. Most public health facilities had lost doctors to GHI funded projects within
and outside the country.
There was a general increase in the number of health workers at all the facilities that were
surveyed, with 145% increase in the number of counsellors and 103% 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 lay
service providers were reduced by 6%. For the rest of the health workforce the increases were over
35%.
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