The impact of global health initiatives on health systems

The Global HIV/AIDS Initiatives Network Alliance for Health Policy and Systems Research study
The Global HIV/AIDS Initiatives Network Alliance for Health Policy and Systems Research study

National, sub-national and district-level effects of the global HIV/AIDS Initiatives

Remarkable, rapid scale-up of support to HIV/AIDS programmes has taken place during the past few years, driven in particular by increased funding from the Presidential Emergency Plan for AIDs Relief (PEPFAR), the Global Fund to Fight AIDS, TB and Malaria, and the World Banks's HIV/AIDS programs including the MAP (Multi-Country AIDS program for Africa). But what effects have these programmes had at the ground level, particularly in terms of health systems?
The Alliance for Health Policy and Systems Research has been funding six country studies (in China, Georgia, Malawi, Peru, Tanzania, and Uganda) which form part of the Global HIV/AIDS Initiatives Network (GHIN). GHIN is a network of researchers exploring the effects of Global HIV/AIDS Initiatives on recipient country health systems. The researchers from these countries met with colleagues from other countries in Dublin at the end of November at a meeting of the GHIN. As part of the week long meeting, agency representatives from the three main HIV/AIDS initiatives, as well as UNAIDS, WHO, bilateral donors and various civil society organizations joined the researchers for a day's discussion of preliminary findings and debate about the implications for policy.

What are the key insights that have emerged so far?

- Multiple studies have examined the effectiveness of coordination efforts at the national, province and district level. While some countries report successes in improving coordination, it still remains a serious obstacle to more effective HIV/AIDS programmes;
- Evidence from a small number of countries suggests that scale-up of HIV/AIDS services is happening; and that it has, to-date, had no impacts (either positive or negative) upon the quantity of other types of health services delivered;
- Expansion of services appears to have been achieved by health workers working harder and longer hours, rather than through the addition of more staff but it is unclear what the scope for further enhanced productivity might be;
- Two emerging concerns were expressed over sustainability and the balance between treatment, prevention and care and support programmes. Even where governments have maintained their HIV/AIDS spending many countries are now extremely reliant upon donor funding for the continuation of their HIV/AIDS programmes and plans for financial sustainability are not developed. And in some countries it appears that efforts to roll out anti-retroviral therapy may be at the expense of sustaining and developing preventive programmes.

All of the country presentations, along with other information about the network are available on the GHIN website.

Cross-country Briefing Sheets

The following cross-country briefing sheets present results from completed and ongoing research by GHIN members in ten countries, on i) scale-up and access to HIV/AIDS services ii) human resources iii) the challenge of coordination, April/May 2008. The findings draw on data collected between 2004 and 2007 in Benin, China, Kyrgyzstan, Malawi, Zambia, Ethiopia, Ukraine, Georgia, Peru and Vietnam. These briefing sheets aim to provide a synthesis of emerging themes

Peru Policy Brief October 2009