MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Introduction: The Maximizing Positive Synergies
project and the purpose of this document
Over the last decade, Global Health Initiatives (GHIs) have mobilized substantial new resources for
health action in many low- and middle-income countries. The expansion of key services,
particularly the provision of HIV/AIDS treatment, has been striking, and millions of people have
benefited. But the scale-up of selected services by GHIs has placed new demands on national
health systems, revealed weaknesses in those systems, and rekindled debates on how countries
can best combine disease-specific programmes with broader agendas to improve the health of
their people.
Addressing knowledge gaps—at a critical time
In July 2009, policymakers of the G8 nations gathering in Italy will review policy and funding
priorities for global health at a critical moment. As the 2015 target date of the Millennium
Development Goals (MDGs) approaches, the global economic crisis threatens to slow recent health
gains and inflict its harshest effects on the world’s poorest countries and people – the very
communities that the MDGs were designed to help. Yet the opportunity exists to accelerate health
progress by sustaining ambitious global investments in health and ensuring that resources are
directed strategically for maximum impact. Understanding interactions between GHIs and health
systems is crucial to reach this objective.
Until recently, little solid evidence was available to guide policymakers and programme
implementers seeking practical, proven ways to shape interactions between disease-specific
programmes and health systems so as to achieve the greatest gains in health. In May 2008, the
World Health Organization (WHO) launched a process to generate evidence-informed guidance on
this issue for GHIs, countries, and global health partners. The “Maximizing Positive Synergies”
(MPS) project has engaged stakeholders in a collaborative effort to build new knowledge on how
GHI-supported programmes are impacting national health systems, and to harness this evidence
for policy and implementation.
This draft document presents an initial compilation of findings from MPS research partners who
have analysed GHI-health systems interactions in more than 20 countries. It offers a new body of
data to inform policy and guide strategic action by national authorities, GHIs and implementers.
Research partners are continuing to analyse their data; the results summarized here are
provisional. As analysis, validation and comparison proceed on the wealth of data gathered, MPS
country studies will provide a robust evidence base to support WHO’s normative guidance on
disease-specific programmes and health systems. In addition, the initial phase of MPS learning
summarized here has clarified directions for future research that will continue to generate fresh
evidence for policy.
Structure of this report
The introductory section of this document summarizes the main research questions, conceptual
framework and methodologies used in MPS country-level research. It describes how countries
were selected for inclusion in the MPS studies and indicates limitations of the work to date. The
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