The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control
This paper, published by the Health Policy and Planning journal, reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. The authors select three initiatives that account for an estimated two-thirds of external funding earmarked for HIV and AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US Presidents Emergency Plan for AIDS Relief (PEPFAR).
The authors, drawing on 31 original country-specific and cross-country articles and reports (based on country-level fieldwork conducted between 2002 and 2007), find positive effects. These include: a rapid scale-up in HIV and AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. On the other hand, the authors find negative effects, namely: distortion of recipient countries national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems.
The authors conclude with a call for sub-national and district studies to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV and AIDS; whether marginalised populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. (2009)