title: Critical interactions between the Global Fund-supported HIV programs and the health system in Ghana.
abstract: The support of global health initiatives in recipient countries has been vigorously debated. Critics are concerned that disease-specific programs may be creating vertical and parallel service delivery structures that to some extent undermine health systems. This case study of Ghana aimed to explore how the Global Fund-supported HIV program interacts with the health system there and to map the extent and nature of integration of the national disease program across 6 key health systems functions. Qualitative interviews of national stakeholders were conducted to understand the perceptions of the strengths and weaknesses of the relationship between Global Fund-supported activities and the health system and to identify positive synergies and unintended consequences of integration. Ghana has a well-functioning sector-wide approach to financing its health system, with a strong emphasis on integrated care delivery. Ghana has benefited from US $175 million of approved Global Fund support to address the HIV epidemic, accounting for almost 85% of the National AIDS Control Program budget. Investments in infrastructure, human resources, and commodities have enabled HIV interventions to increase exponentially. Global Fund-supported activities have been well integrated into key health system functions to strengthen them, especially financing, planning, service delivery, and demand generation. Yet, with governance and monitoring and evaluation functions, parallel structures to national systems have emerged, leading to inefficiencies. This case study demonstrates that interactions and integration are highly varied across different health system functions, and strong government leadership has facilitated the integration of Global Fund-supported activities within national programs.
authors.affiliation: Strategy, Performance and Evaluation Center, The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Chemin de Blandonnet 8, 1214 Vernier, Geneva, Switzerland. rifat.atun@theglobalfund.org
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.forename: Sai Kumar
authors.initials: SK
authors.lastname: Pothapregada
authors.forename: Janet
authors.initials: J
authors.lastname: Kwansah
authors.forename: D
authors.initials: D
authors.lastname: Degbotse
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Lazarus
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D006282:Health Personnel / Q000191:economics / Q000193:education / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007391:International Cooperation; D008297:Male; D019982:Organizational Case Studies / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents; D018501:Antirheumatic Agents