MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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average annual population growth of 1.7% [1]. In 2006, Zambia ranked 163rd out of 179 on the UN Human Development Index [2]. Official Development Assistance (ODA) to Zambia in 2006 was US$ 945 million. In 2005, the International Monetary Fund (IMF) and the World Bank’s International Development Association provided the country with debt relief of approximately US$ 6 billion [3]. In 2008, Zambia’s health sector budget was approximately US$ 295 million or US$ 30 per capita, and donor funds represented 50% of total national health expenditure. In 2007, 65% of Zambians lived in rural areas, but only 52% of all health workers worked in rural settings [4]. Thirteen districts did not have a single doctor, while more than half of all doctors practiced in the capital, Lusaka [5]. HIV/AIDS is the leading cause of death for all ages in Zambia. In 2007, an estimated 1.1 million people in Zambia were living with HIV [6], Prevalence, however, has slightly decreased in recent years from 16% in 2002 to 14% in 2007 [7]. Prevalence is twice as high in urban settings as in rural areas, at 20% and 10% respectively [7]. Zambia has received large amounts of external HIV/AIDS funding over the last seven years to scaleup prevention, treatment and care activities [8]. Although Zambia receives funds from several donor agencies, the major contributors are three global HIV/AIDS initiatives: the Global Fund; PEPFAR; and World Bank MAP (table 3). The national multi-sectoral AIDS response in Zambia is coordinated by the National AIDS Council (NAC). The Global Fund allocates funding to four Principal Recipients in Zambia. Two of these are government agencies: the Ministry of Finance and National Planning (MoFNP) and the Ministry of Health (MOH). Two are non-government: the Churches Health Association of Zambia (CHAZ) and Zambia National AIDS Network (ZNAN). The World Bank MAP (from 2002-2008) has channelled its resources to support the Zambia National Response to HIV/AIDS Project (ZANARA), which is housed in the Ministry of Finance and National Planning. It allocates resources to: the Community Response to HIV/AIDS (CRAIDS); workplace programmes in the line ministries; and the NAC. The Community Response to HIV/AIDS is the only World Bank funds recipient in Zambia that sub-grants to implementing local organizations. Zambia was chosen as one of PEPFAR’s fifteen focus countries in 2003, and by 2006 PEPFAR contributed 62% of total HIV/AIDS funding in Zambia [9]. The major recipient of PEPFAR funds is the United States Agency for International Development (USAID), and implementing agencies mainly include international nongovernmental organizations (NGOs) and faith-based organizations (FBOs), which access funds directly from PEPFAR. The Country Operational Plan (COP) is prepared each year and is the framework through which PEPFAR-supported activities are undertaken. 210
Table 1 Basic Socioeconomic, Demographic and Health Indicators* (*) Full data sources for all indicators are provided in Annex 1. Indicator Value Year Source Population (thousands) 11,920 2007 World Bank Geographic Size (sq. km) 743,390 2007 World Bank GDP per capita, PPP (constant 2005 international $) 1,282.86 2007 World Bank Gini index 50.8 2004 World Bank Government expenditure on health (% general government expenditure) 10.8 2007 WHO NHA Per capita government expenditure on health (current US$) 25 2007 WHO NHA Physician density (per 10,000) 1 2004 WHO SIS Nursing and midwifery density 20 2004 WHO SIS Maternal mortality ratio (per 100,000 live births) 830 2005 WHO SIS DTP3 coverage (%) 80 2007 WHO SIS Estimated adult HIV (15-49) prevalence (%) 15.2 (14.3 – 16.4) 2007 UNAIDS Estimated antiretroviral therapy coverage (%) 46 (40-56) 2007 WHO/UNAIDS/UNICEF Tuberculosis prevalence (per 100,000) 387 2007 WHO GTD Estimated malaria deaths 14,204 2006 WHO WMR Table 2 Global Health Initiative Investments* Global Fund Round & Disease Priority Approved (in US$) Disbursed (in US$) Round 1, HIV/AIDS 90,325,778 81,859,517 Round 1, Malaria 39,273,800 38,673,791 Round 1, TB 47,337,256 29,883,503 Round 4, HIV/AIDS 236,318,738 97,700,670 Round 4, Malaria 42,721,807 27,725,056 Round 7, Malaria 17,715,924 2,422,691 Round 7, TB 3,882,948 1,208,954 Round 8, HIV/AIDS 129,368,645 0 TOTAL: 606,944,896 279,474,182 PEPFAR Year Amount Allocated (in US$) 2004 81,662,410 2005 130,088,605 211
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Table of Contents Key Acronyms Intr
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Policy analysis of the impact of Gl
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OIs Opportunistic infections OVC Or
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core section of the document then p
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Figure 1: Analytic framework for MP
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studies. MPS researchers have linke
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Burundi: Building a health system t
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at between US$ 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
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PEPFAR’s funding practices were l
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medical staff to higher-paying admi
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system (CPDS), in which many stakeh
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needing medical transport. Both GHI
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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 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 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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