MAXIMIZING POSITIVE SYNERGIES - World Health Organization

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funds and more funding focused on improving the system as whole. GHI funding has introduced a tension in the health system by empowering NGOs while at the same time constraining somewhat the Haitian government’s ability to coordinate GHI activities within a national plan and set of healthcare priorities. As a result, there is a desire for the funding to help strengthen the MOH and support its role as the primary coordinator for health action in the country. To achieve complete integration, improved coordination will be needed between the government, the Global Fund and PEPFAR. For example, in Haiti, the Principal Recipient for Global Fund funds is not the government, a fact that perpetuates the lack of coordination. Although initially both the Global Fund and PEPFAR were considered vertical programmes by both the government of Haiti and by implementing NGOs, data showed that certain implementers were willing to challenge the vertical approach of these GHIs from the beginning and to push the funders to allow a more diagonal approach to health system strengthening. This approach, over time, became more accepted by local GHI officials and has also become more acceptable for GHI objectives and programming. The Global Fund, for example, now encourages applications for funding for health system strengthening, and PEPFAR, particularly in its second phase, is described by interviewees as being more open and encouraging of an integrated approach. 86
References [1] World Development Indicators 2007. Washington DC, The World Bank, 2007 (Proprietary online database: http://ddp-ext.worldbank.org.ezpprod1.hul.harvard.edu/ext/DDPQQ/member.do?method=getMembers; accessed 20 March 2009). [2] Government of Haiti, Preparatory Committee for the DSNCRP, Ministry of Planning and External Cooperation. Growth and Poverty Reduction Strategy Paper. Port-au-Prince, Preparatory Committee for the DSNCRP, Ministry of Planning and External Cooperation, 2007. [3] Human Development Report 2006 - Beyond Scarcity: Power, Poverty and the Global Water Crisis. New York, United Nations Development Programme, 2006. [4] United Kingdom Jubilee Debt Campaign. The Debt Crisis: Haiti. London, United Kingdom Jubilee Debt Campaign, 2008 (http://www.jubileedebtcampaign.org.uk/?lid=3113; accessed 13 November 2008). [5] Small Island Developing States: Haiti. UN-OHRLLS, 2008 (http://www.unohrlls.org/en/orphan/92/; accessed 12 November 2008). [6] Buss T. Failure of Foreign Aid to Haiti. Paper presented at the annual meeting of the International Studies Association 48th Annual Convention. Chicago, IL, USA, 28 Feb 2007. [7] Humanitarian Appeal 2004: Haiti Flash Appeal. United Nations Office for the Coordination of Humanitarian Affairs, 2004 (http://www.un.org/depts/ocha/cap/haiti.html; accessed 11 November 2008). [8] Epidemiological Fact Sheet on HIV and AIDS: Core data on epidemiology and response, Haiti 2008 Update. Geneva, UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2008 (http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_HT.pdf; accessed 20 March 2009). [9] Haiti. Epidemiological Bulletin, 2003, 24(1):13-16. [10] Haiti Country Coordinating Mechanism (CCM). The Global Fund to Fight Aids Tuberculosis and Malaria, Proposal Form, Fifth Round. Geneva, GFATM, 2005 (http://www.theglobalfund.org/grantdocuments/5HTIH_1032_492_full.pdf; accessed 20 March 2009). [11] Chatterjee P. Haiti's forgotten emergency. The Lancet, 2008, 372:615-618. [12] Haiti. In: Health in the Americas, 2007 Edition. Volume II-Countries. Pan American Health Organization, 2007:412-429. [13] World Health Statistics 2009 (http://www.who.int/whosis/en/; accessed 15 March 2009). [14] Haiti Fiscal Year 2004 Country PEPFAR Operational Plan (COP). PEPFAR, 2004. 87
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Table of Contents Key Acronyms Intr
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Policy analysis of the impact of Gl
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OIs Opportunistic infections OVC Or
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core section of the document then p
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Figure 1: Analytic framework for MP
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studies. MPS researchers have linke
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Burundi: Building a health system t
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at between US$ 14.5 and US$ 18.5 pe
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collaborations with European school
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epresent only US$ 1.75 per month pe
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Service Delivery The decentralizati
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Long term HSS will require governme
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Cameroon: Evaluation of the Nationa
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Table 1 Basic Socioeconomic, Demogr
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of treatment interruptions (>two da
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side effects) were associated with
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Prevention behaviours Nearly half (
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References [1] The World Bank Group
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Out-of-pocket payments account for
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as well as the number of community
Page 42 and 43: Table 1: Characteristics of facilit
Page 44 and 45: Table 4: Estimated changes in human
Page 46 and 47: Central African Republic: Impact of
Page 48 and 49: Objectives and Methodology In this
Page 50 and 51: Financing There was a general appre
Page 52 and 53: NGOs and Civil Society The overall
Page 54 and 55: Discussion Interviews with key info
Page 56 and 57: China: The Impact of the Global Fun
Page 58 and 59: Table 2 Global Health Initiative In
Page 60 and 61: In Yunnan and Henan, the epidemic i
Page 62 and 63: funded only from the MOH Pilot Prog
Page 64 and 65: References [1] China at a glance. W
Page 66 and 67: 1994, private spending and emergenc
Page 68 and 69: understanding of their roles and re
Page 70 and 71: References [1] Human Development Re
Page 72 and 73: In 2003, the government launched th
