GHF2010 – PS17 – Are GHIs Moving Towards Effective Health Systems Strengthening?

Session Outline

Parallel session PS17, Monday, April 19 2010, 14:00-15:30, Room 4
Chair(s): Rachel Nugent, Deputy Director, Global Health, Centre for Global Development, USA, Wim Van Damme, Professor, Department of Public Health, Institute of Tropical Medicine, Belgium
Summary: The High-Level Dialogue convened in 2009 in Venice by WHO acknowledged 'that the impact of GHIs on health outcomes and health systems, though variable, has been positive on balance and has helped to draw attention to deficiencies in health systems'. This statement recognizes that GHIs and those who invest in country health systems have shared goals, namely to improve health and to save lives. In March 2009, the GFATM, GAVI and World Bank, with technical support from WHO, launched inter-agency consultations on aligning HSS funding frameworks with the aim of developing mechanisms for joint HSS funding and programming. These efforts seek to simplify investments to deliver results in line with country leadership. This session aims at providing a critical reflection on the whether the latter implies just adding another layer to an already complex aid architecture. This session will engage dialogue between GHF delegates and representatives of international organizations (GAVI, GFATM, WHO) about how to move forward with the health systems strengthening agenda.
Debat panel: Martin Taylor, Senior Policy Analyst, Strategy Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland, Carole Presern, Managing Director, Special Projects, The Global Alliance for Vaccines and Immunization, Switzerland, Wim Van Lerberghe, Director, Department for Health System Governance and Service and Delivery (HDS), World Health Organization, Switzerland, Mit Philips, Analysis and Advocacy Unit, Médecins sans frontières, Belgium

Session Document

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Session Report

Contributors: Terri Kluzik (ICVolunteers), Josefine Ridderstrale (ICVolunteers)

Photo by John Brownlee,

Are Global Health Initiatives (GHIs) helping or harming local health care systems in poor countries? This session described the present and the future funding of GHIs, highlighting three areas: the experiences and lessons of Ethiopia, the new integrated platform introduced by the Global Health Fund (GHF) and the trends of long-term impact of the availability of aid.

Should GHIs give long-term funding to countries so that domestic funding can catch up with the level of funding previously provided by donors? Dr. Gorik Ooms, from the Department of Tropical Health, Institute of Tropical Medicine in Antwerp, Belgium, demonstrated the long-term unreliability of global aid. If a country uses GHI funding to train and hire nurses, they may need to fire these workers when the aid ends.

Yibelta Assefa, Medical Services Director from Ethiopia, presented research on how Ethiopia, a challenged and poor country, has been impacted by global aid. They are facing a health care workforce shortage and migration of health care professionals. Health care trends in Ethiopia indicate the total health workforce is significantly lower than the World Health Organization’s (WHO) recommendation. For example, in 2002, 17% of nurses and 30% of doctors left the country.

According to Mr. Assefa, The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Alliance for Vaccines and Immunisation (GAVI) and World Bank have given resources to Ethiopia for health workforce training and salaries. He mentioned that funding has made a positive impact on local health systems and programme implementation, including increasing the numbers and capacity of the workforce. However, it has disrupted the functioning of general services by poaching highly skilled health workers from training institutions and because it lacks a long-term strategy.

Based on the experience in Ethiopia, Mr. Assefa recommends that GHIs should focus on funding that has a health system “mindset” with a long-term impact. They should support the broader health workforce strategy and align with the national healthcare policies and plans, supporting public sector human resources.

Focusing on the financial and global cooperation of GHIs, Dr. Shakarishvill, senior Advisor at the Global Fund, described the health systems funding platform, a joint initiative of the Global Fund, GAVI Alliance, the World Bank and the World Health Organization. They are developing mechanisms for channelling donor funding and improving GHIs by providing flexibility at the local level. The objective is to create a mechanism to harmonise cooperation between the partners and the countries, to decrease costs and increase efficiencies. They expect to launch the new initiative by 2011.

Dr. Kumar of UNICEF reinforced Mr. Shakarishvill’s remarks, stating that the goal of the integrated approach to funding GHIs is to simplify the process for countries to obtain funding.

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