MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Objectives and Methodology
The aim of this study is to understand how programmes supported by the Global Fund in India
interact with existing health systems. The study focuses on the activities of the NACP-3 as well as
the RNTCP since the majority of Global Fund funds are directed at these two programmes. It
attempts to answer the following specific questions:
1. How do Global Fund-supported programmes interact with health systems?
2. What positive synergies emerge when Global Fund-supported programmes interact with
local health systems? Which factors influence the extent and nature of this interaction?
Site Selection
The states of Andhra Pradesh, Uttarakhand and Manipur were selected on the basis of significant
funding provided by the Global Fund, epidemiological profile (HIV and TB) and geographical
spread. Andhra Pradesh has a high caseload of TB and HIV whereas Uttarakhand and Manipur have
a high disease burden of TB and HIV, respectively. Moreover, the states selected offer a broadly
representative sampling due to their location in the southern, northern and eastern parts of the
country respectively.
Selection of Health Facilities
Public sector health facilities where Global Fund funded activities are functioning were selected in
each state. One district nearest to the state capital was randomly selected. From the extant pool of
facilities in the district, the district hospital was automatically included in the sample, as was the
community health centre (CHC) nearest to the district hospital and nearest primary health centre
(PHC). For assessing the RNTCP programme, a district hospital, a CHC and a PHC (preferably a
tuberculosis unit) were selected. Similarly, for the NACO programme, a medical college hospital, a
district hospital and a CHC were chosen. In Uttarakhand all the relevant health facilities were
present in the district where the district capital is located.
Primary data collection – key informant interviews
In-depth interviews with key informants in the three study states were conducted between
February and May 2009. Key Informants were identified purposively based on their roles and
experience with the NACP, the RNTCP and the general health system of India. In addition, others
were identified using the strategy of snowball sampling. Key informants included programme
managers of the NACP, RNTCP, Directorate of Health Services, central and state health ministry and
relevant staff of health facilities.
A key informant guide was developed and used to facilitate the process of data collection. The
guides were pre-tested and a few modifications were made based on this experience.
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