MAXIMIZING POSITIVE SYNERGIES - World Health Organization

It is a very good system that allows having information. This is a revolution in
Haiti. One had to wait three, four months to know what happened the previous
month; now the data is available right away….Now for the [public health] system
we are thinking of a way to put these same systems in place, that allows having
information rapidly accessible to authorized personnel, in reasonable time.
GHI reporting both enhances and hinders funded programmes. Having to report and meet specific
goals enhances some workers’ productivity. But, reporting can be time-consuming and tedious, as
well; sometimes requests for reports come at the last-minute. One informant suggested that
current reporting models also allow organizations to set unrealistic goals, obtain funding, and
make fictitious claims about their achievements. GHI reporting requirements have also led to
duplicate or parallel system development in some instances.
Service Delivery
Since GHIs have begun operating in Haiti, more people have been getting tested for both TB and
HIV. They come seeking care due to the infrastructural improvements and because they know that
they will “get service.” Not only are TB and HIV patients coming, but “where you went from seeing
16 to 20 people, you are seeing 300 people per day, all categories, pregnant women coming for
care, small children, whether for vaccination … [or other services]. Now everybody comes.”
These comments were confirmed by quantitative data from health centres studied. Reduced costs
and the availability of services have also increased care-seeking behaviour. GHI-funded
programmes that offer treatment have brought hope to those with disease and reduced the level
of fear. “People with HIV don’t feel like they have a death sentence anymore,” one informant
reported. Some organizations are paying attention to stigma and working specifically to reduce it:
It is true that there is still stigmatization, but the fact that people know that they
can get free access to care, well, people who are positive come to get care,
without problems. One feels that the tendency to stigmatize and discriminate
toward people who have the virus has diminished. It is not the same thing
anymore.
There are many more sites offering HIV care because of GHI funds, including 48 sites for ART
(compared to two sites prior to GHI support). GHIs have reduced or eliminated the costs of HIV
testing and care for many patients. More people are getting tested and treated for TB, but there is
still not a national TB supply chain. GHI funding for infrastructural enhancements has increased
access to health facilities for patients with non-target diseases, as well. “We see that at those sites
the frequentation has multiplied by even ten,” one informant explained. “This is phenomenal in
terms of… accessibility, of availability of care,” another added. Vaccination coverage in one area
went from insignificant levels to 100%. The availability of medication for non-targeted diseases has
also increased; although in many programmes these services are available on a fee-for-service
basis to patients who do not have HIV, some programmes provide all medications and services
free of charge.
In terms of integration, informants felt that many GHI-funded programmes were not integrated
into the health system, despite the benefits that integration might offer. This may be due, in part,
to the fact that indicators are HIV-based, not requiring organizations to be accountable for other
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