MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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PEPFAR I & II The newest PEPFAR legislation has committed to invest resources that would allow partner countries to provide both health workforce training and capacity-building. 14 The legislation has a stated priority to increase training and retention of health care professionals, paraprofessionals and community health workers. In-service and pre-service training of 140,000 new health care professionals and paraprofessionals with an emphasis on training and in country deployment of doctors and nurses is a first time commitment in the new legislation. The amount of funding PEPFAR country teams could use to support long-term pre-service training increased to $6 million or 3%. 15 As stated above, under PEPFAR II, HSS including “task-shifting,” has taken on a heightened priority and is an explicit goal of the initiative. 16 Finally, PEPFAR II calls for stronger collaboration with other donors, including GFAMT, WHO, WB, and UNAIDS, review of policies that may be obstacles to HSS, and activities that “complement” other donors and other programs from the U.S., such as MCH programs. 17 1 The GAVI Alliance. (2008). Health System Strengthening. Information retrieved on March 17, 2009 from: http://www.gavialliance.org/resources/6_HSS_overview_EN.pdf 2 Idem 3 The Global Fund. (2009). Information retrieved on March 17, 2009 from: http://www.theglobalfund.org/en/fundingdecisions/ 4 The Global Fund. (2009). Clinic 1F: Capacity Development: Using Global Fund Grants to Strengthen Health Systems. Information retrieved on March 17, 2009 from: http://www.theglobalfund.org/documents/partnershipforum/2008/presentations/0812/C1/5PM/HSS%20and%20CSS%2 0vf-short%208-12-2008.ppt#256,1,Clinic 1F Capacity Development: Using Global Fund grants to strengthen health systems 5 The TPR Terms of Reference list as a sustainability and impact criteria for proposals the demonstration of how they will contribute to strengthening the national health system in its different components (human resources, service delivery, infrastructure, procurement, and supply management). 6 Physicians for Human Rights. (2009). Toolkit for Using Round 9 of the Global Fund for Health Systems Strengthening. Information retrieved on March 17, 2009 from: http://physiciansforhumanrights.org/hiv-aids/globalfund_round9.html 7 Idem 8 Idem 9 Physicians for Human Rights. (2009). Toolkit for Using Round 9 of the Global Fund for Health Systems Strengthening. Information retrieved on March 17, 2009 from: http://physiciansforhumanrights.org/hiv-aids/globalfund_round9.html 10 The World Bank MAP. (2009). Overview. Information retrieved on March 17, 2009 from: http://siteresources.worldbank.org/EXTAFRREGTOPHIVAIDS/Resources/717147-1181768523896/overview.pdf 11 World Bank, IDA at work: Health – Supporting Systemic Change in a New Global Context, March 2007 12 The World Bank MAP. (2009). Overview. Information retrieved on March 17, 2009 from: http://siteresources.worldbank.org/EXTAFRREGTOPHIVAIDS/Resources/717147-1181768523896/overview.pdf 13 Idem 14 The President’s Emergency Plan for AIDS Relief. Information retrieved on March 17, 2009 from: http://www.pepfar.gov/documents/organization/105844.pdf 15 The U.S. President’s Emergency Plan for AIDS Relief. Information retrieved on March 16, 2009 from: http://www.pepfar.gov/press/fifth_annual_report/113720.htm 16 HR 5501, Pub L 110-293 17 Idem 222
Objectives and Methods In order to produce this policy analysis, the general approach adopted was qualitative. As such, GW researchers relied on a combination of documentary reviews and interviews with key informants from the four GHIs included in this study as well as individuals knowledgeable about the GHIs studied. Our main questions guiding the analysis were: • What are the policies that guide the operations of each GHI and what are some of the common and different traits shared by the four GHIs in this respect? • What do these policies indicate about funding priorities related to HRH, one of the six health system elements identified by WHO? A typology was developed to guide the systematic analysis and extraction of language from official GHI documents (e.g. laws, policies, guidances) and from a select number of country applications (see Table 3, which displays the countries included for analysis for each GHI, which are a subset of the MPS country case studies). Key domains of the typology were: 1) Education – preservice, in-service, general workforce capacity strengthening, producing different types of health workers; 2) Financial incentives – salary payment, top-ups, rural allowances, pay-for-performance, general recruitment support; 3) Management – general improvements in infrastructure, training of health managers, support for continuous professional developments, career paths. These domains were examined for three types of health workforce – providers who are involved in direct clinical care, providers who are involved in indirect clinical care, and workers who are non-clinical but support the health system in some capacity (e.g. health managers, health planners). Collection of all of the documents publicly available on the websites of each GHI, including country applications, as well as other relevant publications from think tanks and other organizations, occurred over a 1.5 month period and analysis of these documents took place over the following 2.5 month period. While the documentary review was underway, key informant interviews were conducted in person or by telephone. At least one representative from each GHI agreed to participate in the interviews, but in one case we were unable to secure a date and time due to the need to reschedule multiple times. Because key informants were assured confidentiality, the information gathered is not directly quoted or attributed and was strictly used to complement the document reviews in developing the policy analysis. All of the language found in GHI official documents and country applications was extracted and inputted in tables for easier reference and comparison (see Table 4 for several of these tables). The George Washington University Institutional Review Board (GWU IRB) determined this study to be exempt research under #010924. Results GHIs differed in how extensive their official, written guidance was to country applicants, but GHI documents, informants, and country applications highlighted the inherent flexibility that exists around the use of funding for health system-related activities, including interventions pertaining to the health workforce. Guidance is generally, and not surprisingly, worded quite broadly and can be interpreted to encompass many different aspects of strengthening the workforce in a given country. It also varied in what aspect of HRH was emphasized. This section summarizes key findings in three key areas: 1) types of fundable HRH interventions; 2) types of fundable health workers; 3) comparison of approved country applications and GHI guidance. 223
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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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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
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Senegal: The effects of Global Heal
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Table 1: Basic Health System and Ep
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case study. Data analysis was condu
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of respondents aware of treated net
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South Africa: The effects of Global
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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 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 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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