MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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understanding of their roles and responsibilities since the time of the baseline survey, as well as a better knowledge of the health system and ongoing reforms. Financing Other effects of Global Fund financing on the health system are mixed. For example, while support from the Global Fund for TB services is in line with Georgian government priorities to integrate vertical programmes at the primary care level, this is less true for HIV/AIDS and malaria interventions, as both are vertical in nature. In light of ongoing reforms towards complete privatization of primary and hospital care, it is not clear how vertical programmes will be integrated into Georgia’s private health care system. Many stakeholders perceive Global Fund monies as reinforcing vertical tendencies. 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 2, HIV/AIDS 32,855,709 12,111,223 Round 3, Malaria 806,300 806,300 Round 4, TB 5,536,965 4,245,476 Round 6, HIV/AIDS 6,130,724 2,763,821 Round 6, Malaria 1,587,960 1,587,960 Round 6, TB 9,314,136 9,314,136 TOTAL: 56,231,794 30,828,916 PEPFAR* Year Amount Allocated (in US$) 2006 1,689,480 2007 1,520,000 2008 961,130 TOTAL: 4,170,610 *Not a PEPFAR focus country; above sums represent total allocations to PEPFAR country programmes from bilateral U.S. sources including USAID, Department of Health and Human Services, Department of Labor, and Department of Defense. GAVI Disease Priority Amount Approved (in US$) Hepatitis B vaccine 705,000 Vaccine introduction grant 100,000 Injection Safety 65,600 Immunization services 135,500 support Health systems strengthening 435,500 TOTAL: 1,441,398 62
Global Fund resources have had dual effects on public financing for health care. On one hand, these funds have allowed the government to move national, fiscal resources away from HIV/AIDS, TB and malaria and to increase spending levels on other healthcare priorities. For example, from 2001 to 2006 public expenditure on health grew on average by 23% annually, taking into account inflation. However, allocations increased only marginally for TB and malaria and declined for HIV/AIDS. Expectations that the government would increase allocations for target diseases have not been met in Georgia; hence, service provision for target diseases is significantly dependant on the Global Fund. This has raised concerns among stakeholders, as it could threaten the sustainability of service provision after funding ends. The issue has been further aggravated by increases in service availability, which have helped preventive, curative and care services to reach more individuals, but have also significantly increased recurrent cost requirements for HIV/AIDS, TB and malaria. If these diseases are not controlled, recurrent cost requirements will grow and consequently will aggravate funding shortages currently observed. Most key stakeholders interviewed expressed concerns regarding the sustainability of services in the long-term. They were of the view that in the medium to longterm it is unlikely that the government will be able to fully replace Global Fund monies with internal fiscal resources. Policymakers at the national level were particularly concerned that the Global Fund work with the government to develop gradual exit strategies spanning 10-15 years - strategies which would take into account both changes in the epidemic and in the economic situation. In Georgia, Global Fund grants contributed about 2.8% of total health expenditure, which is relatively low compared with sub-Saharan Africa. Health Workforce The study also shows that training funded by the Global Fund grants has helped develop the capacity of health providers in both the private and public sectors, including addressing issues of stigma and marginalization. Between the first phase of the study and the second, findings suggested that health providers’ attitudes towards patients had become more positive: health providers were less afraid of the target diseases and expressed greater readiness to render the necessary care and treatment. Medical Products, Vaccines, and Technologies The impact of Global Fund financing was significant in generating positive results for individuals suffering with target diseases: funds helped to supply necessary diagnostic tests and drugs, and as a result, ART is available to all who require treatment. Community/Civil Society However, while patients with target diseases have benefited from free services, largely funded by the Global Fund, their access to general health services remains limited, and interviewees said they often face stigma and confidentiality problems when they use general health services. The study suggests that Global Fund financing also played a significant role in creating social networks of patients suffering from target diseases. This has facilitated people living with HIV/AIDS (PLWHA) being able to meet and exchange information, better understand their health and social problems and to become more open about their status. 63
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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
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Burundi: Building a health system t
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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 64 and 65: References [1] China at a glance. W
Page 66 and 67: 1994, private spending and emergenc
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
Page 114 and 115: A comprehensive, long-term reform o
Page 116 and 117: 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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