MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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government and nongovernmental providers, were interviewed using a structured survey tool. Twenty-five clients participated in in-depth qualitative interviews and nine organizations were surveyed using a structured facility survey tool. Results Governance Some participants reported that Global Fund-supported programmes have engendered a change in mentality among government medical institutions, including higher levels of transparency among government service providers. In addition, the Global Fund is seen as having promoted improved management practices among both government and nongovernmental agencies providing HIV/AIDS services. Legislative reforms The study found that the Global Fund programme in Ukraine has promoted gradual changes in regulation and legislation. An important component of the first stage of implementation of the Global Fund programme was the development and publication of national clinical protocols by the International HIV/AIDS Alliance and the MOH. These include: protocols for antiretroviral therapy (ART) for adults, teenagers and children, treatment of opportunistic infections in HIV/AIDS patients and methodological recommendations for laboratory monitoring of HIV infection and ART. Coordination structures In 2002, a national HIV/AIDS coordination council was formed, consisting of government representatives, international development actors and civil society members. Since its formation, the council has undergone several changes in structure, focus and membership, and a number of parallel HIV/AIDS structures have been established and abolished. The current structure is called the Coordination Council on HIV/AIDS, TB and Drug Addiction. Many key stakeholders consider the creation of the Council to be a positive step, because it serves as a good example of cooperation between government and NGOs and actively involves PLWHA. However, some have been critical about the functioning of the Council, which meets infrequently and has limited powers beyond financial issues. The study revealed that coordination structures at the sub-national level were particularly weak and lacked decision-making authority in some regions. 196
<strong>Health</strong> Workforce Increase in the health workforce From 2004-2007, the number of personnel increased in most governmental and nongovernmental HIVservice organizations. Table 3: Changes in the number of staff working for organizations providing HIV/AIDS services <strong>Organization</strong> name 2004 2007 Total increase Kyiv city hospital AIDS centre 60 150 90 Odessa AIDS centre 12 37 25 Kyiv office of the All-Ukrainian Network of PLWHA 12 50 38 Odessa NGO “Faith. Hope. Love” 27 90 63 Interviews with service providers revealed that many had experienced an increase in their workload. The key factors contributing to this pattern were increases in client numbers and in administrative work. However, data from most facility surveys show that the number of client visits per worker actually did not change, as the number of workers grew in proportion with the number of clients. The 2008 survey also found that of 50 respondents, 38 considered they were motivated (felt happy delivering HIV services and were sufficiently incentivised), 36 were satisfied with their work and 33 liked working with HIV-positive clients. Training for HIV/AIDS service providers International HIV/AIDS Alliance data indicate that resources have been committed to developing the skills of managers and workers who provide HIV/AIDS services and prevention programmes. Training programmes in 2004 covered the following topics: data collection, monitoring and evaluation (M&E), organization of effective prevention programmes for commercial sex workers, before- and after-test counselling, and advocacy on the rights of vulnerable groups. By 2007, the reach and the topics of training had expanded considerably. There were nine regional HIV/AIDS information and resource centres, and these organized 255 training and seminar sessions for almost 3800 people. The International HIV/AIDS Alliance also introduced training aimed at strengthening regional NGOs, including sessions on financial management, grant management and project management. Of the 50 service providers that were interviewed, 37 had taken part in HIV/AIDS training over the past 12 months. The most common sessions were voluntary counselling and testing (VCT), HIV prevention and social support. In most of these cases, financing was provided by the Global Fund. However, it should be noted that training was mainly short-term, lasting between one and three days, more rarely between four and seven days, and only in some cases continuing between eight days and a month. Service delivery Strengthening HIV/AIDS service delivery The study revealed that the Global Fund has strengthened service delivery in a number of ways including: 197
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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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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 200 and 201: GAVI (in US$) Disease Priority Amou
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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