MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Ukraine: Effects of the Global Fund on the health system Abstract Tetyana Semigina 27 Ukraine has one of the most rapidly growing HIV/AIDS epidemics in Europe, with estimated numbers of people living with HIV/AIDS (PLWHA) reaching 400,000 in 2008. Since 2003, the Global Fund has committed to providing US$ 243 million towards the control of HIV/AIDS in Ukraine. This study examines the impact of Global Fund financing on HIV/AIDS services and the health system in Ukraine. Research was conducted in Kyiv, Odessa and L’viv. The research finds that Global Fund resources have supported a dramatic scale-up of services for PLWHA and at-risk populations. There has been a substantial increase in the number of PLWHA receiving antiretroviral therapy (ART). New laboratory, diagnosis, prevention and support services have been developed. The Global Fund grant has strengthened service delivery by training health workers and supporting the development of HIV/AIDS surveillance systems. Whilst the Global Fund has had a positive impact on governance and leadership, for instance by promoting transparency among government health service providers and improved management practices, cooperation between government and nongovernmental service providers is limited, and coordination structures are weak. Many services financed by the Global Fund are provided by nongovernmental organizations (NGOs) heavily dependent on continued Global Fund support, highlighting issues of sustainability. 27 School of Public Health and School of Social Work, Kyiv-Mohyla Academy, Kyiv, Ukraine. The research for this study summary was funded by The Open Society Institute, New York. The study summary was produced with the support of the GHIN Network (www.ghinet.org). 192
Background General Context Table 1: Basic Socioeconomic, Demographic and Health Indicators* * Full data sources for all indicators are provided in Annex 1 Indicator Value Year Source Population (thousands) 46,383 2007 World Bank Geographic Size (sq. km) 579,380 2007 World Bank GDP per capita, PPP (constant 2005 international $) 6,528.44 2007 World Bank Gini index 28.239 2005 World Bank Government expenditure on health (% general government expenditure) 8.8 2007 WHO NHA Per capita government expenditure on health (current US$) 116 2007 WHO NHA Physician density (per 10,000) 31 2006 WHO SIS Nursing and midwifery density (per 10,000) 83 2006 WHO SIS Maternal mortality ratio (per 100,000 live births) 18 2005 WHO SIS DTP3 coverage (%) 98 2007 WHO SIS Estimated adult HIV (15-49) prevalence (%) 1.6 (1.2-2.0) 2007 UNAIDS Estimated antiretroviral therapy coverage (%) 8 2007 WHO/UNAIDS/UNICEF Tuberculosis prevalence (per 100,000) 102 2007 WHO GTD Estimated malaria deaths N/A N/A N/A Table 2 Global Health Initiative Investment* (other than Global Fund and World Bank) PEPFAR * (in US$) Year Amount Disbursed 2004 5,504,000 2005 7,074,000 2006 5,027,000 2007 6,744,000 2008 5,850,000 TOTAL: 30,199,000 *Not a PEPFAR focus country; above sums represent total allocations to PEPFAR country programmes from bilateral U.S. sources including USAID, Department of Health and Human Services, Department of Labor, and Department of Defense. 193
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Table of Contents Key Acronyms Intr
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Policy analysis of the impact of Gl
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OIs Opportunistic infections OVC Or
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core section of the document then p
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Figure 1: Analytic framework for MP
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studies. MPS researchers have linke
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Burundi: Building a health system t
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at between US$ 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
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Peru: Effects of the Implementation
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Table 2 Global Health Initiative In
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HIV/AIDS, mainly around the Compreh
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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 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 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
Page 240 and 241: HRH Intervention Categories PEPFAR
Page 242 and 243: Conclusion: Directions for future r
Page 244 and 245: GHIs and health systems. Civil soci
Page 246 and 247: Annex 01: Data sources for tables i
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Annex 02: Contributing Institutions
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