MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Prevention behaviours Nearly half (48%) of the HIV patients were living in a couple (defined as marriage or free union and sharing or not the same home) and 45% reported sexual activity during the previous 3 months. Among these patients, 89% declared one main sexual partner and 11% several partners. Regarding unsafe sexual behaviours with the main partner, among the 907 patients who had sexual intercourse during the three months prior to the study with a main partner of seronegative or unknown HIV status, 35% reported not systematically using condoms. Analysis showed that patients receiving ART were two times less likely to report inconsistent condom use than nontreated patients. This may be partly due to the fact that ART-treated patients had better information on prevention strategies as messages of this type are essentially given at the time of diagnosis and at initiation of therapy. These results have important public health implications in terms of secondary prevention. They are confirmed in the female population that represents the majority of PLWHA in Cameroon. Discussion Data suggest that the recovery of health due to ART has opened up new life perspectives for PLWHA. The independent evaluation of the national ART programme confirmed the feasibility of decentralisation in Cameroon: ART-delivery centres based in decentralized district hospitals present similar and sometimes better performance than referral centres. Closer proximity of district hospitals facilitates patients’ adherence to treatment, improvement of their psychological well-being, and earlier access to treatment after HIV diagnosis. Quality of care issues and patients’ dissatisfaction seem to be more prominent at higher levels of the health delivery pyramid because of the higher number of patients attending provincial and central hospitals and the higher workloads of their health care staff. These results highlight the necessity to adapt medical resources to the needs in order to anticipate possible bottlenecks in HIV departments which could limit access to care at any level of the health delivery pyramid. In addition, the evaluation revealed the presence of several barriers which can have an impact on the quality of care: • The difficulties of supply of ARV drugs and reagent for CD4 exams may result in shortages of stock which may have a negative impact on treatment adherence. • Lack of highly qualified medical staff, in particular physicians and social workers, is associated with lower immunological improvements, lower adherence and a poorer quality of life for patients. An insufficient number of physicians also limits access to care, contributes to delays in starting up ARV treatment and undermines equity. • Finally, lack of motivation among the medical staff (possibly associated with precariousness of their employment status, weakness of salaries and high workload) can also influence health care quality, although the impact of this phenomenon could not be quantified. This underlines the urgency to strengthen health services and to set up human resources strategies adapted to the needs, in order to maximize the efficiency of decentralization. Efforts 28
must also involve a better distribution of tasks among staff, in particular in the medical follow-up of patients, and a revalorization of medical and paramedical professions. Despite the policy of free ARVs introduced in May 2007, financial difficulties in access to care have not been solved. While decentralization of HIV care reduced the risk of catastrophic health care expenditures for PLWHA, in the EVAL sample about a quarter of the ART-treated patients still face catastrophic health care expenditures. The sustainability of the free ARV drugs policy at the point of delivery and its potential extension to other components of HIV/AIDS services are needed more than ever in Cameroon and will necessarily imply the improvement of tax-based funding, and/or health insurance risk pooling mechanisms, as well as the allocation of a greater share of public resources to the health system. 29
Page 2 and 3: Table of Contents Key Acronyms Intr
Page 4 and 5: Policy analysis of the impact of Gl
Page 6 and 7: OIs Opportunistic infections OVC Or
Page 8 and 9: core section of the document then p
Page 10 and 11: Figure 1: Analytic framework for MP
Page 12 and 13: studies. MPS researchers have linke
Page 14 and 15: Burundi: Building a health system t
Page 16 and 17: at between US$ 14.5 and US$ 18.5 pe
Page 18 and 19: collaborations with European school
Page 20 and 21: epresent only US$ 1.75 per month pe
Page 22 and 23: Service Delivery The decentralizati
Page 24 and 25: Long term HSS will require governme
Page 26 and 27: Cameroon: Evaluation of the Nationa
Page 28 and 29: Table 1 Basic Socioeconomic, Demogr
Page 30 and 31: of treatment interruptions (>two da
Page 32 and 33: side effects) were associated with
Page 36 and 37: References [1] The World Bank Group
Page 38 and 39: Out-of-pocket payments account for
Page 40 and 41: as well as the number of community
Page 42 and 43: Table 1: Characteristics of facilit
Page 44 and 45: Table 4: Estimated changes in human
Page 46 and 47: Central African Republic: Impact of
Page 48 and 49: Objectives and Methodology In this
Page 50 and 51: Financing There was a general appre
Page 52 and 53: NGOs and Civil Society The overall
Page 54 and 55: Discussion Interviews with key info
Page 56 and 57: China: The Impact of the Global Fun
Page 58 and 59: Table 2 Global Health Initiative In
Page 60 and 61: In Yunnan and Henan, the epidemic i
Page 62 and 63: funded only from the MOH Pilot Prog
Page 64 and 65: References [1] China at a glance. W
Page 66 and 67: 1994, private spending and emergenc
Page 68 and 69: understanding of their roles and re
Page 70 and 71: References [1] Human Development Re
Page 72 and 73: In 2003, the government launched th
Page 74 and 75: Objectives and Methodology The data
Page 76 and 77: Health Workforce Ghana is challenge
Page 78 and 79: Discussion GHIs are critical for ra
Page 80 and 81: Haiti: Maximizing Positive Synergie
Page 82 and 83: Table 1 Basic Socioeconomic, Demogr
Page 84 and 85:
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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References [1] The World Bank Group
Page 104 and 105:
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
Page 112 and 113:
Page 114 and 115:
A comprehensive, long-term reform o
Page 116 and 117:
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
Page 140 and 141:
Peru: Effects of the Implementation
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Table 2 Global Health Initiative In
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HIV/AIDS, mainly around the Compreh
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without substantial emphasis on pre
Page 148 and 149:
Page 150 and 151:
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
Page 164 and 165:
Some informants felt that local NGO
Page 166 and 167:
Senegal: The effects of Global Heal
Page 168 and 169:
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
Page 176 and 177:
Table 2 Global Health Initiative In
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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
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Despite these problems, GHI funding
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[19] The Global Fund for Aids Tuber
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Official Development Assistance (OD
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The study employed both purposive s
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Figure 1: Number of Clinicians at S
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There were very significant increas
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GHIs created an opportunity to cond
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Ukraine: Effects of the Global Fund
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GAVI (in US$) Disease Priority Amou
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government and nongovernmental prov
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• The introduction of new service
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References [1] Data are from the Mi
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The health system struggles with a
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Objectives and Methodology This stu
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Nonetheless, efforts to recruit and
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Page 216 and 217:
average annual population growth of
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2006 149,022,153 2007 216,012,780 2
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isks duplication of services but al
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centres have only one qualified hea
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Policy analysis of the impact of Gl
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countries” [6]. The TRP apply sev
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PEPFAR I & II The newest PEPFAR leg
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Types of fundable HRH interventions
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Global Fund In two country applicat
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TABLE 3: Selected Countries: MPS Ca
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HRH Intervention Categories GAVI: C
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HRH Intervention Categories GLOBAL
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HRH Intervention Categories PEPFAR
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Conclusion: Directions for future r
Page 244 and 245:
GHIs and health systems. Civil soci
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Annex 01: Data sources for tables i
Page 248 and 249:
Annex 02: Contributing Institutions
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MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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