MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Objectives and methodology
Our objectives were to assess the impact of the Global Fund and GAVI in primary health care
facilities in the Limbe and Kumba Health Districts in Cameroon.
The study was exempt from ethical review as not involving human subjects and not involving the
use of identifiable patient information.
Trained research assistants visited 18 health facilities serving the populations of the Kumba and
Limbe Health Districts. In each health district, the health centres surveyed were conveniently
sampled to reflect the urban versus rural make-up of health areas as well as to include facilities run
by both the government and non-governmental organizations. We also surveyed the two district
hospitals (first level referral) and regional hospital (second level referral) serving these two districts.
The facility data abstraction form developed for Maximizing Positive Synergies (MPS) was used in
this study. In each facility we abstracted data on financing, personnel, infrastructure and health
outcomes, as much as available. Available personnel were also queried for non-recorded data,
particularly for preceding years.
We surveyed 18 facilities spread over 16 health areas in both health districts. The overall
population covered in both districts was estimated at 428 991 inhabitants. The majority (12) of
these facilities were government run, with others being run by religious institutions (4) and
parastatal companies (2).
Results
Financing
Budget lines for funds from either GAVI or the Global Fund were not reported by all facilities.
Funding for these GHIs was managed at the intermediate and central levels of the health system,
the peripheral facilities being focused on implementation. Because the funds from these GHIs are
pooled with funds from other sources (such as the government and other bilateral and multilateral
donors) in the central/intermediate levels before dissemination to peripheral levels, it was difficult
for managers at peripheral health facilities to estimate the proportion of funding received from
each GHI. Most managers, however, acknowledged receiving support in the form of free vaccines,
materials for safe injections and cold chain, first-line treatment for tuberculosis, malaria, HIV and
opportunistic infections, as well as reagents for laboratory diagnosis.
Amongst the facilities that could estimate the proportion of different funding sources, there was a
trend towards a lesser proportion of funding from both the MOH and out-of-pocket spending. The
number reporting full funding from the MOH reduced, while the number with less than 50% of
funding from the MOH increased. Concurrently, the number of facilities with less than 50% out-ofpocket
funding increased in the last five years.
Health Workforce
The greatest change in the health system appears to have been the increase in the number of
health care personnel. The total number of human resources increased in half the facilities
surveyed. This increase was mainly driven by both the number of doctors and pharmacy assistants
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