MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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References [1] The World Bank Group. Cameroon at a glance. Washington, DC, World Bank, 2008 (http://devdata.worldbank.org/AAG/cmr_aag.pdf; accessed 20 May 2009). [2] The World Bank Group. World Development Indicators (WDI) Online. [3] United Nations Development Programme. Human Development Reports: Cameroon. New York, UNDP, 2008 (http://hdrstats.undp.org/en/2008/countries/country_fact_sheets/cty_fs_CMR.html; accessed 20 May 2009). [4] World Health Organization. Cameroon Summary Country Profile for HIV/AIDS Treatment Scale- Up. Geneva, WHO, 2005 ( http://www.who.int/hiv/HIVCP_CMR.pdf; accessed 20 May 2009). [5] INS (Institut National de la Statistique) & ORC Macro. Demographic Health Survey in Cameroon [in French]. Calverton, Maryland, USA, 2004. [6] UNAIDS. 2008 Report on the global AIDS epidemic 2008. [7] World Health Organization. WHO Statistical Information System (WHOSIS). (http://www.who.int/whosis/en/). [8] World Health Organization. Global Tuberculosis Database. (http://www.who.int/globalatlas/dataQuery/default.asp). [9] World Health Organization. The World Health Report 2006. Working together for health. Geneva, WHO, 2006. [10] World Health Organization. Global Atlas of the Health Workforce 2008. Geneva, WHO, 2008. [11] Ministère de la Santé Publique, République du Cameroun. Guide national de prise en charge des personnes vivant avec le VIH/SIDA niveau hôpital de district. Yaoundé, Ministère de la Santé Publique, République du Cameroun, 2005. [12] World Health Organization. Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach (2003 revision). Geneva, WHO, 2004. 30
Cameroon: Impact of Global Health Initiatives on primary level health care facilities: Abstract The case of Kumba and Limbe Health Districts Peter M. Ndumbe, Julius Atashili 9 In the past five years, The Republic of Cameroon has received support from at least two GHIs: the Global Fund and GAVI. Although national data suggest an overall improvement of health service delivery and outcomes with these initiatives, it is not clear what their impact has been on peripheral primary level health facilities. We surveyed 18 health facilities in the Kumba and Limbe health districts in the South-West region of Cameroon. Overall, data collection and storage in these facilities was rudimentary, seriously hampering an exhaustive assessment of the impact of GHIs. Nevertheless, the limited available data suggest modest increases in human resources and not much improvement in the financing of these health facilities, the infrastructure, and selected indicator services such as referral services, tuberculosis care services and radiology services. Most peripheral facilities could identify specific immunization activities that were indirectly supported by GAVI. The impact of the Global Fund was mainly experienced in the regional (provincial) and district hospitals, in which there were improvements in the human resources, and facilities involved in tuberculosis and/or HIV care. Notwithstanding, these services still appeared insufficient, as district level data revealed a lower than expected vaccine coverage rate and low antiretroviral adherence rates. The assessment of the impact of GHIs in this milieu and their subsequent improvement will require a more rigorous monitoring and evaluation system at the peripheral level. Background Cameroon is bordered by the Federal Republic of Nigeria to the west; the Republic of Chad to the northeast; the Central African Republic to the east; and the Republic of Equatorial Guinea, Gabonese Republic, and the Republic of the Congo to the south. Cameroon ranked 150th out of 179 countries on the UN Human Development Index in 2006 [1]. The health system in Cameroon is organized at three levels: a central level including national administrative units in the Ministry of Health (MOH), along with referral hospitals, responsible for setting policy; an intermediary level, including regional delegations and regional programme coordinators, in charge of technical support to district-level programmes; and a peripheral level, which is composed of health areas grouped into health districts and is considered the operational level for the provision of primary health care services. 9 Faculty of Health Sciences, University of Buea / Centre for the Study and Control of Communicable Diseases, University of Yaounde I 31
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 34 and 35: Prevention behaviours Nearly half (
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
Page 86 and 87:
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
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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
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Peru: Effects of the Implementation
Page 142 and 143:
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
Page 184 and 185:
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
Page 210 and 211:
Objectives and Methodology This stu
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Nonetheless, efforts to recruit and
Page 214 and 215:
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
Page 224 and 225:
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
Page 246 and 247:
Annex 01: Data sources for tables i
Page 248 and 249:
Annex 02: Contributing Institutions
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