MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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
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