MAXIMIZING POSITIVE SYNERGIES - World Health Organization

countries” [6]. The TRP apply several general criteria to reviews of applications: “Soundness of
approach; Feasibility; and Potential for sustainability and impact” [6]. Each of these criteria is
spelled out in greater detail in the Terms of Reference of the Technical Review Panel.
The World Bank MAP
The World Bank provides low-interest loans, interest-free credits, and grants to developing
countries for a wide array of purposes that include investments in education, health, public
administration, infrastructure, financial and private sector development, agriculture, and
environmental and natural resource management [7]. Typically, the Bank requires applicants to
produce a strategic plan to demonstrate how they expect the financing to have a desirable effect.
In the area of health, the Bank (via IDA) supports systemic change building on priorities and needs
identified by recipient countries. Governments develop Country Assistance Strategies to
determine areas for IDA assistance. IDA funding can be used flexibly to complement other sources
and deliver sustained support to strengthen health systems. Similarly, for the MAP each country
project has to have a national strategic plan as its basis, which is negotiated and agreed upon
between each country and the Bank [3]. MAP focuses mostly on a national AIDS response, capacity
building and institutional strengthening, with strong monitoring and evaluation (M&E) built in.
Speed, scaling-up existing programmes, building capacity, "learning by doing" and continuous
project revisions has necessitated significant reliance on the immediate M&E of programmes to
determine which activities are efficient and effective and should be expanded further, and which
are not and should be stopped or would benefit from more capacity building [8].
PEPFAR
The original five-year financial commitment of PEPFAR was $15 billion dollars supported by
American taxpayers. The actual expenditure during the following five-year period (2003-2008) was
$18.8 billion dollars. On July 30 2008 the Tom Lantos and Henry J. Hyde United States Global
Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 was signed
into law. This legislation authorizes a U.S. financial commitment of up to US$ 48 billion to combat
these three diseases over the next five years [9] . The United States Government (USG) uses the
Country Operational Plan (COP) to award funding, most of which goes to international, mostly US,
non-governmental entities and is heavily concentrated in a number of focus countries (15 until
2008 now expanding to more under the reauthorization of PEPFAR) [3]. The 2008 law removes
many of the earmarks, which previously determined allocation of funds, although it still requires
that over 50% of the funding be allocated to the treatment of HIV/AIDS (e.g. ARV drugs, ARV
services, laboratory infrastructure), rather than to prevention and care. In PEPFAR I, countries were
required to spend some funds on strategic information (up to seven percent) and policy analysis
and HSS (up to seven percent). In PEPFAR II, HSS, including the rational allocation of health tasks
among health care workers (“task-shifting”), has taken on a heightened priority and is an explicit
goal of the initiative [10]. Although criteria for awarding funds are not provided in general
guidance, recipients of funds are required to meet a number of expectations, such as adherence to
Emergency Plan policy, collaboration with the Global Fund, accountability and reporting [11].
GHIs and Health Systems Strengthening
GHIs and experts alike recognize that progress toward providing treatment to persons affected
with HIV/AIDS and other diseases has been achieved in countries receiving funding. However,
they also acknowledge today that limited progress will be achieved from now on without paying
special attention to, not only the country’s macroeconomic framework, but also its health care
system. Particular attention will also need to be paid to the country’s legal and policy framework
for health and health systems in order to achieve greater integration of disease specific funding,
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