MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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China: The Impact of the Global Fund HIV/AIDS Programmes on Coordination and Coverage of Financial Assistance Schemes for People Living with HIV/AIDS and their Families Abstract: Zhang Xiulan, Pierre Miège and Zhang Yurong 10 This study assesses the impact of the implementation of Global Fund financed programmes on coordination between different institutions at the local level, as well as on the distribution of social assistance schemes for people living with HIV/AIDS (PLWHA) and their families. It is based on a large household survey (involving 1120 households and 4850 people) and in-depth interviews with local public health leaders, conducted in 12 counties within four provinces (Anhui, Henan, Yunnan and Guizhou) between October 2006 and April 2007. Analysis of these qualitative data shows that Global Fund programmes contribute to improved coordination at the local level because they are implemented through the leadership of the local Centers for Disease Control (CDCs). The CDCs successfully coordinate the actions and programmes of the diversity of actors involved in HIV/AIDS prevention and treatment. Household interviews reveal that counties receiving (round 3 or 4) Global Fund monies benefit from improved access to treatment and better coverage by the different financial support programmes. Consequently, PLWHA and their families report lower economic pressure and better integration within the community. These findings therefore point to better coordination between the Public Health Bureaux,, which register patients and insure access to treatment, and Civil Affairs Bureaux in charge of the distribution of social assistance to PLWHA. Background The world’s most populous country, China is home to 1.32 billion people and averaged a 0.6% population growth rate between 2001 and 2007 [1]. The country ranked 81 st out of 177 countries on the UN Human Development Index in 2005 [2]. The richest 10% held 34.9% of the country’s income in 2004 [2]. China now has the world’s fastest-growing economy and is undergoing what has been described as a ‘second industrial revolution.’ The economy averaged a real gross domestic product (GDP) growth rate of 9.5% between 1997 and 2007. However, corresponding progress on the country’s social indicators has lagged behind [1]. The economic disparity between 10School of Social Development and Public Policy, Beijing Normal University Acknowledgement: The research for this study summary was funded by The Alliance for Health Policy and Systems Research, based at the World Health Organization. The study summary was produced with the support of the GHIN Network (www.ghinet.org). 50
urban China and the rural hinterlands, industrial expansion, and rising incomes, have accelerated migration from the rural areas to the country’s eastern cities. Disease burden has largely shifted from communicable to non-communicable diseases and injuries [3]. This transition, in combination with decreasing birth rates and an increasingly elderly population, has created new challenges for the health system. In addition, the outbreak of severe acute respiratory syndrome (SARS) in southern China in 2003 cost an estimated US$ 11 billion globally and challenged the Chinese government to strengthen its approach to public health [4]. Most low-income households in China face significant financial and other barriers to essential health services and medicines. In 2004, an estimated 85% of the population lacked health insurance and out-of-pocket payments constituted the majority of growing health expenditure [4]. In 2008, up to 30% of poor people in China stated that health is the single most important cause of their poverty [5]. The new Rural Cooperative Medical Scheme (RCMS) aimed to achieve 100% coverage by the end of 2008. However, benefits are limited to catastrophic illness and inpatient medical services, pre-payment is frequently required, and reimbursement is low [5]. The public sector’s share of overall health expenditures has steadily gone down in terms of real GDP [4]. A large portion of the Chinese population seeks out traditional Chinese medicine (TCM), while the government has promoted the development of a modern TCM industry [5]. China is one of the few countries where doctors outnumber nurses, but many experienced health professions have moved to hospitals or clinics in the cities [5]. Official Development Assistance (ODA) to China was US$ 1.25 billion in 2006 [6]. The country’s total external debt was US$ 322.85 billion or 12.1% of GDP [1, 6]. Since 2003, the Global Fund has approved US$ 482.5 million in funding for China and has disbursed US$ 313.1 million to date. Two grants, one for HIV/AIDS and one for TB, have been approved, but are still awaiting funding [7]. 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) 1,304,500 2007 World Bank Geographic Size (sq. km) 9,327,488 2007 World Bank GDP per capita, PPP (constant 2005 international $) 5,045.64 2007 World Bank Gini index 46.9 2004 World Bank Government expenditure on health (% general government expenditure) 10.3 2007 WHO NHA Per capita government expenditure on health at average exchange rate (current US$) 51 2007 WHO NHA Physician density (per 10,000) 14 2003 WHO SIS Nursing and midwifery density (per 10,000) 10 2003 WHO SIS Maternal mortality ratio (per 100,000 live births) 45 2005 WHO SIS DTP3 coverage (%) 93 2007 WHO SIS Estimated adult HIV (15-49) prevalence (%) 0.1 (
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Table of Contents Key Acronyms Intr
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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 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 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
Page 96 and 97: PEPFAR* Year Amount Disbursed (in U
Page 98 and 99: Primary data collection - facility
Page 100 and 101: The Global Fund has strengthened th
Page 102 and 103: 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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References [1] The World Bank Group
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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
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Annex 02: Contributing Institutions
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