MAXIMIZING POSITIVE SYNERGIES - World Health Organization

with need. With GHI funding, district level coordination has been easier to maintain than national
level control, but there has been a lack of experienced or visionary leadership in many districts:
When there is absence of leadership in a specific field, there is always someone
that takes the leadership. That’s what we see in Haiti: the leadership in the fight
of HIV/AIDS is out of the Ministry, is out of the public sector. It belongs to the
NGOs - and that is the funders - and this is not the ideal situation.
Other data suggest that the GHIs have, in fact, led to stronger partnerships between NGOs and the
MOH in some instances. NGOs that were previously strong and working with the MOH are even
stronger now and continue to work with and support them. Some suggest that the MOH has
achieved something of a coordination role in certain departments and is better able to help NGOs
make a greater impact, despite the need for further efforts.
The study showed that GHIs have enhanced leadership capacities in the country in various ways,
despite needing further support. Organizations dealing with salary inequalities among workers
were forced to learn new means of human resource and budget management. The culture of
programme management that has developed with GHI funding is highly regarded and valued in
the public and private sectors. In part, organizations know that they must efficiently manage
finances as well as reporting mechanisms in order to continue receiving funds.
On the negative side, data suggested that GHIs and some NGOs neglect national or local goals and
priorities in favour of their own. One informant from an NGO explained, “The fact that we have
funds that are three times greater than the MOH funds that go to HIV/AIDS—that introduces
distortions, especially if those funds are not associated with a vision to intervene on systemic
elements.” The GHIs do not necessarily take state goals or priorities into account when planning.
PEPFAR came “from the White House” with its own vision, without local field experience; it “had a
rather obtuse vision, which was the vision of the CDC that knew they know better than anyone; the
field experience was not their concern.”
Informants reported that some NGOs entered health departments in the same way, with their
own vision, reporting to the health directors what they were doing after being awarded the
financing, rather than discussing plans in advance.
GHIs may also force recipient NGOs to choose priority areas and hinder NGOs’ flexibility. The
decision to get either ABC (Abstinence, Be Faithful, Condoms) or ABY (Abstinence, be Faithful for
Youth) funding from PEPFAR, for example, can divide organizations and refocus their goals:
There are definitely different camps, obviously, or philosophies to the approach
of how to address the issues …. But even for us… our general philosophy … is
not to exclude condoms– but we took on funding from Track One, ABY, which
excluded us from handing out condoms or including them. We were able to
promote via references to where you can get condoms, but – so we were
obviously forced to come up with ways that probably via our technical advisors
were against their general operating principles, or simply what they thought was
probably the most effective approach.
On the positive side, some data show GHIs have, in fact, come to support national goals. While
PEPFAR looked very vertical at the beginning, it has changed. The Country Coordinating
78