International AIDS Society


Health system strengthening through global health initiatives - a mixed methods case study from Haiti

L. Ivers1,2,3, J.-G. Jerome4, E. Sullivan5, J. Talbot2, N. Dhavan2, S.L. Mackinley4, W. Lambert4, J. Rhatigan3, J. Kim5, J. Mukherjee1

1Partners In Health, Boston, United States, 2Brigham and Women's Hospital, Boston, United States, 3Harvard Medical School, Boston, United States, 4Partners In Health/Zanmi Lasante, Cange, Haiti, 5Harvard School of Public Health, The François-Xavier Bagnoud Center for Health & Human Rights, Boston, United States

Background: International funding for HIV care has increased in the last five years due to new Global Health Initiatives (GHI) such as the Global Fund to fight AIDS, TB and Malaria (GFATM) and the United States President's Emergency Fund for AIDS Relief (PEPFAR) Though these GHI are targeted to specific disease entities, increasing attention is being paid to the impact that such initiatives have on the health system as a whole. Our objective was to evaluate the impact of GFATM and PEPFAR on the health system in Haiti since their introductions in 2003 and 2004 respectively.
Methods: We used mixed qualitative and quantitative methods, including semi-structured interviews, observation, examination of documentary material, and collection of quantitative data. Twelve key informants from nongovernmental organizations (NGOs), international organizations and the Ministry of Health (MOH) participated in semi-structured interviews. We used NVivo8 software to analyze the transcripts. Quantitative data from 1998-2008 from five representative health facilities triangulated the qualitative findings.
Results: Preliminary analysis demonstrates a complex interaction between GFATM/PEPFAR and Haiti's health system as a whole. GFATM /PEPFAR were largely associated with strengthening of the health system, particularly in geographic areas and in programs where NGO leaders and/or MOH officials specifically designed and coordinated their interventions to have such an impact. Where deliberate planning and coordination did not exist, the GHIs had a more 'vertical' effect, impacting primarily the targeted diseases. GFATM/PEPFAR were associated with overall improvement in human resources capacity and retention, but the influx of funding did cause some tensions due to salary inequities. GFATM/PEPFAR funds were not received directly by the government of Haiti, and this empowered NGOs to work independently of the MOH.
Conclusions: Targeted GHI such as GFATM and PEPFAR can successfully strengthen health systems if this objective is included in planning and design and if leadership and coordination are ensured.

Cape Town - IAS 2009
Abstract no. 2009_MOPED062

Suggested Citation
"L.Ivers, et al. Health system strengthening through global health initiatives - a mixed methods case study from Haiti. : Cape Town - IAS 2009: Abstract no. MOPED062"

Also available