Global Fund Financing and Human Resources for Health Investments in the Eastern Mediterranean Region

Abstract

Background: Despite the large investments in donor-related health activities in areas of the globe prone to tension and conflict, few studies have examined in detail the role of these donor investments in human resources for health (HRH). Methods: We used a mixed-methods research methodology comprising both quantitative and qualitative analysis to analyze the Enhanced Financial Reporting System of the Global Fund to Fight AIDS, Tuberculosis and Malaria budget and expenditure data from 2003-2017 for 13 countries in the Eastern Mediterranean Region (EMR). We analysed additional detailed budgetary data over the period 2013-2017 for a sub-set of these countries. Two country-case studies were conducted in Afghanistan and Sudan for a more in-depth understanding of the HRH-related activities that occurred as a result of Global Fund grants. Results: The results show that US$2.2 billion Global Fund dollars had been budgeted and US$1.6 billion were expended over the period 2003-2017 in 13 Eastern Mediterranean countries. The average expenditures for human resources for health (training and human resources) as a percentage of total expenditure is 28%. Additional detailed budgetary data analysis shows a more conservative investment in HRH with 13% of total budgets allocated to “direct” HRH activities such as salaries, training costs, and technical assistance. HRH-related activities supported by the Global Fund in Afghanistan and Sudan were similar, including pre-service and in-services training, hiring of program coordinators and staff, and top-ups for clinical staff. Conclusions: HRH remains a key issue in strengthening the health systems of low- and middle-income countries. While this study suggests that Global Fund’s HRH investments in the EMR are not lagging behind the global average, there appears to be a need to further scale up these investments considering this region’s unique HRH challenges.

Development assistance for human resources for health, 1990–2020

“…This is especially so, after initial efforts showed that the achievement of target outcomes set by development agencies such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM) and the President's Emergency Plan for Aids Relief (PEP-FAR) were constrained by the shortage of health workers [6,7]. This realization galvanized donor investment in the health workforce-related activities in countries of high priority and relevance [8][9][10][11]. A previous study estimated that only 4% of development assistance for health has been targeted towards human resources for health, when the Global Strategy was set in 2016 [12].…”

Positioning global pharmacy research partnerships to advance health equity

“…Many low- and middle-income countries (LMICs) have weak health systems and are challenged by lack of adequate number of a well-trained health workforce. 29 Several LMICs have attempted to address the healthcare worker gap by training and deploying community health workers that provide a package of essential health services to their citizens. In the East African nation of Ethiopia, for example, the Federal Ministry of Health trained and deployed more than 35,000 community health workers (locally known as Health Extension Workers), the majority of which are women high school graduates.…”