Global health initiative investments and health systems strengthening: a content analysis of global fund investments

Abstract

BackgroundMillions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities – through conventional ‘vertical-programming’ approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities.MethodsWe operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion).ResultsAccording to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding.ConclusionsThis study shows that a substantial portion of Global Fund’s Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.

Power and Politics in the Global Health Landscape: Beliefs, Competition and Negotiation Among Global Advocacy Coalitions in the Policy-Making Process

“…7 These private-public initiatives have also brought new challenges to health governance, as a wide range of non-state actors assumed key positions of influence over a growing set of resources. 8,9 In response to this changing landscape of actors, there have been calls for stronger global health governance, especially in light of the cross-border nature of the issues and the need for greater solidarity and accountability among actors to address health problems and their social and economic determinants. [10][11][12] While examples of compulsory and structural power are reasonably apparent in global health, 6 productive power may be less visible, and therefore of particular interest in understanding the norms and behaviours of global networks.…”

Using Training as a Tool for Cultivating Communities of Practice around Health Information Systems in Low and Middle Income Countries: A Longitudinal Mixed Method Study

“…In Low and Middle Income Countries (LMICs), electronic health information systems (HISs) have been recognized as a key facilitator of better and equitable health care (Nolen et al, 2005;Warren et al, 2013). However, not many HIS implementations move beyond pilots in these countries due to different reasons even when infrastructure, technology and funding remain adequate.…”

Health systems strengthening in global and national contexts

“…Millions of dollars were allocated under the umbrella of HSS (Warren, Wyss, Shakarishvili, Atun, & de Savigny, 2013). For example, the Global Fund, which is a partnership organisation designed to accelerate the end of AIDS, tuberculosis, and malaria as epidemics (Global Fund, 2015), allocated about 38% of its funding for HSS in 2015 (Warren et al, 2013).…”

“…Millions of dollars were allocated under the umbrella of HSS (Warren, Wyss, Shakarishvili, Atun, & de Savigny, 2013). For example, the Global Fund, which is a partnership organisation designed to accelerate the end of AIDS, tuberculosis, and malaria as epidemics (Global Fund, 2015), allocated about 38% of its funding for HSS in 2015 (Warren et al, 2013). Around US$ 296 million was also allocated to specific health systems building blocks relevant to service delivery, human resources, and medicines and technology (Warren et al, 2013).…”

“…For example, the Global Fund, which is a partnership organisation designed to accelerate the end of AIDS, tuberculosis, and malaria as epidemics (Global Fund, 2015), allocated about 38% of its funding for HSS in 2015 (Warren et al, 2013). Around US$ 296 million was also allocated to specific health systems building blocks relevant to service delivery, human resources, and medicines and technology (Warren et al, 2013). Further, the global health threats posed by recent viral epidemics such as Ebola and Zika increased calls to invest in and enhance health systems performance (Moon et al, 2015).…”