MAXIMIZING POSITIVE SYNERGIES - World Health Organization

NGOs and Civil Society
The overall perception was that GHIs, the Global Fund in particular, substantially improved the
participation of NGOs in the health system in CAR. Local and international NGOs were represented
in the CCM. Some local NGOs also served as secondary beneficiaries of funds, while others have
been involved in HIV information and education campaigns, mosquito net distributions, homebased
HIV-care and even TB care. GAVI also supported NGOs involved in vaccination campaigns.
While NGOs are hampered by the lack of financial and human resources, there was a perception
that partnership with governmental institutions allowed for training in areas where their capacity
is presently inadequate. Informants believed that NGOs played an important role in the system
and that their participation was a plus for the system. There was however a concern that some
NGOs would not be likely to be sustainable in the absence of GHI funds.
Service Delivery
Overall there were perceived improvements in all aspects of health care delivery and these were
not limited to HIV/AIDS, TB and malaria or vaccine-preventable diseases. There was also improved
public awareness about the target diseases. Testing and counselling for HIV was fuelled by the
sense that an HIV diagnosis was not fatal, owing to increased access to antiretroviral treatment
(ART). With the availability of GHI funding the price of drugs and laboratory assays has been
markedly reduced. Malaria treatment and insecticide-treated bed nets are free for children and
pregnant women. TB treatment is also free and there have been fewer interruptions in drug
supply. Drugs are also more widely distributed nationwide. GHIs have thus made a significant
impact in the numbers of patients receiving services.
Under GAVI more vaccines have been made available and supplemental vaccination campaigns
have been organized with the aim of “catching-up” vaccinations in children who may have missed
some regularly scheduled vaccines because of armed conflict.
Key informants did not have hard data on the impact of the GHIs on health outcomes per se.
Nevertheless there was an impression that there was reduced mortality and prolonged survival in
patients with HIV. It was not known however whether HIV prevalence was decreasing, as the
surveys that have been conducted used different methodologies. It was not clear what impact may
have been made on the frequency of high-risk behaviour. Although data specific to malaria were
also lacking, at least one informant felt that an observed reduction in infant mortality could be
due, in part, to better malaria care.
GAVI was perceived to have improved vaccine coverage and also to have increased the number of
diseases targeted in the expanded immunization program. Vaccines against Haemophilus influenza
b and Hepatitis B Virus were expected to be added with support from GAVI.
Cross-Cutting Themes
Some themes discussed by the informants did not fit into any of the aforementioned categories or
included multiple categories. One such area was the coordination and integration of GHIs within
the health system. Informants thought that while some aspects of GHIs were well integrated in the
system, others were not. GHIs are well coordinated at the central level of the MOH. Drug supply,
training and M&E also appear to be well integrated. Funds from GAVI in particular have been
involved in strengthening the health system and there was a belief that GAVI was well integrated
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