MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Global Fund In two country applications out of a total of three reviewed, Global Fund funded in-service training for, among other types of cadres, <strong>Health</strong> Surveillance Assistants (HSAs) and community nurses (Malawi), and health professionals (Rwanda). <strong>World</strong> Bank MAP In one country programme documentation out of a total of one reviewed, WB MAP funded inservice training for, among other types of cadres, public sector employees in planning, management and monitoring (Rwanda). PEPFAR I In seven Country Operational Plans (COP) out of a total of eight reviewed, PEPFAR funded inservice training for, among other types of cadres, medical doctors, nurses, nurse midwives, laboratorians, TBA, ANC providers and Ob/Gyn (Ethiopia), TBA, midwives, doctors, counselors, laboratory staff, and pharmacists (Cambodia), health care workers, doctors, nurses, midwives, others such as clinical officers, and public health officers (Kenya), Prevention of Mother to Child Transmission (PMTCT) providers, MCH workers, HSAs, nurses, clinicians, lab technicians, and midwives (Malawi), Antenatal Care (ANC)/PMTCT staff, teaching faculty, Tecnicos de Medicina, and MCH nurses (Mozambique), health care providers, pediatricians, doctors, nurses, social workers, HIV case managers, and nutritionists (Rwanda), and health workers to provide PMTCT (Sudan). Discussion Based on the review of documents and discussions with key informants, we conclude that GHI written guidance generally exhibits flexibility for country-level funding in the area of human resources for health. However, the guidance in some instances is very broad - so much so as to create uncertainty regarding what kinds of interventions might be permissible. GHIs also communicate expectations beyond the written word via internal communications, site visits, technical fora and other mechanisms, which vary by GHI and presumably in effectiveness. One aspect that we were not able to probe was how countries, particularly those whose country applications were reviewed, perceived the written and oral expectations from each funder. In addition, several key themes started to emerge, which are summarized below. Defining health systems strengthening The four GHIs had a varied sense of what HSS means and often referenced the WHO framework and its six components in describing their initiatives. Consensus also emerged that it is a useful framework to begin the discussion but that it is much less practical for countries when they seek funding or for each GHI when they need to issue their own guidance. 226
Clarity of GHI policies/guidelines/guidance for funding The four GHIs provide different kinds of flexibilities, and also communicate their expectations, in ways that may not be clear to host countries. Countries may benefit from more explicit guidance on the range of issues for which they may request funds from each GHI. The proper balance must be found between each GHI's mission, goals and overarching operating model, and the need to provide countries with clarity on funding options for supporting health systems. Some GHIs stressed the importance of being more explicit with countries, arguing it did not detract from the GHI’s basic mission and purpose. HRH as a barrier to successful implementation of programmes The four GHIs recognize that the lack of sufficient HRH in countries constitutes a severe limitation to achieving their policy goal and consequently are each pursuing initiatives to scale up HRH in a number of countries. They also pursue these initiatives independently of each other in order to address their own objectives. These separate approaches have resulted in duplication of GHIfunded efforts at country and local levels or in inadequate alignment with national and local priorities for the health system. While this study focused on the problem of HRH supply, distribution, and capacity strengthening, other issues related to HRH and systems, e.g. the need to beef up infrastructures, were also highlighted in interviews and country applications. The effect of the global economic crisis on GHIs The four GHIs are reportedly committed to their mission and purpose but also acutely aware of the current reality of the financial markets and the effect this may have on the availability and certainty of acquiring funds. They also acknowledge the importance of continuing to emphasize HSS alongside disease-specific approaches. Conclusion In conclusion, GHI support for HSS can be communicated and coordinated more effectively, while taking into account each GHI’s specific structure and political context, the types of flexibility each GHI grants countries seeking funds for HSS (either separately or as part of a disease-focused plan), and the degree to which GHI-funded programmes are harmonized and aligned with national and local priorities. What is not well known other than anecdotally is how country officials applying for funding perceive and understand the current way GHI funding operates and how they would respond to improved communication and coordination, particularly within their own political and legal framework. More research needs to be conducted to answer this key question. 227
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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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of South Africa (GHI2, ND6). 26 Don
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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 228 and 229: PEPFAR I & II The newest PEPFAR leg
Page 230 and 231: Types of fundable HRH interventions
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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