MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Central African Republic: Impact of Global Health Initiatives health systems: perceptions of informants Julius Atashili 1,2 , Marie-Claire Okomo 2 , Emilia Lyonga 2 , Nayana Dhavan 3 , Nikita Carney 3 , Erin Sullivan, 3 Peter Ndumbe 1,2 Abstract The Central African Republic (CAR) has received funds from GHIs targeting HIV, malaria, TB and vaccine-preventable diseases. We interviewed 18 informants involved in these GHIs. Overall, GHIs were thought to have positively impacted the governance, financing, monitoring and evaluation, workforce, infrastructure and technology and community participation in the health system. There was a perceived improvement in access to prevention and care of targeted diseases with multiple treatments or vaccines being made free. GHIs also fostered decentralization of services, promoting greater equity of access. Nevertheless, there was still room to improve the impact of GHIs. Informants thought that GHIs should focus on reinforcing the health system, not just targeted diseases. In the grant allocation procedures, consideration should be given to country needs and not limited to the quality of proposals. More funding is needed for training, recruitment of human resources and infrastructure. There was also a perceived need for better incentives and salaries for health care workers and concern about the sustainability of the programs initiated with GHI funding. Background The Central African Republic (CAR) is a landlocked country in Central Africa. Bordered by Chad in the north, Sudan in the east, the Republic of the Congo and the Democratic Republic of the Congo in the south, and Cameroon in the west, the CAR is home to 4.3 million people. Its population has grown at an average rate of 1.7% since 2001 [1]. The CAR ranked 171 st out of 177 countries on the UN Human Development Index in 2005[2]. Most of the population has limited access to basic health services. In 2008, 76% of the population lived more than 10km from the nearest health centre [3]. Malaria remains the leading cause of premature death in the CAR. The entire population is at risk of malaria, with an estimated 4268 malaria deaths in 2006 [4]. The HIV epidemic in the CAR is widespread and generalized and has been steadily growing since the first AIDS case was reported in the early 1980s [5] In 2007, 160 000 people were living with HIV/AIDS [6]. The infant mortality rate in the CAR was 114 per 1000 live births in 2006; the maternal mortality rate was 980 per 100 000 live births in 2005 [7]. WHO estimated that incidence of smear-positive pulmonary TB in the CAR was 149 per 100 000 in 2006 [8]. Of all new cases, 18% occurred in HIV-positive individuals, and 1.1% were multi-drug resistant (MDR-TB) [8]. 40
Table 1 Basic Socioeconomic, Demographic, and Health Indicators* *Full data sources for all indicators are provided in Annex 1 Indicator Value Year Source Population (thousands) 4,343 2007 World Bank Geographic Size (sq. km) 623,000 2007 World Bank GDP per capita, PPP (constant 2005 international $) 673.66 2007 World Bank Gini index 43.57 2003 World Bank Government expenditure on health (% general government expenditure) 10.893 2007 WHO NHA Per capita government expenditure on health (current US$) 6 2007 WHO NHA Physician density (per 10,000)
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 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 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
Page 88 and 89: Much of the initial enthusiasm abou
Page 90 and 91: services, or for measures of qualit
Page 92 and 93: funds and more funding focused on i
Page 94 and 95: 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
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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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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
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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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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
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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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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
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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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