Evaluation of PEPFAR (2013) / Chapter Skim
Currently Skimming:
9 Strengthening Health Systems for an Effective HIV/AIDS Response
9 Strengthening Health Systems for an Effective HIV/AIDS Response
Pages 435-536
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 435... ...
. The primary objectives of a health system are to improve health by achieving the best attainable average level of population health and minimizing the differences between individuals and groups.
|
From page 436... ...
. Large global health initiatives such as PEPFAR, the Global Fund, and the Global Alliance for Vaccines and Immunization have facilitated the tremendous increase in development assistance for health, but there is concern about the effects, intended and unintended, of these initiatives on partner country health systems (Bärnighausen et al., 2012; Biesma et al., 2009; Grépin, 2012a; Levine and Oomman, 2009; Samb et al., 2009)
|
From page 437... ...
Several studies have examined the effects of global HIV/AIDS initiatives and broader global health initiatives on health systems. Positive effects have included strengthened infrastructure and laboratories, scale-up of HIV/AIDS service delivery, improved primary health care services, a slowing of HIV/AIDS-related deaths among the health workforce through the provision of antiretroviral treatment, greater participation of stakeholder
|
From page 438... ...
generate more reliable data for the costs and benefits of strengthening health systems, and (5) commit to increased national and global health financing that is more predictable in order to support sustainable and equitable growth of health systems (Samb et al., 2009)
|
From page 439... ...
STRENGTHENING HEALTH SYSTEMS 439 TABLE 9-1 Health System Constraints with Potential Disease-Specific and Health System Responses Constraint Disease-Specific Response Health-System Response Financing Financial inaccessibility: Permit exemptions or Develop risk pooling strategies inability to pay, informal reduce prices for focal fees diseases Service Delivery Physical inaccessibility: Provide outreach for focal Reconsider plans for longdistance to facility diseases term capital investment and planning for facilities Poor quality of care among Provide trainings for Develop systems for providers in the private private-sector providers accreditation and regulation sector Workforce Inappropriately skilled staff Implement continuous Review basic medical and education and training nursing training curricula to workshops aimed at ensure basic training includes developing skills in focal necessary and appropriate diseases skills Poorly motivated staff Offer financial incentives to Institute appropriate reward delivery of priority performance review systems, services create greater clarity around performance roles and expectations, review salary structures and promotion procedures Leadership and Governance Weak planning and Provide continuous Restructure ministries of management education and training health, recruit and develop a workshops aimed at cadre of dedicated managers developing planning and management skills Lack of intersectoral action Create special disease- Build systems of local and partnership focused cross-sectoral government that incorporate committees and task representatives from health, forces at the national level education, and agriculture and that promote accountability of local governance structures to the people SOURCE: Adapted from Travis et al., 2004. OVERVIEW OF PEPFAR'S HEALTH SYSTEMS STRENGTHENING ACTIVITIES As part of the current Institute of Medicine (IOM)
|
From page 440... ...
. The reauthorization legislation provided the opportunity for PEPFAR to formally identify and support strategies to "strengthen overall health systems in high-prevalence countries, including support for workforce training, retention, and effective deployment, capacity building, laboratory development, equipment maintenance and repair, and public health and related public financial management systems and operations"3 as well as for PEPFAR and partner country governments to commit to a "deeper integration" of HIV services into existing national programs and systems.4 The reauthorization legislation laid out goals for PEPFAR to strengthen health policies and systems for not only HIV/AIDS, but also tuberculosis and malaria, in support of increasing 2 Tom Lantos and Henry J
|
From page 441... ...
Over the years, PEPFAR's budget code definitions were revised, but HSS activities have generally included broad policy reform efforts, system-wide approaches (e.g., supply chain, procurement, and information) , and capacity building for financial and program management (OGAC, 2008a, 2010a)
|
From page 442... ...
, institutional capacity building, supply chain or pro curement systems, [strengthening of local coordinating mechanisms for implementation of] Global Fund programs [or other external grants,]
|
From page 443... ...
SOURCE: OGAC, 2005a, 2006b, 2007c, 2008b, 2010b, 2011d,e. Committee's Approach to the Assessment of PEPFAR by Health Systems Building Block The committee systematically collected and analyzed data about PEPFAR activities and effects for each health systems building block; these data included semi-structured interviews with key stakeholders, program matic and financial data, and other published information including peer reviewed and grey literature, PEPFAR/OGAC guidance documents, and a targeted review of 2008 and 2010 PEPFAR Country Operational Plans (COPs)
|
From page 444... ...