Page 74 and 75: Objectives and Methodology The data
Page 76 and 77: Health Workforce Ghana is challenge
Page 78 and 79: Discussion GHIs are critical for ra
Page 80 and 81: Haiti: Maximizing Positive Synergie
Page 82 and 83: Table 1 Basic Socioeconomic, Demogr
Page 84 and 85: with need. With GHI funding, distri
Page 86 and 87: I know that within [the organizatio
Page 88 and 89: Much of the initial enthusiasm abou
Page 90 and 91: services, or for measures of qualit
Page 94 and 95: INDIA: Exploring how disease-specif
Page 96 and 97: PEPFAR* Year Amount Disbursed (in U
Page 98 and 99: Primary data collection - facility
Page 100 and 101: The Global Fund has strengthened th
Page 102 and 103: References [1] The World Bank Group
Page 104 and 105: Background The Republic of Kenya li
Page 106 and 107: Results Leadership and Governance D
Page 108 and 109: Informants noted that a general lac
Page 110 and 111: time periods. Informants believed t
Page 112 and 113: References [1] The World Bank Group
Page 114 and 115: A comprehensive, long-term reform o
Page 116 and 117: The effects of GHIs on the capacity
Page 118 and 119: their budget was comprised of Globa
Page 120 and 121: Quality of services The majority of
Page 122 and 123: References [1] Kyrgyzstan at a glan
Page 124 and 125: Commission (NAC) in 2001 as a multi
Page 126 and 127: Objectives and methodology The main
Page 128 and 129: Discussion The findings of the Mala
Page 130 and 131: Pakistan: The impact of the Global
Page 132 and 133: international standards. The Under
Page 134 and 135: the US Centers for Disease Control
Page 136 and 137: Some negative effects are also attr
Page 138 and 139: to country health systems by way of
Page 140 and 141: Peru: Effects of the Implementation
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Table 2 Global Health Initiative In
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HIV/AIDS, mainly around the Compreh
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without substantial emphasis on pre
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Rwanda: The Impact of Global Health
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Rwanda was US$ 584.9 million in 200
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International Health Partnership, t
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PEPFAR’s funding practices were l
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medical staff to higher-paying admi
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system (CPDS), in which many stakeh
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needing medical transport. Both GHI
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Some informants felt that local NGO
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Senegal: The effects of Global Heal
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Table 1: Basic Health System and Ep
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case study. Data analysis was condu
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of respondents aware of treated net
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South Africa: The effects of Global
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Table 2 Global Health Initiative In
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of South Africa (GHI2, ND6). 26 Don
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NDOH to disburse external funds in
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The lack of effective monitoring an
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Despite these problems, GHI funding
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[19] The Global Fund for Aids Tuber
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Official Development Assistance (OD
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The study employed both purposive s
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Figure 1: Number of Clinicians at S
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There were very significant increas
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GHIs created an opportunity to cond
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Ukraine: Effects of the Global Fund
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GAVI (in US$) Disease Priority Amou
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government and nongovernmental prov
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• The introduction of new service
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References [1] Data are from the Mi
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The health system struggles with a
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Objectives and Methodology This stu
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Nonetheless, efforts to recruit and
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average annual population growth of
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2006 149,022,153 2007 216,012,780 2
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isks duplication of services but al
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centres have only one qualified hea
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Policy analysis of the impact of Gl
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countries” [6]. The TRP apply sev
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PEPFAR I & II The newest PEPFAR leg
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Types of fundable HRH interventions
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Global Fund In two country applicat
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TABLE 3: Selected Countries: MPS Ca
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HRH Intervention Categories GAVI: C
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HRH Intervention Categories GLOBAL
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HRH Intervention Categories PEPFAR
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Conclusion: Directions for future r
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GHIs and health systems. Civil soci
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Annex 01: Data sources for tables i
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Annex 02: Contributing Institutions
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