Health Systemwide Effects of the Global Fund in Benin and Ethiopia

XV International AIDS Conference

Bangkok

July 12, 2004

Owen Smith, Abt Associates Inc., Presenter

Sara Bennett, Abt Associates Inc., Principal Investigator

Kate Stillman, Abt Associates Inc.

Pia Schneider, Abt Associates Inc.

Scale of Donor Support Examples from Sub-Saharan Africa

Sources: GF, WB/WDI 2001, WHO/WHOSIS 2001

0%

20%

40%

60%

80%

100%

120%

140%

160%

Benin Ethiopia Ghana Kenya Malawi Namibia SouthAfrica

Tanzania Uganda Zambia

Average annual GFATM, MAP, and PEPFAR funding as a share of annual public health spending

Motivation and Background

Funding mechanisms such as the Global Fund may have a variety of direct and indirect effects upon health care systems.

While increased funding to fight HIV/AIDS, TB, and malaria is equitable, just, and necessary, it is unclear how this money could be best spent.

To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems.

Research Objectives

To document the effects on health care systems of applying for and receiving a Global Fund grant, and implementing Global Fund-supported activities

To derive lessons for: Country level stakeholders Global Fund Board and Secretariat Broader global health community

Thematic Areas and Conceptual Framework

Conceptual framework suggests that effects may be intended or unintended, and they may enhance health system performance or detract from it

Studies focus on four thematic areas, namely effects on: Policy Environment

Human Resources Public / Private Mix Pharmaceuticals and Commodities

Research Approach

Research conducted through the Systemwide Effects of the Fund (SWEF) research network Collaborative network of research organizations and individual

researchers from the South and North

SWEF partners seek to measure systemwide effects through a series of country studies SWEF partners are implementing components of the

study in Benin, Ethiopia, Malawi, Georgia, Nicaragua, Zambia*, Uganda*, Mozambique*

* Not confirmed

Methodology

Based on a SWEF core research protocol, adapted to fit country context and information needs Facility surveys Provider interviews Key informant interviews Document review, routine HIS, other sources

Use of common protocol helps ensure quality and comparability

Emerging IssuesEarly observations from Benin and Ethiopia

Decentralized vs. centralized approaches Integration vs. verticalization Shortage of health workers Extensive training and capacity building Alignment with existing pharmaceutical

procurement systems or creation of parallel systems

Harmonization with existing cost recovery policies or new policies

Lab strengthening

For more information:

www.phrplus.org/swef

SWEF Network Members Partners for Health Reform plus London School of Hygiene and Tropical Medicine Institute for Tropical Medicine Antwerp Curatio International Foundation (Georgia) Instituto Centroamericana de la Salud (ICAS, Nicaragua) Miz-Hasab Research Center (Ethiopia) Health Systems Trust (South Africa) Measure Evaluation & Rational Pharmaceutical Mgt plus Projects IBF Consulting Independent researchers

Thank you