. Although national governments are ultimately responsible for the performance of their health systems, other entities and institutions from the private sector and civil society may be involved in or carry out some of the functions of stewardship (IOM and NRC, 2009; WHO, 2000, 2007a)
|
From page 445... ...
. To achieve good governance, governments must have the capacity to "plan, manage, and regulate policy, financial resources, and service delivery" with efficiency, effectiveness, openness, transparency, and accountability (Brinkerhoff and Bossert, 2008; Fox et al., 2010, p.
|
From page 446... ...
. Global advocacy for HIV/AIDS and donor-funded global health initiatives have catalyzed stronger involvement of civil society in decision-making processes
|
From page 447... ...
. The Global Fund requires that funding proposals be developed with representatives from all sectors, including government, civil society, the business sector, and people living with HIV (PLHIV)
|
From page 448... ...
. In addition to what it heard about the presence of high-level leadership in many partner countries, the committee also heard about gaps in national leadership and management skills (240-19-USACA; 587-22-USG; 196-11-USNGO; 636-9-USG; 116-7-USG; 116-11-PCGOV; 166-13-PCGOV; 935-2-USG; 935-12-USPS; 935-24-USNGO)
|
From page 449... ...
At the end of the 5-year time-frame, the expectation is that, in addition to results in the prevention, care and treatment of HIV/AIDS, country governments will be better positioned to assume primary responsibility for the national responses to HIV/AIDS in terms of management, strategic direction, performance monitoring, decision-making, coordination, and, where possible, financial support and service delivery" (OGAC, 2009a, p.
|
From page 450... ...
. PFs, although not legally binding in either country of the partnership, are guided by the following principles: • Country ownership • Sustainability • Support for coordination of country resources • USG interagency collaboration • Engagement and participation • Strategic framework • Flexibility • Progress toward policy reform and increased financial accountability • Integration of HIV/AIDS into strengthened health systems and a broader health and development agenda • Monitoring and evaluation • Collaborative but not contractual • Transparency • "Do no harm" (highlighting PEPFAR's continued support of exist ing implementing partner service delivery systems while the transi tion to country ownership occurs over time)
|
From page 451... ...
. In one country visit an inter viewee pointed out that PEPFAR is the only external donor that provides support for governance capacity building, specifically by working with the country's Global Fund CCM (587-6-CCM)
|
From page 452... ...
. TA for HIV-related institutional capacity building may include strategic planning; registration; financial management; human resource manage ment; networks development; commodities, equipment and logistics management; and infrastructure development (OGAC, 2007b, p.
|
From page 453... ...
. Training In conjunction with TA, PEPFAR also supports training for individuals in HIV-related policy development, institutional capacity building, and stigma and discrimination reduction (see Table 9-3)
|
From page 454... ...
Contributions to policy development and strengthening, as a part of leadership and governance to plan and oversee a national response, can occur through direct negotiations with national counterparts or through less direct efforts to influence dialogue around topics or issues with policy implications. Throughout the course of its interview data gathering, the committee heard several examples of efforts by PEPFAR mission teams and implementing partners to shape or influence policy in the countries in which they work.
|
From page 455... ...
. Across the partner countries visited by the evaluation teams, data use emerged as an important theme for program planners and implementers at the national level.
|
From page 456... ...
. Interviewees from PEPFAR mission teams and implementing partners described PEPFAR support for a wide range of national frameworks and strategic plans related to the HIV/AIDS response (272-12-USNGO; 272-1-USG)
|
From page 457... ...
. PEPFAR Achievements PEPFAR supports strengthening partner country leadership and governance primarily through training and technical assistance, and it collaborates with partner countries to improve strategic planning and to develop policies to guide national HIV/AIDS responses.
|
From page 458... ...
Conclusion: PEPFAR's capacity building approach has been holistic and includes developing human resources; strengthening financial management; and building organizational capacity at national, provincial, and district levels and across government, private, and civil society sectors. Despite these efforts, leadership and financial management capacity were frequently mentioned as challenges to effective HIV/AIDS responses.
|
From page 459... ...
This section of the report presents some information on the availability of resources for health in PEPFAR countries, followed by a discussion of PEPFAR efforts to build capacity for health financing in partner countries. Accountability and transparency are two governance functions of particular importance for health financing.
|
From page 460... ...
. Figure 9-3 presents external resources for health as a percentage of total health expenditure for 2010.
|
From page 461... ...
