MAXIMIZING POSITIVE SYNERGIES - World Health Organization

More documents

Recommendations

Info

Table 1 Basic Socioeconomic, Demographic and Health Indicators* * Full data sources for all indicators are provided in Annex 1 Indicator Value Year Source Population (thousands) 9,612 2007 World Bank Geographic Size (sq. km) 27,560 2007 World Bank GDP per capita, PPP (constant 2005 international $) 1,090.37 2007 World Bank Gini index 59.21 2001 World Bank Government expenditure on health (% general government expenditure) 27.7 2007 WHO NHA Per capita government expenditure on health (current US$) 38 2007 WHO NHA Physician density (per 10,000) 3 1998 WHO SIS Nursing and midwifery density (per 10,000) 1 1998 WHO SIS Maternal mortality ratio (per 100,000 live births) 670 2005 WHO SIS DTP3 coverage (%) 53 2007 WHO SIS Estimated adult HIV (15-49) prevalence 2.2 (1.9-2.5) 2007 UNAIDS Estimated antiretroviral therapy coverage (%) 41 (33-51) 2007 WHO/UNAIDS/UNICEF Tuberculosis prevalence (per 100,000) 366 2007 WHO GTD Estimated malaria deaths 741 2006 WHO WMR Table 2 Global Health Initiative Investments* *Full data sources for all indicators are provided in Annex 1 Global Fund Round & Disease Priority Approved Disbursed Round 1, HIV/AIDS 159,733,983 83,684,238 Round 3, Malaria 14,431,577 12,631,744 Round 3, TB 14,034,665 13,201,730 Round 5, HIV/AIDS 18,821,754 18,821,754 Round 7, HIV/AIDS 6,199,554 2,450,766 Round 8, Malaria 33,402,457 0 TOTAL: 246,623,970 130,790,232 PEPFAR Year Amount Disbursed 2004 28,039,418 2005 51,785,021 2006 55,606,667 2007 84,689,732 2008 100,646,286 76
Methodology Data collection included semi-structured interviews, observation, examination of documentary material, and collection of quantitative data. Key informant interviews addressed key elements of the health system: governance, financing, health workforce, monitoring and evaluation (M&E), health technologies, and communities and civil society. The sampling strategy for key informants targeted a diverse range of implementers, policymakers and health leaders, using purposive and snowball sampling. Most of the 12 resulting key informants had well-defined roles in the country’s health system and included people working in the MOH at national, district and hospital level (size = 6), a range of NGOs, which was geographically diverse and included both Haitian-based and international NGOs (size = 5) as well as one informant from the local Haiti WHO office. Interviews were conducted in English, French or Haitian Creole using the native language of the interviewee where possible. They were recorded, then translated into English and transcribed. Transcribed interviews were entered into NVivo8, a qualitative data analysis programme (QSR International, Cambridge, MA). A thematic qualitative analysis approach and iteratively developed set of codes were used to examine the data. To further support the authenticity of findings and auditability of analytic processes, we engaged in inter-rater reliability activities as we created and applied codes; wrote memos about our analytic decision-making; and conducted participant validation exercises. For the purposes of triangulating key informant interviews, we collected and reviewed publicly available documents (i.e. National Health Strategy, PEPFAR or Global Fund Country Reports). Quantitative data was collected from seven health centres in urban and rural Haiti. Convenience sampling was used to select facilities from departments that interviewees represented and to select facilities with different degrees of GHI funding and different models of care. Quantitative data collection is ongoing in three facilities at the time of this report. Results Leadership and Governance Many feel that GHI funding has taken away the MOH’s autonomy and control in providing health care. The MOH first relinquished some control to other institutions during the first round of Global Fund funding because monies were not awarded to the MOH as a Principal Recipient. Since then, the trend for funding to go to the private sector has continued. One district director commented: Most of the funds are not allocated to the state organizations; they are allocated to private organizations or to non-profit – and the means that are available to us to ensure an effective control, an effective supervision, an effective monitoring – we don’t have those means, and as a consequence, we cannot play our role of coordination. It is often hard for the MOH to intervene in GHI-funded projects when they are already funded, especially when the projects have more financing than the MOH itself. The funded NGOs often do not want to be managed by the MOH, given that they are already reporting to the GHI. Without getting reports from the NGOs, the MOH is unable to assess the impact of interventions or keep up 77
