Effects of Global Health Initiatives on Health Systems Development, Georgia
The Effect of the "Global Fund to Fight AIDS, TB and Malaria" on the Development of Georgia’s Health System
Global health initiatives like the Global Fund to fight HIV/AIDS, TB and Malaria (GFATM), Global Alliance for Vaccines Initiative (GAVI), Roll Back Malaria and Stop TB etc. are intended to support developing countries to effectively deal with specific diseases/conditions. In practice, the vertical nature of such financing is likely to have a variety of direct and indirect effects upon health care systems, both positive and negative. The size and the components of Global Fund grants make it the most significant player, at least for now. But evidence shows that experience with disbursement of GFATM grants has caused considerable frustration in recipient countries. In some countries, these new financing sources are providing larger sources of funding than the entire annual public health budget. Depending on how these resources are used, they have the potential to overstretch already weakened systems, or they may serve to support to the broader health care system with potentially positive effects on other health priorities as well.
In Georgia, this study led by the Curatio International Foundation (CIF) looked at the possible system-wide impact of the Global Fund (GFATM) on Georgia’s health care system. The aim of the study was to look at the actual effects of GFATM on the policy environment, on public-private interaction, on human resources and on access to specific services by clients. The findings stem from a base-line survey implemented in 2004 with financial support received from EU and an end-line survey financially supported by Alliance HPSR.
Based on their analysis, the CIF found that the main impacts of GFATM on Georgia’s health care system during 2004-2007 were:
- The GFATM is not expected to have a net negative impact on Georgia’s health care system. It is certainly contributing to improving availability and access to focal disease treatment;
- Funds provided by the GFATM are significant in paying for the inputs and interventions necessary to fight focal diseases. Increased availability of financial resources from GFATM helped the Government of Georgia to move public resources away from focal diseases towards other Government priorities. Therefore, the public expenditure on HIV/AIDS and TB has declined since the GFATM’s entrance. Georgia’s dependency on increased recurrent cost financing has grown sincethen to the point that when GFATM financing comes to an end, the country may face significant challenges in sustaining observed achievements. The GFATM has to consider new gradual phase-out strategies over the period of 10-15 years as opposed to an immediate exit.
- Through broader participation and consultations, assured by Georgia’s CCM, Georgia has developed GFATM proposals strongly in line with the country’s priorities. Thus, it is not expected that GFATM will disrupt ongoing health care reforms.
- GFATM facilitated development of public-private partnerships. On four occasions, consortia represented by the state and the non-state sector received competitive funding from the GFATM and/or the Principal Recipient.
- Activities funded through the GFATM helped change primary-care provider attitude towards provision of services to PLWHA and TB patients. Statistically significant changes were observed between the baseline and end-line surveys. Number of providers calling provision of services to TB patients “safe” increased by 9.6%, to HIV/AIDS patients by 24.1%, and to malaria patients by 21.4%. Additionally, 88.6% of surveyed providers, regardless of their involvement in GFATM project activities and training, expressed their readiness to provide services to the above-mentioned groups.
- GFATM-funded activities for HIV/AIDS helped create social networks and a more positive environment for HIV- positive people and helped them to become more open about their status.
Project description
Programme: Effects of Global Health Initiatives on Health Systems Development
Research title: The Effect of the "Global Fund to Fight AIDS, TB and Malaria" on the Development of Georgia’s Health System
Thematic Research Area: Cross-cutting
Grantee Country: Georgia
Grantee Institution: Curatio International Foundation
Program Coordinator/Principle Investigator: Dr Akaki Zoidze
Start date: October 2005
Status of grant: Completed in February 2008