MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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Table 2 Global Health Initiative Investments (*) (*) Full data sources for all indicators are provided in Annex 1. Global Fund Round & Disease Priority Approved (in US$) Disbursed (in US$) Round 1, Malaria 6,406,659 6,242,698 Round 1, TB 91,118,721 66,174,166 Round 3, HIV/AIDS 302,919,984 92,033,746 Round 4, HIV/AIDS 63,742,277 56,475,863 Round 4, TB 56,140,000 51,096,518 Round 5, HIV/AIDS 28,902,073 19,934,233 Round 5, Malaria 38,522,396 26,117,213 Round 5, TB 49,453,178 28,039,132 Round 6, HIV/AIDS 5,812,876 5,164,504 Round 6, Malaria 7,047,932 6,686,758 Round 7, TB 5,313,263 1,104,382 Round 8, HIV/AIDS 19,916,552 0 Round 8, TB 28,561,014 0 TOTAL: 703,856,925 359,069,213 PEPFAR* Year Amount Allocated (in US$) 2004 4,000,000 2005 7,250,000 2006 9,250,000 2007 9,750,000 2008 9,959,500 TOTAL: 40,209,500 *Not a PEPFAR focus country; above sums represent total allocations to PEPFAR country programmes from bilateral U.S. sources including USAID, Department of Health and Human Services, Department of Labor, and Department of Defense. GAVI Disease Priority Amount Approved (in US$) Hepatitis B vaccine 21,953,000 Vaccine introduction grant 800,000 Injection Safety 15,925,729 TOTAL: 38,678,919 52
Context In 2007, the number of PLWHA was estimated by a joint mission by the Chinese Ministry of Health (MOH), UNAIDS and the WHO to be 700,000 (a range of 550,000-850,000) [8]. China is classed as having a concentrated epidemic with a low HIV prevalence, (around 0.05 to 0.08%, depending on data source) but high incidence rates among specific sub-populations. Indeed, 39% of reported HIV-positive cases have been transmitted through needle exchange by injecting drug users (IDUs), 19% through blood sales, 18% through heterosexual transmissions, and 1% through homosexual transmission. In total 70% of PLWHA are between 20-39 years old, and over 70% are male [9]. The epidemic mostly affects rural communities in the poorest provinces, especially in central China, the south-west and the east. This patterning of the HIV/AIDS epidemic in China has required the extension of social and financial assistance to these already economically vulnerable rural populations [9]. China has benefited from Global Fund support in rounds 3,4,5,6 and 8, with US$ 421 million approved and US$ 163 million disbursed (up to Round 6) for HIV/AIDS programmes. Most of the funding has been disbursed to rural and relatively poor counties that have been identified as needing special attention. Launched in 2003, mostly through the support of Global Fund Round 3, the China Comprehensive Aids Response (CARES) project has supported HIV/AIDS activities in a number of counties in the most affected provinces of China. Antiretroviral therapy (ART) has been extended and scale-up has been impressive: in December 2004, 8500 people were receiving ART; by October 2007, more than 31 000 people were being treated with ART including 805 children [9]. Different financial and economic support schemes have been set up, although these are not funded by the Global Fund or other GHIs. The only programme designed specifically for PLWHA is the “Four free services and one care” (si mian yi guan huai). This provides free treatment, free voluntary counselling and testing (VCT), free prevention of mother-to-child transmission (PMTCT), free schooling for AIDS orphans, and social relief for HIV patients. In addition, PLWHA and their households are also eligible to join local level social assistance schemes managed by the Civil Affairs Bureaux. These include the: “Five Guarantees” scheme, which provides a collective safetynet for the rural elderly, people with disabilities, and orphans without family caregivers; the Minimum Income Guarantee Scheme (Dibao); the Assistance for Extremely Poor Households (Tekun); and the Medical Financial Assistance (MFA) [10]. Objectives and Methodology The purpose of this study was to assess the extent to which the implementation of Global Fund financed programmes has contributed to increased coordination between different institutions at the local level, and whether this has led to improvements in access to social assistance schemes for PLWHA and their families. The survey took place between October 2006 and April 2007 in twelve counties within four provinces: Anhui, Henan, Yunnan and Guizhou. Anhui and Henan, in central China, are two of the provinces where most HIV infections were caused by the practice of blood selling. These provinces were targeted with money from the third round Global Fund grant. In Yunnan and Guizhou, in the south of the country, the main mode of HIV transmission is sharing needles and syringes amongst IDUs. Round 4 funding was used to support HIV/AIDS activities in a number of locations within these provinces. 53
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Table of Contents Key Acronyms Intr
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Policy analysis of the impact of Gl
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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 56 and 57: China: The Impact of the Global Fun
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
Page 106 and 107: 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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MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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