MAXIMIZING POSITIVE SYNERGIES - World Health Organization

y many key informants as a duplication of existing structures for coordination among partners.
The CCM is widely regarded as a body with authority (for shaping and approval of country
proposals for Global Fund funding) but with no clearly identifiable accountability structures.
Financing
Global Fund support for HIV/AIDS accounted for 40% of total external support for the entire
HIV/AIDS sector in 2007 (budgetary estimates) and 57% in 2008 (budgetary estimates). In 2007 the
Global Fund supported more than 85% of the National AIDS Control Programme’s (NACP)
expenditure. Global Fund contributions towards the National TB Control Programme accounted
for more than 95% of its budget in 2006 (excluding salaries and Government of Ghana (GoG)
expenditure on the general health system).
The health sector has seen improvements in overall funding, primarily due to increments in the
Internally Generated Funds (IGF) from the NHIS, accounting for more than 30% of total budget in
2006. The donor pool fund has fallen from 12.7% in 2005 to 3.4% in 2007, as budget support was
brought into line with the Paris Declaration and the Ghana Harmonization and Alignment Plan.
This policy change has raised concerns that health care has to compete with other government
priorities. There is no evidence, however, to back up the argument that Global Fund support led to
a decline in GoG funding or that of other partners. As noted by a high-level official, in the absence
of Global Fund support it would not have been feasible to scale-up HIV/AIDS interventions, or to
initiate either public-private mix (PPM) schemes or the Enablers package for TB control.
With reference to institutional arrangements for HIV/AIDS financing, the Ghana AIDS Commission
(GAC) was created in 2001 as the supra-ministerial body responsible for coordinating a broad
based, multi-sectoral approach for HIV/AIDS in the country (National Strategic Framework II: 2006-
2010). The GAC oversees and coordinates funding for all HIV/AIDS interventions, including the
health sector response. Global Fund support is captured as direct funding to the implementing
agency (the MOH/GHS), as against the other pooled and earmarked funds received by the GAC. In
order to minimize duplication of activities and to optimize the use of scarce resources, several key
informants expressed a need for improved coordination between GAC and other implementing
partners, including NACP.
In contrast to the TB programme, where funds are routed through regional/district accounts, the
HIV/AIDS programme division manages most of the funds (80% of which go towards drugs,
commodities, and infrastructure/equipment for HIV/AIDS), with sub-recipients (including
NGOs/Faith-based organizations) accounting for 7% of total expenditure. This results in limited
flexibility at the regional and district level to plan or implement interventions or for M&E.
As mentioned above, the health system has structures in place for capturing expenditures by
source and by activity, including for Global Fund grants. However, the demand for quarterly
reporting and reporting by Service Delivery Areas (SDAs) places an added burden on the system.
This is further complicated by frequent changes to the ways in which activities are grouped into
SDAs and the nomenclature of the SDAs.
With the Global Fund as a major source of health sector funding, another crucial challenge
concerns the sustainability of activities in the event of an interruption of grants or the failure of
future proposal submissions. Such disruptions can severely jeopardize the national planning
process.
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