MAXIMIZING POSITIVE SYNERGIES - World Health Organization

oth national and external, with the broader system. “Stronger and robust health systems are
essential” in a successful response to HIV/AIDS, tuberculosis, and malaria [12]. They are also
essential in ensuring the long-term, sustainable growth of national health systems and the overall
health of country populations. Over the past few years, HSS has been viewed as a necessary
component of a comprehensive GHI approach to combating infectious disease. An understanding
of this principle has led the major GHIs to consider the place of health sector capacity building
from a strategic, policy, and funding perspective.
As previously noted, all four GHIs had already included HSS as a consideration for their funding.
(See Table 1, below, for some of the historical evolution of the concept.) However, there is no
general consensus definition of HSS among the different GHIs, although the WHO framework is
often referenced. In regard to Human Resources for Health (HRH), however, there is growing
consensus that HRH constitutes all areas of the health (direct, indirect) workforce as well as the
health workforce that is needed to work in WHO's other five elements of the heath system (e.g.
health managers, health policy analysts, health finance personnel, and HMIS personnel, among
other cadres).
Table 1: GHIs & Historical Emphasis on HSS
GAVI
GAVI since its inception (as expressed in its by-laws) has made HSS an integral and explicit component of its mission. In
addition, more recently, in an effort to promote sustainability, GAVI is implementing a new co-financing policy. The
results of a study commissioned by the GAVI alliance in 2004 showed that health system issues beyond the
immunization system alone constrained the majority of the developing partner countries trying to increase or maintain
high immunization coverage. The GAVI Alliance determined that overcoming some of these health system barriers was
a major priority for the initiative and that addressing them would improve access to other child and maternal health
services, thereby increasing synergy. 1 In 2006, the GAVI Alliance Board invested $500 million for HSS for the 2006 to
2010 period and issued and posted on-line HSS-specific guidelines. 2
Global Fund
The Global Fund began accepting separate proposals for HSS in 2005 during the Round 5 proposal session, although
disease-specific proposals could also include a HSS component if they met Global Fund criteria. In 2007, the Global Fund
Board made the decision to “encourage applicants, wherever possible, to integrate requests for funding for HSS actions
within the relevant disease components.”3 Proposals for Round 9, due in June of 2009, allow countries to apply for
funding necessary to overcome fundamental health system and human resource constraints to successful and sustained
scale-up of HIV, TB, and malaria interventions.4 This round will also fund portions of national health workforce
strategies.5 HSS activities, for which applicants may apply, can be tied to a particular disease or system-wide, crosscutting
activities that benefit not only a particular disease program but also a wide range of health priorities.6 Currently,
35% of the $4 billion of approved financing within the Global Fund is supporting key health systems elements.
Additionally, $186 million was approved in the Round 7 application process for cross-cutting HHS funding.7 A $290
million allotment for cross-cutting HHS funding was recommended during the Round 8 process.8 9
World Bank
WB IDA and MAP have as a premise “building systems and institutions to channel resources to affected communities and
bring public, private, nonprofit sectors together to delivery effective evidence based strategies and policies.” A focus on
HSS was initiated at the World Bank in 1999. 10 At that time the Bank developed a new strategy for responding to the
HIV/AIDS epidemic, with a focus on the African continent. 11 This strategy sought to create a flexible way to provide
resources quickly, both to governments and civil society, within sound strategic frameworks to begin implementing
national programs while strengthening institutions and accountability. 12 As of 2006 the World Bank MAP had
committed $534 million (approximately 41% of total funds) to systems strengthening and $223 million to the health
sector. 13
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