MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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References [1] China at a glance. World Bank, 2005 (http://www.worldbank.org.cn/English/Content/chn_aag02.pdf; accessed 20 March 2009). [2] Human Development Reports: China 2008 Statistical Update. New York, United Nations Development Programme, 2008 (http://hdrstats.undp.org/en/2008/countries/country_fact_sheets/cty_fs_CHN.html; accessed 20 March 2009). [3] Country Cooperation Strategy at a glance: China. Geneva, World Health Organization, 2008 (http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_china_en.pdf; accessed 20 March 2009). [4] World Health Statistics 2009 (http://www.who.int/whosis/en/). [5] World Development Indicators 2007. Washington DC, The World Bank, 2007 (Proprietary online database: http://ddp-ext.worldbank.org.ezpprod1.hul.harvard.edu/ext/DDPQQ/member.do?method=getMembers; accessed 20 March 2009). [6] China National Health Account. Geneva, World Health Organization, 2009 (http://www.who.int/nha/country/chn.pdf; accessed 20 March 2009). [7] Epidemiological Fact Sheet on HIV and AIDS: Core data on epidemiology and response, China 2008 Update. Geneva, UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2008 (http://www.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_CN.pdf; accessed 20 March 2009). [8] 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing, Ministry of Health, People’s Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization, 2006 (http://data.unaids.org/publications/External- Documents/rp_2005chinaestimation_25jan06_en.pdf; accessed 20 March 2009). [9] UNGASS Country Progress Report, P.R. China, January 2006-December 2007. State Council AIDS Working Committee Office, United Nations Theme Group on AIDS, 2008 (http://data.unaids.org/pub/Report/2008/china_2008_country_progress_report_en.pdf; accessed 20 March 2009). [10] Xu Y, Zhang X, Zhu X. Medical Finance Assistance in Rural China: Policy Design and Implementation. Studies in HSO&P, 2008, 23:295-317. 58
Georgia: System-wide Effects of the Global Fund on Georgia’s Health Care Systems Abstract Ketevan Chkhatarashvili, George Gotsadze, Natia Rukhadze ∗ This study assesses the effects of the Global Fund on the health system in Georgia, focusing on the policy environment, public-private interactions, human resources and access to HIV/AIDS services. The Global Fund is the largest GHI in Georgia and has disbursed over US$ 26 million over six rounds of funding. These grants contributed to approximately 2.8% of total health expenditure in the country. Global Fund resources have led to more HIV/AIDS preventative, diagnostic, curative and care services, and currently antiretroviral therapy (ART) is available to all people known to require treatment. Grants have also been used to develop the capacity of government and nongovernmental health providers and include addressing issues of stigma and marginalization. Stigma, however, continues to be a barrier for HIV patients when they access general health services. Funding for HIV/AIDS has enabled the government to move national resources away from this area and increase spending on other healthcare priorities. As a consequence, HIV/AIDS service providers have become significantly dependant on GHI funding, threatening their sustainability when the funding ends. In light of ongoing reforms towards complete privatization of primary and hospital care, it is not clear how HIV/AIDS services that are supported by GHIs will be integrated in Georgia’s private health care system. Background Located in the Caucasus region between Europe and Asia, Georgia is bordered by the Russian Federation to the north, Azerbaijan to the east, Armenia to the south, and Turkey to the southwest. Georgia ranked 93 rd out of 179 countries on the UN Human Development Index in 2006 [1]. The country has experienced rapid growth in real GDP, but the war over South Ossetia (in 2008) caused significant damage to the economy, and Georgia is now faced with rising poverty in the rural areas, a lack of employment opportunities, and poor infant and maternal health [2]. There are a number of financial and geographic barriers to accessing health care in Georgia. Prior to emerging as an independent state amidst the Soviet Union’s collapse in 1991, 4.5% of GDP was spent on health. The estimated public health spending was around US$ 500 per capita. The fiscal crisis of the transition in the early 1990s hit the health sector particularly hard, and by 1994, government expenditure on health declined to around US$ 0.8 per capita (0.3% of GDP) [3]. From ∗ All authors are affiliated with the Curatio International Foundation. 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). 59
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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
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core section of the document then p
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Figure 1: Analytic framework for MP
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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 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 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 104 and 105: Background The Republic of Kenya li
Page 106 and 107: Results Leadership and Governance D
Page 108 and 109: Informants noted that a general lac
Page 110 and 111: 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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References [1] The World Bank Group
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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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References [1] The World Bank Group
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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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