MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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References [1] Data are from the Ministry of <strong>Health</strong> of Ukraine, Kyiv, 2008. [2] Ukraine: National report on Monitoring Progress toward the UNGASS Declaration on Commitment on HIV/AIDS. Kyiv, Ukraine, Ministry of <strong>Health</strong> of Ukraine, 2008 (http://www.aidsukraine.com/de/upload/ukraine_2008_country_progress_report_en.pdf; accessed 20 March 2009). [3] Support for HIV and AIDS Prevention, Treatment and Care for the Most Vulnerable Populations in Ukraine: Ukraine Proposal for GFATM Sixth Call for Proposals. Kyiv, Ukraine, 2006. [4] Ukraine TB and HIV/AIDS Control project: Current status. In: 13th meeting of the parties involved, 7 December 2007 (http://www.network.org.ua; accessed 20 March 2009). [5] See the Context Mapping report and Interim Report from this project for an overview of the epidemiological context in Ukraine and the policy and programmatic response. 200
United Republic of Tanzania: Strengthening the health system to address the burden of HIV/AIDS and TB Abstract Thyra de Jongh, Rifat Atun 28 The United Republic of Tanzania is facing a massive burden of HIV/AIDS and TB. Addressing these issues is complicated by a weak health care infrastructure and a severe human resources crisis. In response, the country has enjoyed considerable donor support, including several grants from the Global Fund. Although these grants are primarily intended to fund disease-specific activities, it is recognized that strengthening of the overall health system is a prerequisite to reap the full benefits of the investment. This case study examined the effects of focused investment on Tanzania’s health system as a whole. A mixed-methods design was used, based on the Systemic Rapid Assessment toolkit (SYSRA). We conducted interviews with key stakeholders at all levels. We found that, in addition to significant contributions in the areas of TB and HIV, the Global Fund has strengthened the health system through training of health care workers and investment in general health facilities. It has, however, also led to some duplication of activities, particularly in the area of monitoring and reporting, diversion of resources, and potential distortion of resource allocation. Although promising steps have been taken to further align national and donor activities, scope for improvement remains. Background The United Republic of Tanzania was formed in 1964 by the union of the mainland territory then known as Tanganyika with the island archipelago of Zanzibar. The largest country in East Africa, Tanzania shares a border with Kenya, Uganda, Burundi, Zambia, Malawi, Mozambique, Rwanda, and the Democratic Republic of Congo. As of 2007, Tanzania’s population was 40.4 million, with an estimated 2.4% annual growth rate [1]. In 2006, Tanzania ranked 152 nd out of 179 countries on the Human Development Index [2]. Though Tanzania is one of the continent’s most politically stable countries, it remains one of the poorest countries in the world despite a real annual GDP growth of about 6.3% since 2000 [1]. Significant macroeconomic and structural reforms introduced since the mid-1990s have not succeeded in pulling the country out of poverty. Tanzania’s economy is largely dependent on agriculture and tourism. Since the first three cases were detected in 1983 in Kagera Region, HIV/AIDS has taken its place as one of the leading causes of death in Tanzania [3]. In 2007, 1.4 million people were living with HIV/AIDS [4]. 28 Imperial College London/ Global Fund to Fight AIDS, TB and Malaria 201
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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
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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 204 and 205: • The introduction of new service
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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