MAXIMIZING POSITIVE SYNERGIES - World Health Organization

and non-targeted disease measures, when compared to other models of care. Qualitative data
demonstrated that the model was specifically designed to be comprehensive and to work within
the public sector.
Informants reported there had been recent shifts towards integration. One informant commented
that the Global Fund has helped reinforce the MOH in terms of coordination in the last few years
and has begun working more closely with other funders in the last year to create synergies with
them. “PEPFAR…came with its own indicators, its own vision that is not integrated…. It came with
its own employees…. That is how it was…. It was vertical, in a straight line …. Now, little by little, it
has changed.” Data suggested that both the Global Fund and PEPFAR are now more aware of the
need to deliver more comprehensive care, rather than vertical programmes.
GHI funding has improved access to and quality of primary care and non-target diseases in some
cases. GHI-funded programmes have made more health information available. Organizations that
have hired field agents for HIV/AIDS use them to bring information on other diseases to the
community, as well as to detect and refer people for treatment. Human resource capacity in health
centres is also improved. There are more health workers available, their attitude and motivation is
generally improved, and they are better trained.
Community/Civil Society
GHI funding reinforced NGOs in terms of their size, their power, and their roles. NGOs often have
bigger budgets than the districts in which they work. One informant suggested that GHIs have
empowered NGOs beyond what is normal or healthy for the system:
The NGOs are taking places that should not be theirs in this country. They often
make their own rules. They comply very little with the very few norms of the
national health authority. And that being said, this is not the fault of the NGOs;
this is more the fault of the public authority, the fault of the funders, the donors
who, during several years, especially during the period of political crisis, have
abandoned the financing of the state to give the funds to the NGOs.
Given the large number of NGOs working in the country and lack of state authority, there is little
coordination among NGOs. Greater coordination could presumably serve to strengthen NGOs’
impact. GHI funding has also affected the role of NGOs by encouraging them to shift their focus to
target diseases. The number of NGOs working on HIV has multiplied with GHI funding, and the
organizations previously working on target diseases have been strengthened further in those
areas.
Discussion
The majority of interviewees report that the Global Fund and PEPFAR have had a positive impact
on the Haitian health system as a whole; positive effects on infrastructure, M&E, and health
workforce are most evident. In particular, informants note that all those people seeking healthcare,
not just those with HIV, benefit from improvements in physical infrastructure and expansion of the
trained health workforce. Many respondents believe that the most pressing issue is that of creating
an integrated healthcare system. This would require fewer vertical programmes related to GHI
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