MAXIMIZING POSITIVE SYNERGIES - World Health Organization

enovation of health care facilities, which were often in dire shape. With support from its
development partners Tanzania has, furthermore, been able to set up a network of CTCs for the
provision of HIV/AIDS services.
Funds have also been used to purchase laboratory equipment and reagents. Some of these
investments have spillover effects beyond their disease-specific primary purpose. TB patients, for
instance, are seen in general health facilities, and investments in waiting and examination rooms
have thus also benefited the wider patient population. Microscopes purchased within the context
of the TB programme are sometimes also being used in the diagnosis of malaria and other
illnesses. Expanding the range of services on offer at health facilities through strengthening of the
HIV/AIDS and TB programmes is assumed to have brought greater trust in the public health system
as a whole. In the longer term this could have a positive impact on the uptake of other services,
such as those for family planning or reproductive and child health.
Discussion
GHIs have been indispensable partners in the fight against HIV/AIDS and TB in Tanzania, making
care and treatment options available to a population in a country that suffers from a high burden
of disease and which is unable to finance such options itself. At times, the investment has been
narrow and has had limited positive impact on the health system as a whole. For instance,
investment in health facilities and laboratories has often concentrated solely on strengthening the
delivery system for HIV/AIDS activities. At other times these efforts have spilled over into the
health system as a whole, for instance through training in transferable skills. Greater emphasis is
needed to systematically build these positive spillover effects into the supported proposals.
Negative impacts are felt mostly in areas of financing, governance and M&E where the presence of
the Global Fund has to an extent resulted in the creation of parallel systems and in duplication of
activities. Significant steps have already been taken to address these issues, but further efforts are
required to bring greater harmonization between the Government of Tanzania and its
development partners.
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