MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Policy analysis of the impact of
Global Health Initiatives on health systems:
Policies and lessons learned from donor programmes*
Anne Rossier Markus, Seble Frehywot, Amie Heap, Alan Greenberg
Abstract
Understanding the broader context under which GHIs operate and the flexibility they grant
countries that apply for funding for health system strengthening (HSS) either separately or as an
integral component of a disease focused plan, is key in understanding the types of synergies that
may take place at the local, regional, and national levels. GHIs express this flexibility in very broad
terms and communicate their flexibility in different ways and often independently from each
other. This broad guidance and variation in communication must be counterbalanced with how
these messages are perceived by countries as well as the need for countries to better understand
in which health system areas they may request funds from individual GHIs. The proper balance
must be found between each GHI’s mission, goals and overarching operating model, and the need
for countries to have increased clarity about funding options and the likelihood of having their
applications met with success. GHIs should strive to achieve this balance “internally” within their
own programmes and “externally” with other GHIs that fund similar, overlapping, and even
distinct activities. This paper summarizes key findings from a systematic review of four GHIs’ laws,
policies and guidance, key informant interviews, and funded country applications for HSS,
particularly in the area of health workforce production, distribution, and retention.
Background
Major GHIs, such as GAVI and the Global Fund, have been developed and implemented over the
past several years to help reduce disease-specific morbidity and mortality in low and middleincome
countries. Core principal policies from donor countries and organizations have guided to a
great extent the trajectory and implementation of GHI funds at the host country level. Specifically,
these policies may influence how GHI funds can or cannot be used to strengthen different
elements of the health system as defined by WHO, namely health workforce, health information,
service delivery, governance and leadership, health financing, and medical products and
technologies. Concurrently, an increasing number of host countries have developed policies at the
national and local levels to address the different elements of their health systems, the specific
needs of their countries as they relate to varying disease burdens, and the three health-related
Millennium Development Goals. Despite general guidance from GHIs of how and when countries
can use GHI funds for HSS, these policies have been interpreted differently by various host
countries and implementing partners. Therefore, to maximize potential synergies between GHI
funding and health systems, it is important to improve our understanding of these guiding GHI
policies, and how they are viewed and interpreted at the host country level.
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