MAXIMIZING POSITIVE SYNERGIES - World Health Organization

More documents

Recommendations

Info

centres have only one qualified health worker [11]. The urban-rural breakdown in our study shows that virtually all of the recent increases in clinical staff numbers were in urban health centres, with a slight reduction in rural health centres. The Human Resources for Health Strategic Plan is attempting to address these gaps by introducing a rural placement and retention package. Despite support from GHIs, this scheme has been slow to roll out due to shortage of accommodation and a short timeframe for retention allowances. In addition, until 2007, only doctors were eligible for the scheme, but it has now been extended to include nurses and nurse tutors. Our findings support other studies that reported that PEPFAR-funded NGOs have attracted staff away from the public sector [13,14]. Health staff in Mumbwa – where PEPFAR funded organizations do not operate – were less likely to receive financial incentives for delivering HIV services. Given their success in contributing to HIV/AIDS service scale-up, GHIs now need to support government to train and retain new staff. To date, such support has not been forthcoming. PEPFAR has committed to training new health workers in its focus countries, although this had not commenced in Zambia at the time of the study. A multisectoral response, across ministries and including non-state actors, has been adopted throughout the implementation of Zambia’s HIV/AIDS programme. The Zambian National HIV/AIDS Strategic Framework 2006–2010 demonstrates commitment to coordination through policies explicitly embracing multisectoral HIV/AIDS control, including NGO engagement in decision making. Despite this commitment, findings suggest weak coordination at the national and particularly at the district levels, which has been compounded by the increasing numbers of stakeholders. Although some informants hailed the NAC for its coordination role, they believed that some stakeholders undermine the mandate of the council. Some PEPFAR-funded organizations have sidelined the government coordination structures in their dealings with district- and community-based organizations. This is seen as a source of conflict, as it does not promote the collective spirit of “Three Ones” principles: one national AIDS framework, one coordination body, one monitoring and evaluation (M&E) plan. It is evident that greater coordination is required at the district level, where implementation of activities takes place, if duplication of services and difficulties in accounting for numbers of clients are to be avoided. Limited resources allocated to DATFs, along with the limited devolution of decision-making powers, acutely affect district and community-level structures. While direct attribution of system effects to specific GHIs is difficult, it is clear that the significant resources provided by the GHIs have had effects, both positive and negative, at the district level in Zambia. Given the amount of resources available from the GHIs for implementing HIV/AIDS services – the Global Fund and PEPFAR are still active, although the World Bank MAP grant ended in 2008 – the multiplicity of stakeholders makes coordination difficult and essential. Together, the GHIs, other donors and government need to focus on training health workers and managers and building up weak human resource capacity at all levels. We pose two recommendations at this stage: 1. While the three GHIs have made positive contributions to human resources and in particular in-service training, the issue of health worker shortages has been exacerbated by the scale-up of HIV services. The GHIs should invest in new health worker hire in alignment with the government strategic plan for human resources. 2. The GHIs should support capacity development for DATFs as the main coordination body at the district level. All GHIs – but PEPFAR in particular - should encourage their recipient organizations to work with DATFs. 216
References [1] The World Bank Group. Zambia at a glance (http://devdata.worldbank.org/AAG/zmb_aag.pdf.; accessed 17 March 2009). [2] United Nations Development Programme. Human Development Reports: Zambia (http://hdrstats.undp.org/en/2008/countries/country_fact_sheets/cty_fs_ZMB.html; accessed 17 March 2009). [3] The World Bank Group. Zambia Country Brief. Washington, DC, World Bank, 2008. [4] Ministry of Health, Republic of Zambia. National Health Strategic Plan 2006-2010. Lusaka, 2005. [5] Herbst CH, Gijsbrechts D. Comprehensive and Accurate Information on Health Worker Stock, Profiles, and Distribution in Zambia: Analysis of the JICA Data. Conference presentation. Human Resources for Health Research Conference. Lusaka, Zambia, 2007. [6] UNAIDS. 