Lessons Learned From Implementing Prospective, Multicountry Mixed-Methods Evaluations for Gavi and the Global Fund

Carnahan, Emily; Gurley, Nikki; Asiimwe, Gilbert; Chilundo, Baltazar; Duber, Herbert C.; Faye, Adama; Kamya, Carol; Mpanya, Godefroid; Nagasha, Shakilah; Phillips, David; Salisbury, Nicole; Shearer, Jessica; Shelley, Katharine D.

doi:10.9745/ghsp-d-20-00126

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…These new models of development financing have helped bridge gaps in some of the world's poorest countries. 2,3 But they have also contributed to the verticalization of program efforts at the global and often country level, with limited integration even within programs. For example, in many countries, there has been little integration between polio eradication efforts and the delivery of routine immunization services.…”

Section: A Changing Landscapementioning

confidence: 99%

Ten Years for GHSP: Where Are We Now? Where Will We Go?

Bhutta

Ved

Twum-Danso

et al. 2023

Glob Health Sci Pract

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Section: A Changing Landscapementioning

confidence: 99%

Ten Years for GHSP: Where Are We Now? Where Will We Go?

Bhutta

Ved

Twum-Danso

et al. 2023

Glob Health Sci Pract

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“…(5) While OOP represents the main component of health expenditure, the role of donor funds is catalytic in certain areas, particularly those related to strengthening the health system. (15) Development partners including GAVI and the Global Fund for AIDs, TB, and Malaria (GF) support multiple health systems ‘building blocks’, including HRH capacity building, procurement, and supply chain management system, and health information systems in Sudan (15). The National Health Sector Partners’ Forum is the main coordination mechanism for all the health and development sector partners.…”

Section: Introductionmentioning

confidence: 99%

Health financing in Sudan: key informant interviews in the wake of the 2023 conflict

Bashir,

Allen

2023

Preprint

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BackgroundSudan is a large, landlocked, African country with a population of 46 million. It is considered a ‘least developed’ country, and coverage of essential health services is low. In April 2023 fighting broke out between the Sudanese Armed Forces and the paramilitary Rapid Support Forces. The conflict quickly escalated and has claimed 9,000 lives so far, with hundreds of thousands of people internally displaced. It is unclear exactly how the war has impacted Sudan’s already fragile health financing system.MethodsWe conducted one-to-one semi-structured interviews with a purposive sample of experienced health financing policymakers and policy advisors working in- or with the Sudanese government. Five senior key informants were recruited using snowball sampling. Interview transcripts were analysed using thematic analysis, with reference to the WHO national health financing framework and Sparkes and colleagues’ political economy framework.FindingsConflict has undoubtedly undermined Sudan’s ability to mobilise, allocate, and distribute financial resources. However, the existing health infrastructure was already so weak, and state funds so meagre, that the challenges posed by fighting were overshadowed by themes around Sudan’s underlying structural issues: out of pocket payments account for over 70% of all health expenditure; the existing national insurance scheme only covers a minority of the population; and there is unclear delineation of responsibilities between purchasers and providers and between the federal and state ministries of health. Major themes emerged around governance, revenue raising, risk pooling, purchasing and service delivery, and external donor funding.ConclusionsInvestment in developing health financing capacity at the state level, implementation planning, blended financing for the national health insurance fund, donor coordination, and community mobilisation to agitate for greater risk pooling were identified as essential steps. Without robust mechanisms to pool risk and diversification of financing sources, it will not be possible to extend financial risk protection or basic health services to large sections of Sudan’s population.

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