An assessment of interactions between global health initiatives and country health systems
Authors & affiliation
Badara Samb, Tim Evans, Mark Dybul, Rifat Atun, Jean-Paul Moatti, Sania Nishtar, Anna Wright, Francesca Celletti, Justine Hsu, Jim Yong Kim, Ruairi Brugha, Asia Russell, Carissa Etienne, Susna De, Takondwa Mwase, Wenjuan Wang, Jenna Wright, Lola Dare, Jean-François Delfraissy, François Boillot, Pierre Miege, Xiulan Zhang, Joseph Rhatigan, Rebecca Weintraub, Sok Pun, C Abe, Carlos Caceres, Mamadou Camara, Benjamin Coriat, Cristina d'Almeida, Julia Aleshkina, Gulgun Murzalieva, John Kadzandira, N Hammami, Victor Mwapasa, Ketevan Chkhatarashvili, Eric Buch, Katabaro Miti, Claudes Kamenga, Marthe Sylvie Essengue Elouma, Nina Schwalbe, Alan Greenberg, Seble Frehywot, Anne Markus, Lieve Goeman, Alia Khan, Jael Amati, Esther Mwaura-Muiru, Louise C Ivers, Andrew Ellner, Aaron Shakow, Jim Yong Kim, Nicole C Kley, Alec Irwin, Erin Sullivan, Brook Baker, Jennifer Cohn, Paul Davis, Jamila Headley, Asia Russell, Patricia Siplon, Sania Nishtar, Clare Dickinson, Mark Pearson, Catriona Waddington, Rifat Atun, Mark Pearson, Sylvie Boyer, Fred Eboko, Jean-Paul Moatti, Fabienne Orsi, Bernard Larouze, Guillaume Le Loup, Phillimon Ndubani, Joseph Simbaya, Marleen Boelaert, Anna Cavalli, Gorik Ooms, Marjan Pirard, Katja Polman, Wim Van Damme, Monique Van Dormael, Peter Vermeiren, Waranya Teokul, Riitta Dlodlo, Paula Fujiwara, Sandrine Ruppol, Stefano Vella, Tetyana Semigina, Elizabeth Corbett, Peter Godfrey-Faussett, Neil Spicer, Gill Walt, Churnrurtai Kanchanachitra, Mit Philips, Guglielmo Riva, Jean-Pierre Kabuayi, Alain Kambale Kiputsu, Andre Ndongosieme, Sinata Koulla-Shiro, Salif Samake, Sory Ibrahima Bamba, Youssouf Coulibaly, Mamadou Namory Traore, Issa Bara Issa Berthe, Suwit Wibulpolprasert, Somsak Chunharas, Gregory Jerome, Joia Mukherjee, Mathias Eric Owona Nguini, Krishna Dipankar Rao, Srinath Reddy, Lot Nyirenda, Regien Biesma, Carlos Bruen, Ruairi Brugha, Patrick Dicker, Aisling Walsh, Johann Cailhol, Ann Parsons, Thubelihle Mathole, David Sanders, Sai Subhasree Raghavan, Felix Mwanza, Etukoit Bernard Michael, Wanyama Richard, P Banati, Matthew Blakley, N Ingenkamp, MA Lansang, Daniel Low-Beer, George Shakarishvili, Mark Dybul, Alice Kayongo, Kent Buse, Tim Martineau, Karl Dehne, Ian Pett, Peter Salama, Baltazar Chilundo, Peter Ndumbe, Julius Atashili, Papa Salif Sow, Peter S Hill, Logan Brenzel, Magali Babaley, Francesca Celletti, Manuel Dayrit, Isabelle de Zoysa, Jane Dyrhauge, Carissa Etienne, Timothy Evans, Benedicte Galichet, Justine Hsu, Patrick Kadama, Denis Porignon, Sarah Russell, Badara Samb, Helen Tata, Wim Van Lerberghe, Anna Wright
Abstract
Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity value for money, and outcomes in global public health, then these opportunities should not be missed.
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