2008 Report on the global AIDS epidemic. Geneva, UNAIDS, 2008. [7] Zambia Demographic and Health Survey 2007. Lusaka, 2009. [8] Zambia National AIDS Council. Zambia Country Report: Multi-sectoral AIDS Response Monitoring and Evaluation Biennial Report 2006-2007. Lusaka, NAC, 2008. [9] Ooman N, Bernstein M, Rosenzweig S. Following the Funding for HIV/AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and the World Bank MAP in Mozambique, Uganda and Zambia. Washington, DC, Center for Global Development, 2007. [10] Ministry of Health, Republic of Zambia. Human Resources for Health Strategic Plan (Draft) 2006-2010. Lusaka, 2005. [11] Ministry of Health, Republic of Zambia. Human Resource Crisis in Zambia. A Paper for The High Level Forum Abuja, December 2004. [12] Ministry of Health, Republic of Zambia. Joint Annual Review for 2007 Main Report. Lusaka, 2008. [13] Hanefeld J, Musheke M. What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia. Human Resources for Health, 2009, 7:8. [14] Ooman N, Bernstein M, Rosenzweig S. Seizing the Opportunity on AIDS and health systems: a comparison of donor interactions with national health systems in Mozambique, Uganda and Zambia, focusing on the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, TB and Malaria, and the World Bank’s Africa Multi-country AIDS Program. Washington, DC, Center for Global Development, 2008. 217
Page 2 and 3:
Table of Contents Key Acronyms Intr
Page 4 and 5:
Policy analysis of the impact of Gl
Page 6 and 7:
OIs Opportunistic infections OVC Or
Page 8 and 9:
core section of the document then p
Page 10 and 11:
Figure 1: Analytic framework for MP
Page 12 and 13:
studies. MPS researchers have linke
Page 14 and 15:
Burundi: Building a health system t
Page 16 and 17:
at between US$ 14.5 and US$ 18.5 pe
Page 18 and 19:
collaborations with European school
Page 20 and 21:
epresent only US$ 1.75 per month pe
Page 22 and 23:
Service Delivery The decentralizati
Page 24 and 25:
Long term HSS will require governme
Page 26 and 27:
Cameroon: Evaluation of the Nationa
Page 28 and 29:
Table 1 Basic Socioeconomic, Demogr
Page 30 and 31:
of treatment interruptions (>two da
Page 32 and 33:
side effects) were associated with
Page 34 and 35:
Prevention behaviours Nearly half (
Page 36 and 37:
References [1] The World Bank Group
Page 38 and 39:
Out-of-pocket payments account for
Page 40 and 41:
as well as the number of community
Page 42 and 43:
Table 1: Characteristics of facilit
Page 44 and 45:
Table 4: Estimated changes in human
Page 46 and 47:
Central African Republic: Impact of
Page 48 and 49:
Objectives and Methodology In this
Page 50 and 51:
Financing There was a general appre
Page 52 and 53:
NGOs and Civil Society The overall
Page 54 and 55:
Discussion Interviews with key info
Page 56 and 57:
China: The Impact of the Global Fun
Page 58 and 59:
Table 2 Global Health Initiative In
Page 60 and 61:
In Yunnan and Henan, the epidemic i
Page 62 and 63:
funded only from the MOH Pilot Prog
Page 64 and 65:
References [1] China at a glance. W
Page 66 and 67:
1994, private spending and emergenc
Page 68 and 69:
understanding of their roles and re
Page 70 and 71:
References [1] Human Development Re
Page 72 and 73:
In 2003, the government launched th
Page 74 and 75:
Objectives and Methodology The data
Page 76 and 77:
Health Workforce Ghana is challenge
Page 78 and 79:
Discussion GHIs are critical for ra
Page 80 and 81:
Haiti: Maximizing Positive Synergie
Page 82 and 83:
Table 1 Basic Socioeconomic, Demogr
Page 84 and 85:
with need. With GHI funding, distri
Page 86 and 87:
I know that within [the organizatio
Page 88 and 89:
Much of the initial enthusiasm abou
Page 90 and 91:
services, or for measures of qualit
Page 92 and 93:
funds and more funding focused on i
Page 94 and 95:
INDIA: Exploring how disease-specif
Page 96 and 97:
PEPFAR* Year Amount Disbursed (in U
Page 98 and 99:
Primary data collection - facility
Page 100 and 101:
The Global Fund has strengthened th
Page 102 and 103:
Page 104 and 105:
Background The Republic of Kenya li
Page 106 and 107:
Results Leadership and Governance D
Page 108 and 109:
Informants noted that a general lac
Page 110 and 111:
time periods. Informants believed t
Page 112 and 113:
Page 114 and 115:
A comprehensive, long-term reform o
Page 116 and 117:
The effects of GHIs on the capacity
Page 118 and 119:
their budget was comprised of Globa
Page 120 and 121:
Quality of services The majority of
Page 122 and 123:
References [1] Kyrgyzstan at a glan
Page 124 and 125:
Commission (NAC) in 2001 as a multi
Page 126 and 127:
Objectives and methodology The main
Page 128 and 129:
Discussion The findings of the Mala
Page 130 and 131:
Pakistan: The impact of the Global
Page 132 and 133:
international standards. The Under
Page 134 and 135:
the US Centers for Disease Control
Page 136 and 137:
Some negative effects are also attr
Page 138 and 139:
to country health systems by way of
Page 140 and 141:
Peru: Effects of the Implementation
Page 142 and 143:
Table 2 Global Health Initiative In
Page 144 and 145:
HIV/AIDS, mainly around the Compreh
Page 146 and 147:
without substantial emphasis on pre
Page 148 and 149:
Page 150 and 151:
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 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 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 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
show all

MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?