Using global health initiatives to strengthen health systems: A civil society perspective

Cohn, Jennifer; Russell, Asia; Baker, Brook K.; Kayongo, Alice; Wanjiku, Esther; Davis, Paul A.

doi:10.1080/17441692.2010.521165

Cited by 25 publications

(22 citation statements)

References 27 publications

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“…More recently, the unprecedented scale and speed of this investment and the concomitant agendas of those providing the funds and implementing the programmes, have generated debate concerning the relative benefits of disease-specific programmes vs broader health systems strengthening (HSS) (El-Sadr and Abrams 2007; Cohn et al . 2011).…”

Section: Introductionmentioning

confidence: 99%

Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

Topp

Chipukuma

Chiko

et al. 2012

Health Policy and Planning

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Background Integration of HIV treatment with other primary care services has been argued to potentially improve effectiveness, efficiency and equity. However, outside the field of reproductive health, there is limited empirical evidence regarding the scope or depth of integrated HIV programmes or their relative benefits. Moreover, the body of work describing operational models of integrated service-delivery in context remains thin. Between 2008 and 2011, the Lusaka District Health Management Team piloted and scaled-up a model of integrated HIV and general outpatient department (OPD) services in 12 primary health care clinics. This paper examines the effect of the integrated model on the organization of clinic services, and explores service providers’ perceptions of the integrated model.Methods We used a mixed methods approach incorporating facility surveys and key informant interviews with clinic managers and district officials. On-site facility surveys were carried out in 12 integrated facilities to collect data on the scope of integrated services, and 15 semi-structured interviews were carried out with 12 clinic managers and three district officials to explore strengths and weaknesses of the model. Quantitative and qualitative data were triangulated to inform overall analysis.Findings Implementation of the integrated model substantially changed the organization of service delivery across a range of clinic systems. Organizational and managerial advantages were identified, including more efficient use of staff time and clinic space, improved teamwork and accountability, and more equitable delivery of care to HIV and non-HIV patients. However, integration did not solve ongoing human resource shortages or inadequate infrastructure, which limited the efficacy of the model and were perceived to undermine service delivery.Conclusion While resource and allocative efficiencies are associated with this model of integration, a more important finding was the model’s demonstrated potential for strengthening organizational culture and staff relationships, in turn facilitating more collaborative and motivated service delivery in chronically under-resourced primary healthcare clinics.

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Section: Introductionmentioning

confidence: 99%

Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

Topp

Chipukuma

Chiko

et al. 2012

Health Policy and Planning

View full text Add to dashboard Cite

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“…Over the past decade, increasing critical attention from a variety of academic disciplines has been brought to bear on the organization, implementation, and effects of GHIs (Cohn et al. ; Hanefeld , ; Kapilashrami and McPake ; Kapilashrami and O'Brien ; Khanna ; Spicer et al. ).…”

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confidence: 99%

Dying for Money: The Effects of Global Health Initiatives on NGOs Working with Gay Men and HIV/AIDS in Northwest China

Miller

2016

Med Anthropol Q

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Drawing on 17 months of ethnographic fieldwork (2007-2011), this article critically examines the consequences of two global health initiatives (GHIs), the Global Fund and the Gates Foundation, on NGOs engaged in HIV/AIDS prevention and treatment among gay men in northwest China. I argue that a short-term surge in funding provided by GHIs between 2008 and 2010 exacerbated preexisting conflicts between NGOs by promoting a neoliberal process in which the state outsourced public health services to civil society organizations, deliberately encouraging a climate of competition among NGOs. I also show how GHIs encouraged the bureaucratization and medicalization of one grassroots gay NGO, channeling its activities away from broader political and social objectives and compelling the group to develop a narrower and more entrepreneurial emphasis on HIV testing and treatment. This article contributes to a deeper ethnographic understanding of the complex and perhaps unintended consequences of GHIs.

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“…Although there is evidence that the voice of the civil society component of the Country Coordinating Mechanism is minimized in the outline of program priorities [55], it appears that the Global Fund is dedicated to increasing outlets for civil society engagement. Researchers have found there to be both positive and negative effects of high levels of civil society engagement.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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Using global health initiatives to strengthen health systems: A civil society perspective

Cited by 25 publications

References 27 publications

Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

Dying for Money: The Effects of Global Health Initiatives on NGOs Working with Gay Men and HIV/AIDS in Northwest China

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

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