. In the United Kingdom and the United States, economic uncertainty has prompted discussions about reducing development assistance (IHME, 2011)
|
From page 462... ...
Vietnam NOTES: Russia and Zimbabwe have been excluded from the figure because there were no data available. China, Thailand, and Ukraine have been excluded from the figure because less than 0.5 percentage of their total health expenditures came from external resources in 2010.
|
From page 463... ...
. In 2002, the Global Fund introduced the concept of CCMs -- broad partnerships with representatives from all sectors, including government, civil society, the business sector, and PLHIV -- to coordinate the development of Global Fund proposals and the implementation of grants (Global Fund, 2012; Spicer et al., 2010)
|
From page 464... ...
. As described in Chapter 4, some PEPFAR funding is provided to partner country governments and other local entities directly as prime partners or indirectly as sub-partners.
|
From page 465... ...
. Guidance OGAC has highlighted capacity building for governmental and nongovernmental organizations as one of its strategies to ensure sustainability and country ownership, and the key activities for capacity building include improving financial management and accounting systems as well as strategic information activities that inform financial management (OGAC, 2004, 2008a, 2009f)
|
From page 466... ...
. Often, partner country governments and other entities will be sub-partners of PEPFAR prime partners that actively work to build capacity for grants and financial management (240-12-USG; 196-9-USNGO; 116-4-USG; 272-16-PCNGO)
|
From page 467... ...
. Interviewees identified the need for greater advocacy aimed at convincing partner country governments to increase resources (542-8-USNGO; 935-12-USPS; 461-19-USG)
|
From page 468... ...
In most countries, partner country governments are the Principal Recipients of Global Fund grants, so this money moves through the government systems (116-11-PCGOV; 240-7-PCGOV)
|
From page 469... ...
. In another country, a PEPFAR partner helped the MOH set up a Global Fund Management Unit to support the financial management, monitoring and evaluation, and supply chain management of Global Fund grants (166-22-USPS)
|
From page 470... ...
. PEPFAR supported-partners have also provided training and technical assistance to build capacity for partner country governments for tracking health and HIV/AIDS expenditures through NHAs or NASAs (587-10-USG; 116-23-USPS; 461-15-USG)
|
From page 471... ...
. Other PEPFAR partner countries rely on the private sector to provide access to insurance (116-23-USPS)
|
From page 472... ...
. Conclusion: Although there are nascent efforts in PEPFAR for the costing of services and the projecting of needs to help countries develop a costed HIV/AIDS response, PEPFAR has not yet system atically implemented assistance for partner countries to develop resource mobilization plans, conduct costing activities and resource projections, or identify funding needs.
|
From page 473... ...
. PEPFAR Inputs Guidance In 2004, PEPFAR's first Five-Year Strategy recognized that existing HISs in many partner countries lacked the capacity to provide the information necessary to monitor and manage interventions.
|
From page 474... ...
with its use, the HMN enhanced by being This can be achieved by placing Framework empowers all those accessible to decision a greater value on information who contribute to strengthening makers and by providing collection, management, and the system. incentives for information use use FIGURE 9-4 Components of a health information system (HIS)
|
From page 475... ...
. PEPFAR Activities Through technical assistance and support and capacity building, PEPFAR mission teams and partners have supported the development of national plans and frameworks for monitoring the HIV/AIDS response
|
From page 476... ...
. Mission teams reported on two PEPFAR indicators to monitor capacity building for strategic information activities (including M&E, surveillance, and HMIS)
|
From page 477... ...
• lectronic medical records (166-15-USACA; 166-ES; 116-ES; 116-9-PCNGO; 636-1-USG; E 461-13-USACA) • ommodities/logistics/supply chain management information sys C tems (240-2-USG; 240-5-PCGOV; 331-12-USG; 331-43-USG; 331-38-USPS; 166-12-USG)
|
From page 478... ...
. Finally, PEPFAR partners have also supported M&E training for health care workers (e.g., doctors, nurses, etc.)
|
From page 479... ...
Integration of Information Systems Partner countries often have multiple, separate health information sources. Some interviewees expressed a desire to integrate information, monitoring and evaluation, and surveillance systems for HIV and other diseases (636-18-ONGO; 934-46-PCGOV; 331-24-PCGOV; 240-ES; 116-ES; 116-9-PCNGO; 116-16-PCGOV; 935-ES; 196-8-ML)
|
From page 480... ...
