MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Mechanism (CCM) also has helped unify the goals of the state and the Global Fund in the eyes of
some. In addition, some of the GHI-funded NGOs have used funds to benefit the system and
implement the visions held by local communities. The initial GHI emphasis on getting people on
treatment has been muted somewhat by the new understanding that primary care and other
community needs are important too. The “trickle-down effect” has not impacted the indicators yet,
but many informants believed that a shift is underway. The Global Fund presented an opportunity
to apply for health system strengthening in Round 8.
Financing
One informant explained, “Those two programmes together [PEPFAR and the Global Fund]
account for five times the budget of the MOH. There isn’t any rationale between the burden of
diseases, the very serious public health problems linked to HIV, and the funds invested in them.”
Organizations often feel compelled to spend the GHI-awarded money as specified rather than in
ways that align with local or national health needs.
Another informant explained that, despite the focus on target diseases, it is possible for
organizations to use the GHI funds where they are most needed:
There’s been so much of a focus on HIV that people aren’t looking at the overall
epidemiologic problems in Haiti in terms of the other diseases that are killing
people. And I think for us, nobody ever says, ‘There’s going to be a fund for acute
respiratory infection or a fund for childhood diarrhoea,’ although, I think the PEPFAR
money and the Global Fund money, if you’re aware of the fact that it doesn’t cover
those things, and you’d like to work on what’s going to be the best thing for the
public’s health, then I think then you can use that money to address those other
issues.
Others also have become aware of the GHIs’ limits and learned ways to use the funding to address
issues they see as important to public health by making a conscious effort to do so rather than by
obtaining specific GHI approval.
The funding process itself impacts recipients both positively and negatively. It leaves recipients
with some uncertainty around the rules of how the money can be spent and the timing and
continuity of funding. Among secondary beneficiaries of PEPFAR who rely on primary beneficiary
interpretations, the rules are often unclear or change:
I think the hard part for us is because we’ve been a secondary grantee, we don’t
always know what PEPFAR is deciding to do. I mean, we do our own background
research and try and figure it out. But it’s very easy for the programme managers to
hide behind some sort of a ‘The government’s making us do this this year.’ …
There’s a lot of – people are just reading the rules how they would like to.
The Global Fund funding process was also unclear, especially to those not receiving funding and
without connections to the CCM:
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