Page 2 and 3:
Table of Contents Key Acronyms Intr
Page 4 and 5:
Policy analysis of the impact of Gl
Page 6 and 7:
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 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 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 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
Page 118 and 119: their budget was comprised of Globa
Page 120 and 121: Quality of services The majority of
Page 122 and 123: References [1] Kyrgyzstan at a glan
Page 124 and 125: Commission (NAC) in 2001 as a multi
Page 126 and 127: Objectives and methodology The main
Page 128 and 129: Discussion The findings of the Mala
Page 130 and 131: Pakistan: The impact of the Global
Page 132 and 133:
international standards. The Under
Page 134 and 135:
the US Centers for Disease Control
Page 136 and 137:
Some negative effects are also attr
Page 138 and 139:
to country health systems by way of
Page 140 and 141:
Peru: Effects of the Implementation
Page 142 and 143:
Table 2 Global Health Initiative In
Page 144 and 145:
HIV/AIDS, mainly around the Compreh
Page 146 and 147:
without substantial emphasis on pre
Page 148 and 149:
References [1] The World Bank Group
Page 150 and 151:
Rwanda: The Impact of Global Health
Page 152 and 153:
Rwanda was US$ 584.9 million in 200
Page 154 and 155:
International Health Partnership, t
Page 156 and 157:
PEPFAR’s funding practices were l
Page 158 and 159:
medical staff to higher-paying admi
Page 160 and 161:
system (CPDS), in which many stakeh
Page 162 and 163:
needing medical transport. Both GHI
Page 164 and 165:
Some informants felt that local NGO
Page 166 and 167:
Senegal: The effects of Global Heal
Page 168 and 169:
Table 1: Basic Health System and Ep
Page 170 and 171:
case study. Data analysis was condu
Page 172 and 173:
of respondents aware of treated net
Page 174 and 175:
South Africa: The effects of Global
Page 176 and 177:
Table 2 Global Health Initiative In
Page 178 and 179:
of South Africa (GHI2, ND6). 26 Don
Page 180 and 181:
NDOH to disburse external funds in
Page 182 and 183:
The lack of effective monitoring an
Page 184 and 185:
Despite these problems, GHI funding
Page 186 and 187:
[19] The Global Fund for Aids Tuber
Page 188 and 189:
Official Development Assistance (OD
Page 190 and 191:
The study employed both purposive s
Page 192 and 193:
Figure 1: Number of Clinicians at S
Page 194 and 195:
There were very significant increas
Page 196 and 197:
GHIs created an opportunity to cond
Page 198 and 199:
Ukraine: Effects of the Global Fund
Page 200 and 201:
GAVI (in US$) Disease Priority Amou
Page 202 and 203:
government and nongovernmental prov
Page 204 and 205:
• The introduction of new service
Page 206 and 207:
References [1] Data are from the Mi
Page 208 and 209:
The health system struggles with a
Page 210 and 211:
Objectives and Methodology This stu
Page 212 and 213:
Nonetheless, efforts to recruit and
Page 214 and 215:
References [1] The World Bank Group
Page 216 and 217:
average annual population growth of
Page 218 and 219:
2006 149,022,153 2007 216,012,780 2
Page 220 and 221:
isks duplication of services but al
Page 222 and 223:
centres have only one qualified hea
Page 224 and 225:
Policy analysis of the impact of Gl
Page 226 and 227:
countries” [6]. The TRP apply sev
Page 228 and 229:
PEPFAR I & II The newest PEPFAR leg
Page 230 and 231:
Types of fundable HRH interventions
Page 232 and 233:
Global Fund In two country applicat
Page 234 and 235:
TABLE 3: Selected Countries: MPS Ca
Page 236 and 237:
HRH Intervention Categories GAVI: C
Page 238 and 239:
HRH Intervention Categories GLOBAL
Page 240 and 241:
HRH Intervention Categories PEPFAR
Page 242 and 243:
Conclusion: Directions for future r
Page 244 and 245:
GHIs and health systems. Civil soci
Page 246 and 247:
Annex 01: Data sources for tables i
Page 248 and 249:
Annex 02: Contributing Institutions
show all

MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?