. In addition, PEPFAR has contributed to strengthening health workforce capacity for M&E, HMIS, surveillance, and the use of health information by supporting partner country education programs and institutions to integrate SI skills into pre-service curricula at local universities and colleges (331-1-USG; 331-15-USG; 331-34-USNGO; 240-12-USG)
|
From page 481... ...
. PEPFAR Achievements Despite contributing to parallel systems for collecting health information, PEPFAR has at the same time supported capacity building for national information systems across countries and improved the availability of quality information regarding HIV/AIDS (Samb et al., 2009)
|
From page 482... ...
How ever, ongoing support to strengthen partner country health infor mation systems -- and better alignment and integration with those systems -- is needed to enhance timely data availability and quality for use in strategic program planning, resource allocation, and commodities procurement. MEDICAL PRODUCTS AND TECHNOLOGIES Commodities and Supply Chain Management Background and Context Consistent access to diagnostic reagents, medicines, vaccines, and technologies requires a system of links that run from unprocessed raw materials to the delivery of the finished product; this system is commonly referred to as a supply chain (CSCMP, 2010)
|
From page 483... ...
To support effective supply chain management, the strategy committed to training supply chain management personnel and strengthening health logistics systems. The strategy also pledged to coordinate supply chain management systems to "reduce and eliminate diversion, counterfeiting, and the sale of HIV/AIDS products and supplies on the black market" (OGAC, 2004, pp.
|
From page 484... ...
Technical assistance to strengthen existing supply chains 3. Collaboration with in-country and global partners to coordinate efforts in these areas Capacity building for supply chain management To build partner country capacity for supply chain management, SCMS provides technical assistance for the strengthening of local supply chains (Jamieson, 2011)
|
From page 485... ...
to training, supportive supervision, and mentorship for health care workers (636-20-PCGOV; 240-12-USNGO; 461-13-USACA; 331-30-USPS) , including study tours abroad to learn skills for proper supply chain management (587-11-PCGOV)
|
From page 486... ...
. Partner country challenges Across partner countries, interviewees described common challenges with procurement and supply chain management (196-7-PCNGO; 196-26-USG; 331-43-USG; 636-9-USACA; 116-2-USG; 116-16-PCGOV; 166-6-USG; 166-31-USG; 461-17-PCNGO; 461-25-ML; 542-21-USNGO)
|
From page 487... ...
. When partner countries have faced stock-outs due to supply chain constraints or delays in disbursements from the Global Fund and other donors, PEPFAR has often provided buffer stocks of medicines and commodities on an emergency basis to prevent the interruption of treatment and to ensure the continuity of care (935-8-PCGOV; 935-17-USG; 587-1-USG; 461-10-PCNGO; 116-9-PCNGO; 240-7-PCGOV; 331-43-USG)
|
From page 488... ...
Reliable supply chains will be critical for sustainable and cost-efficient HIV/AIDS responses and for avoid ing disruptions to the clinical care and treatment of people living with HIV/AIDS. Laboratory Infrastructure Functioning laboratories, with the capacity to run screening, diagnostic, and clinical laboratory tests, are fundamental to the monitoring and management of patients with HIV/AIDS and other diseases (Gershy-Damet et al., 2010)
|
From page 489... ...
. COP guidance through 2009 emphasized a programmatic focus on increasing the availability and quality of laboratory services at various levels of the health system in partner countries through the purchase of equipment and commodities, the provision of quality assurance, staff training, and technical assistance (OGAC, 2008a)
|
From page 490... ...
. PEPFAR support for laboratory strengthen ing has often been aligned with partner country strategic plans, and in many countries, PEPFAR partners have assisted countries with the development of laboratory strategic plans (396-22-USG; 396-55-USG; 240-21-PCGOV; 331-17-USG)
|
From page 491... ...
During PEPFAR I, the number of individuals trained in the provision of lab-related activities increased from 3,131 in FY 2004 to 60,037 in FY 2009. During the same time period, the number of testing facilities in partner countries with the capacity to perform clinical lab tests increased from 282 to 7,211 (see Figure 9-6)
|
From page 492... ...
SOURCE: Program monitoring indicators provided by OGAC. CHALLENGES Despite PEPFAR's achievements with laboratory strengthening in partner countries, challenges remain.
|
From page 493... ...
PEPFAR support for labs has increased partner country capacity to provide laboratory services such as HIV testing (331-17-USG; 587-2-USG; 240-2-USG) , viral load testing (934-5-USG)
|
From page 494... ...
. In 2009, OGAC elevated the importance of health workforce activities by requiring that PEPFAR mission teams describe these activities in a new section of the COPs: the Human Capacity Development narrative.
|
From page 495... ...
