MAXIMIZING POSITIVE SYNERGIES - World Health Organization

I know that within [the organization] there’re a couple of us who understand, or
somewhat understand, the process involved, but if you take other people who’ve
been working with the foundation and would like to get involved in the Global
Fund, they wouldn’t even know – it hasn’t been advertised well enough for them to
understand what channels to enter.
Respondents also suggested the Global Fund has a tendency to disburse funds late, which leaves
some organizations needing to rearrange their budgets to create “bridge funding.”
Although some appreciate the CCM for its ability to bring people together at the same table,
neither the MOH nor any other national entity must approve all GHI-funded proposals, leading to a
lack of cohesion and coordination among them.
There is also general uncertainty about the continuity of both Global Fund and PEPFAR funding. If
GHI funding ends, many programmes will be forced to end, leading to what one informant called
an “obsessive fear”.
The funding process, on the positive side, may make organizations more efficient, accountable, or
help to reinforce administrative and financial capacities:
The institutions [getting PEPFAR /Global Fund funding]… know that if they are not
performing, they will not have financing. They make lots of efforts. There you see a
change of behaviour in the management of funds….This contributes to a better
management.
Human Resources/Health Workforce
Both qualitative and quantitative data showed that GHI funding has increased the staffing levels in
areas previously understaffed as well as in areas that were previously not covered at all by health
personnel. There are significant increases in the absolute number of community health workers,
pharmacists, doctors, nurses, laboratory technicians, obstetricians and counsellors, and this
included both those specialized in HIV care, as well as generalists. More often these positions have
been financed through PEPFAR rather than Global Fund. One informant suggested that some
positions have not made as much of an impact as they might have, because stipulations required
funding only PEPFAR staff (as opposed to MOH staff).
GHI funding contributed significantly to workforce training for community health workers, agents
de santé, peer educators, departmental leaders, doctors, nurses, social workers and laboratory
technicians. While HIV/AIDS was often the focus of trainings, trainings also taught health care
workers about supervision and managerial capacity, how to use computers, management of
multidrug resistant tuberculosis (MDR-TB), sexually transmitted infections, family planning and the
treatment of other diseases Some trainings have allowed nurses to gain skills in areas previously
reserved for physicians, permitting planned “task-shifting,” a transfer of tasks from higher level
cadres to less trained cadres in healthcare. While the health workforce was described previously as
being unmotivated, given poor working conditions as well as limited tools and resources, trainings
brought new ideas, information, and knowledge that reinvigorated some and improved the
general attitude among health workers.
One informant suggested that while significant investments in training have been made, the
investments are not coordinated, so the same people may attend the same trainings multiple
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