MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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• The introduction of new services, including ART and opiate substitution therapy; • Training of medical and NGO personnel providing HIV/AIDS services; • Refurbishment of premises of HIV/AIDS services; • Funding the purchase of equipment; • Fostering some improvements in cooperation between government and nongovernmental service providers; • Systems of epidemiological surveillance have been strengthened. Scale-up of HIV/AIDS services Funding has been used to dramatically scale-up medical, prevention and care/support services for PLWHA and the most at-risk population. The Global Fund programme has led to a substantial increase in the number of PLWHA receiving ART. In 2003 only 53 people received ART, whilst in 2008 this number increased to 900, of whom 6000 received treatment financed by the Global Fund. In addition, new laboratory and diagnosis services have been developed, and prevention, care and support programmes have been created. These include harm reduction and drug dependence reduction programmes, such as needle/syringe exchange and substitution therapy. Table 4 illustrates scale-up in client numbers in the three regions of Ukraine that were selected to be a part of the study. Table 4: Total client numbers receiving key HIV/AIDS services in Kyiv, Odessa and L’viv Kyiv Odessa L’viv Services 2004/2005 2006 2004/2005 2006 2004/2005 2006 Preventative services 7843 23139 11214 28536 782 4305 Substitution therapy - 240 - 99 - - Care and support 1111 2862 989 4658 29 221 ARV treatment 232 301 373 374 - - Source: International HIV/AIDS Alliance in Ukraine Communities/Civil Society Many of the services financed by the Global Fund are provided by NGOs and community organizations. These are sometimes based at, or in cooperation with, government organizations. Since the Global Fund programme was implemented, NGOs have played an increasingly important role in delivering prevention, care and support services. This study suggests the peer-to-peer approach to providing services for vulnerable groups such as drug users and sex workers is effective. This approach was valued by clients and helped to break down the barriers between providers and clients, thereby improving access to services. Respondents pointed out that the Global Fund has had an impact on the development of civil society in a number of ways: 1. The Principal Recipients of the Global Fund grant are NGOs. In 2007 and 2008 the majority of HIV-service organizations in Ukraine received financing through the two Global Fund 198
Principal Recipients: the International HIV/AIDS Alliance in Ukraine and the All-Ukrainian Network of People Living with HIV. Both organizations have become important actors in Ukrainian policy to combat HIV/AIDS. 2. A substantial part of funding has been disseminated among NGOs. The research suggests that in Kyiv, Odessa and L’viv, between 60% and 85% of funding for NGOs is from the Global Fund. 3. NGO staff have received training, including in topics related to service provision and organizational management. 4. NGOs have become involved in decision-making processes relating to public health policy and HIV/AIDS. This is partly the result of the Global Fund’s requirement that the National Coordination Committee should include representatives from civil society organizations. Discussion The implementation of the Global Fund programme in Ukraine has led to an increase in the number of government and nongovernmental stakeholders from different sectors involved in HIV/AIDS-related activities, and to scale-up of HIV/AIDS services, including prevention, testing, treatment, care and support. The study highlighted the challenges to extending access to key HIV services among vulnerable populations. Potential obstacles include: stigmatisation of HIV-positive people, the criminalization of drug use, and limited provision of information about HIV/AIDS services. The study suggests that the quality of services provided by NGOs varies and depends on the individuals who implement projects. This is because there are no official quality standards for the provision of HIV/AIDS services by NGOs. Moreover, there is a lack of commitment by the government to fund NGOs, which are currently highly dependent upon international donors and initiatives, particularly the Global Fund. This has implications for NGOs’ long term sustainability. 199
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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
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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 202 and 203: government and nongovernmental prov
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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MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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