The target emphasized training for "critically needed doctors and nurses" in order to strengthen partner country capacity to deliver primary health care and help partner countries achieve the WHO-identified critical threshold of 2.3 doctors, nurses, and midwives per 1,000 population.17 The reauthorization legislation called for building the capacity of partner country institutions in order to promote pre-service training of and postsecondary education for health professionals. OGAC's FY 2010 COP guidance prioritized the development and retention of health care workers in public and nongovernmental settings (OGAC, 2009b)
|
From page 496... ...
. Interviewees described various aspects of PEPFAR support for planning and management of national health workforces, such as support for national 18 Theselimitations refer to funding from the Global Health and Child Survival appropriations account, which is the largest source of PEPFAR funding (in FY 2010, 86 percent of PEPFAR funding was appropriated through the Global Health and Child Survival account)
|
From page 497... ...
. PEPFAR supports in-service training for multiple cadres of health workers in partner country health systems, including • doctors (396-29-PCGOV; 542-8-USNGO; 542-11-PCNGO)
|
From page 498... ...
24.1a 45.9a 28.3 26.9 21.1 23.5 In HIV-related institutional capacity building (14.4) 45.4 69.6 83.5 102.6 In HIV-related stigma and discrimination reduction (14.5)
|
From page 499... ...
, and nonclinical health workers (including workers in a health ministry, hospital and facility administrators, managers, monitoring and evaluation advisors, epidemiologists, and other professional staff critical to health service delivery and program support)
|
From page 500... ...
MEPI is coordinated by the George Washington University School of Public Health and Health Services, in partnership with the African Centre for Global Health and Social Transformation in Kampala, Uganda. The coordinating center is responsible for evaluating each grantee's program and providing technical support.
|
From page 501... ...
who completed a pre-service training program with PEPFAR support. Although CHSWs do not count toward the legislative target, these jobs are often the first step in entering the health workforce and they contribute to the pipeline for health workers (OGAC, 2009c)
|
From page 502... ...
. In 2010, recognizing the need to "increase the quantity, quality, and relevance of health care workers" in partner countries, OGAC established the Medical Education Partnership Initiative (MEPI)
|
From page 503... ...
. Retention of Health Workforce Despite tremendous efforts to train health care workers in partner countries, nearly every country has faced workforce shortages that have challenged the proper functioning of the health system (396-7-PCGOV; 396-9-PCGOV; 240-21-PCGOV; 331-6-CCM; 461-8-PCGOV; 587-10-USG; 587-25-ML; 196-16-PCGOV; 636-2-USG; 166-13; 116-23; 272 13-USG; 934-15-PCGOV)
|
From page 504... ...
. Partner country interviewees described PEPFAR support for financial and nonfinancial incentives for retaining health workers, such as the provision of health care to health care workers and their families (240-12-USG)
|
From page 505... ...
. In one partner country, increased donor funding for HIV/AIDS had both negative and positive effects; health care workers were recruited away from rural areas to work in the capital or away from primary care to HIV services, but increased funding had also increased job opportunities, which gave health care workers who had previously emigrated an incentive to return back to the country (935-2-USG)
|
From page 506... ...
For example, the initiation of antiretroviral therapy may be reassigned from doctors to nurses or health officers (240-2-USG; 272-20-NGO; 934-10-PCGOV; 636-4-PCGOV; 1167-USG; 166-6-USG; 461-14-USG) ; HIV testing may be reassigned from registered nurses to lay counselors or community health workers (272-13-USG; 934-10-PCGOV)
|
From page 507... ...
. PEPFAR Achievements PEPFAR has supported millions of training encounters, but without data on the number of health care workers working for PEPFAR programs or supported by PEPFAR funding, it is difficult to determine PEPFAR's impact on the quantity, distribution, productivity, and motivation of health care workers in partner countries (Oomman et al., 2010)
|
From page 508... ...
Service delivery stands on a pillar composed of the other blocks: leadership and governance, financing, health information, access to essential medicines and commodities, and health workforce (see Figure 9-7)
|
From page 509... ...
. While developing improved drug regimens or new laboratory tests is clearly important, true innovation in health systems approaches will come from developing new service delivery models.
|
From page 510... ...
Quality of Service Delivery PEPFAR Inputs Guidance Since its inception, PEPFAR has emphasized its goal of providing quality services for HIV/AIDS and has recognized the importance of interventions across the health systems building blocks in order to achieve this goal (OGAC, 2006a)
|
From page 511... ...
