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Global health initiative investments and health systems strengthening: a content analysis of global fund investments.

Warren AE, Wyss K, Shakarishvili G, Atun R, de Savigny D - Global Health (2013)

Bottom Line: Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions.There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds.Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. ashley.warren@unibas.ch

ABSTRACT

Background: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities.

Methods: We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion).

Results: According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding.

Conclusions: This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.

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Resource allocation profile of WHO building blocks. Sub-set absolute values- Total HSS $463 million; Governance $19 million; Financing $4 million; Information $44 million; Human Resources $82 million; Medicines and Technology $101 million; and Service Delivery $112 million.
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Figure 3: Resource allocation profile of WHO building blocks. Sub-set absolute values- Total HSS $463 million; Governance $19 million; Financing $4 million; Information $44 million; Human Resources $82 million; Medicines and Technology $101 million; and Service Delivery $112 million.

Mentions: Nearly one-third of the funds budgeted for HSS were dedicated to Service Delivery, whereas the Governance, Financing, and Information building blocks comprise under one-quarter of the funds (FigureĀ 3).


Global health initiative investments and health systems strengthening: a content analysis of global fund investments.

Warren AE, Wyss K, Shakarishvili G, Atun R, de Savigny D - Global Health (2013)

Resource allocation profile of WHO building blocks. Sub-set absolute values- Total HSS $463 million; Governance $19 million; Financing $4 million; Information $44 million; Human Resources $82 million; Medicines and Technology $101 million; and Service Delivery $112 million.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750586&req=5

Figure 3: Resource allocation profile of WHO building blocks. Sub-set absolute values- Total HSS $463 million; Governance $19 million; Financing $4 million; Information $44 million; Human Resources $82 million; Medicines and Technology $101 million; and Service Delivery $112 million.
Mentions: Nearly one-third of the funds budgeted for HSS were dedicated to Service Delivery, whereas the Governance, Financing, and Information building blocks comprise under one-quarter of the funds (FigureĀ 3).

Bottom Line: Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions.There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds.Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. ashley.warren@unibas.ch

ABSTRACT

Background: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities.

Methods: We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion).

Results: According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding.

Conclusions: This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.

Show MeSH
Related in: MedlinePlus