MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Much of the initial enthusiasm about PEPFAR funding was due to its ability to increase salaries, not
its ability to help patients, one informant explained. People working in the funded disease areas
appeared to feel that they were being paid by PEPFAR for AIDS work, no longer working for the
organization as a whole, and there were divisions among programmes within the organization.
While one informant suggested that the higher salaries paid to healthcare workers did not
contribute to improved care or result in other constructive changes, many of the human resource
strategies have led to greater access to services. GHI-funded staff hired for targeted disease
activities often reinforced institutions by providing non-targeted services, as one informant
reported: “This same staff engaged in the context of the project don’t work only on HIV/AIDS, but
they are more or less reinforcement for the institutions.” Informants displayed some concerns that
the workforce will return to its pre-GHI funding status when GHI funding dries up, and the state
once again becomes responsible for paying salaries. Informants were also concerned that doctors
will continue moving away from non-GHI funded fields unless the funding structure is changed to
equalize the fields.
Medical Vaccines, Products and Technologies
GHI funding has been used to a large extent to build, restore and renovate health system
infrastructure, especially the spaces used for antiretroviral therapy (ART) clinics. It has also
increased laboratory and diagnostic capacity, including general diagnostic capacities for TB and
MDR-TB, as well as infection control equipment. Technical capacity has increased with new
operating rooms as well as functioning Internet, made possible with generators and other
enhancements. GHI funding has improved electricity and water supply in health centres. Data
showed that PEPFAR has had a more significant response than the Global Fund in terms of
infrastructural enhancements, as well as in laboratory equipment, and funding for technologies
and material support.
While most of the changes in technology have been positive, one organization faced the challenge
of having to incorporate PEPFAR’s required equipment that they found to be inefficient.
Laboratory and diagnostic capacities created for target diseases have expanded non-target
disease diagnostic capacities. Since the basic biochemical equipment is now in place, even in some
of the most remote areas, it costs little more to offer additional tests in those settings, where
health care was once considered inaccessible. Even so, laboratory services in many places remain
prohibitively expensive for some patients, as services are provided free of charge only to those
with HIV.
Information
GHI requirements for monitoring and evaluation (M&E) have encouraged better data collection
techniques, improved information systems and the use of data for both targeted and non-targeted
diseases. These gains stem from improvements to information systems themselves and from the
additional personnel trained and hired to work with these systems. Organizations, including the
MOH, have been forced to become “more professional” about M&E. The MOH put a new
monitoring team in place to help reinforce data collection and analysis activities. The MESI
[National information system] is financed by PEPFAR. As one informant explained:
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