. In nearly all countries, interviewees described interventions with the health workforce as crucial for ensuring the delivery of quality services.
|
From page 512... ...
. Some PEPFAR partners provide technical assistance to support partner countries in the development and implementation of standards of care for services (240-2-USG; 196-11-USNGO; 331-12-USG; 331-16-USG; 461-18-USG; 166-15-USACA; 116-20-USNGO; 272-9-USG)
|
From page 513... ...
, and the reauthorization legislation called specifically for the integration of services to ensure a continuum of care for those affected by HIV/AIDS.20 OGAC's guidance for the development of Partnership Frameworks called for the integration of "existing parallel service delivery systems with [.
|
From page 514... ...
. In several partner countries, there was strong government support and commitment for integration (166-10-USNGO; 331-2-USG; 240-24-USG; 461-11-PCGOV)
|
From page 515... ...
. Some interviewees believed that integration of HIV services would reduce the cost of service delivery, particularly in rural areas (240-2-USG; 934-10-PCGOV; 272-20-PCNGO)
|
From page 516... ...
. In many countries, PEPFAR-supported partners have integrated reproductive health services -- such as family planning and cervical cancer screening -- with HIV services (166-9-ML/OBL/USACA/USNGO/PCNGO/PCPS; 116-18-PCNGO; 166-10-USNGO; 935-21-PCGOV; 240-24-USG; 461-21-PCNGO; 542-11-PCNGO; 934-8-USNGO; 934-17-PCGOV; .
|
From page 517... ...
. PEPFAR support has also contributed to the integrated delivery of food and nutrition interventions and HIV services, particularly for children and moderately to severely malnourished patients on ART (240-2-USG; 116-20-USNGO; 331-16-USG; 396-42-PCGOV)
|
From page 518... ...
. Interviewees noted that scaling up successful integration models could promote sus Challenges specific to partner country governments Interviewees reported vertically structured government health systems as a challenge to integration because of the lack of connections between separate government programs for managing diseases (396-22-USG; 396-45-USNGO; 542-6-ML; 587-3-USG; 272-24-USG)
|
From page 519... ...
. In many countries, PEPFAR support has strengthened health information systems, workforce capacity, and supply chain networks, and through the integration of services, these in vestments can be leveraged to improve non-HIV-related health outcomes (116-2-USG; 396-55-USG; 166-6-USG)
|
From page 520... ...
. PEPFAR supported many integration initiatives, some of them as projects or pilots, which meant that the funding stopped when the project ended.
|
From page 521... ...
. PEPFAR funding was used to support implementing partners in the provision of quality services that would ensure the confidentiality of patients (396-44-PCGOV)
|
From page 522... ...
. Data from Zambia showed both positive and negative synergies between the scale-up of nonHIV services and the scale-up of HIV services supported by PEPFAR and the Global Fund (Brugha et al., 2010b)
|
From page 523... ...
. SUMMATION There are a number of ways in which PEPFAR, in both phases of the program, has contributed to the strengthening of health systems in highHIV burden countries in the areas of workforce development, training, and retention; health information tools and systems development; health financing, with an emphasis on financial management capacity building; and capacity building and opportunities for the practical application for leadership and governance with the Partnership Frameworks and Implementation Plans.
|
From page 524... ...
• Building on the progress made through the public–private part nership with the Supply Chain Management System, PEPFAR should enhance and expand efforts with a greater focus on capacity building for accountable supply chain management in partner countries. The aim of this improved capacity should be
|
From page 525... ...
2009. The effects of global health initiatives on country health systems: a review of the evidence from HIV/ AIDS control.
|
From page 526... ...
2010a. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia.
|
From page 527... ...
:393-400. GHWA (Global Health Workforce Alliance)
|
From page 528... ...
2008. Impact beyond intent: the role of global health initiatives in ART roll-out.
|
From page 529... ...
2010. Promoting cardiovascular health in the developing world: A critical challenge to achieve global health.
|
From page 530... ...
2007. Strengthening health systems.
|
From page 531... ...
An nex: PEPFAR's contribution to the Global Health Initiative. Washington, DC: OGAC.
|
From page 532... ...
2009. An assessment of interactions between global health initiatives and country health systems.
|
From page 533... ...
2011. The logistics handbook: A practical guide for the supply chain management of health commodities.
|
From page 534... ...
2007a. Everybody's business: Strengthening health systems to improve health out comes: WHO's framework for action.
|
From page 535... ...
Global Health 4:8. Zachariah, R., N
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.