MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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GAVI (in US$) Disease Priority Amount Approved Hepatitis B vaccine 3,212,000 Vaccine introduction grant 100,000 Injection Safety 792,000 TOTAL: 4,326,280 NB: Investments from Global Fund and World Bank are reflected in Figure 1, below. Epidemiological context Ukraine has the most rapidly growing HIV/AIDS epidemic in Europe. The number of registered people living with HIV/AIDS (PLWHA) was 131 000 in 2008; the number has increased from approximately 46 000 registered cases in 2002. Many PLWHA remain unregistered, and indeed, estimates suggest that there may currently be about 400 000 PLWHA in Ukraine. According to Ministry of Health (MOH) data, as of 1 January 2008, the highest levels of HIV prevalence were in Odessa (414 cases per 100 000 population), Dnipropetrovsk (409) and Donetsk (390) regions. Intravenous drug use accounted for most HIV transmission (approximately 40%), sexual (mainly heterosexual) for 38%, and vertical mother to child transmission for 19% [1]. Funding for HIV/AIDS programmes in Ukraine Several donors and GHIs provide funding for HIV/AIDS prevention, treatment and care programmes in Ukraine. The largest GHI is the Global Fund, which is slated to provide US$ 243 million between 2003 and 2011 for HIV/AIDS projects (see Figure 1). The World Bank programme to fight HIV/AIDS and tuberculosis (US$ 77 million) was launched in Ukraine in 2003. The country has also received additional funding and technical assistance from UN organizations (WHO, UNAIDS, UNICEF, UNDP, ILO), bilateral programmes (USAID and the Swedish International Development Agency [SIDA]), and NGOs. In 2006, the total amount of funding for HIV/AIDS programmes in Ukraine was US$ 55.4 million, of which US$ 28.1 million was provided by the state budget and US$ 20.1 million from Global Fund grants [2]. There are two principal recipients of the current Round 6 Global Fund grant: the International HIV/AIDS Alliance and the Network of People Living with HIV/AIDS [3]. Figure 1 summarizes Global Fund and World Bank HIV/AIDS programmes in Ukraine. Figure 1: Global Fund and World Bank HIV/AIDS funding in Ukraine GF 1 round $ 92M 6 round $151M WB $ 77M 2003 2004 2005 2006 2007 2008 2009 2010 2011 Error! Reference source not found. MOH +UNDP International HIV/AIDS Alliance MOH +State Department of Corrections 194 International HIV/AIDS Alliance + Network of People Living with HIV/AIDS
Methodology Between July 2006 and December 2008, a team from the School of Public Health and the School of Social Work at the National University, Kyiv-Mohyla Academy, supported by a team from the London School of Hygiene and Tropical Medicine, conducted the Ukrainian part of an international research project on the national and sub-national effects of GHIs for HIV/AIDS on country health systems. The research was funded by the Open Society Institute. The study focused on scale-up of HIV/AIDS services; coordination structures and coordinated service delivery, strengthening the health workforce and service delivery/access. This case study summarizes findings from the final study report, based on 2008 data collection. The focus of the study is on Global Fund-financed programmes in Ukraine and their implementation in three regions of the country: Kyiv, Odesa and L’viv. The World Bank’s Ukrainian HIV/AIDS loan was not assessed in detail as part of this research, since in April 2006 the World Bank suspended its support, arguing that the government had not distributed the funds and implemented the programme adequately. Support resumed in November 2006 on the condition that Ukraine would improve the management and implementation of the project. The programme was scheduled to end in mid-2008 but was extended until the end of 2008. Only a limited proportion of the overall funds have, however, been used [4]. Studying the influence of GHIs in Ukraine is particularly important given the slow progress that the country has made in stabilizing and reducing the spread of HIV/AIDS [5]. This is despite the legislative, political, organizational and administrative measures that have been taken in response to the epidemic, including the recent formation of the National Coordination Council for HIV/AIDS and increased activities among NGOs providing HIV/AIDS services. Previous research has not provided a systematic analysis of the GHIs that operate in Ukraine and their influence on HIV/AIDS services and the health system. Qualitative and quantitative research methods were used to collect the data. Researchers analysed documents including: annual reports of the International HIV/AIDS Alliance in Ukraine and the All- Ukrainian Network of People Living with HIV/AIDS; national progress reports on the United Nations General Assembly Special Session (UNGASS) Declaration of Commitment on HIV/AIDS; documents from international organizations; presentations from stakeholders’ meetings organized by the Principal Recipients of the Global Fund grant; official statistics on the epidemic in Ukraine; and policy documents, including documentation on the national programme to combat HIV/AIDS, as well as laws and decrees adopted by the Parliament, President and Cabinet of Ministries. Researchers conducted semi-structured interviews with national and sub-national key informants; semi-structured and structured interviews with clients of HIV-service organizations; and structured interviews with providers of medical and social services. Instruments for the study were developed jointly by the Ukrainian team and the Global HIV/AIDS Initiative Network (GHIN) partners. The study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee prior to being undertaken. In 2008, 49 key informants were interviewed using a semi-structured topic guide. Interviewees included national stakeholders (n=21) and sub-national stakeholders from Kyiv (n=12); Odessa (n=10); and L’viv (n=6). Stakeholders are defined as individuals making decisions about HIV/AIDS programmes or implementing those programmes at national and regional levels. They include representatives from government and international organizations, from regional government departments, and from national and regional NGOs, including members of national and regional HIV/AIDS Coordination Councils. A sample of 50 HIV/AIDS service providers, including both 195
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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
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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 198 and 199: Ukraine: Effects of the Global Fund
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
Page 248 and 249: Annex 02: Contributing Institutions
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