Belgium, Benin, Burundi, China, Ethiopia, Georgia, Ireland, Kyrgyzstan, Lesotho, Malawi, Mozambique
Peru, South Africa, Sweden, Tanzania, Uganda, Ukraine, United Kingdom, USA, Vietnam, Zambia
Researching National & Subnational Effects of Global HIV/AIDS Initiatives at the Country Level
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Tragard A. Shrestha I.
Health Policy and Planning 25 (suppl 1): i58i62
Institute of Medicine Kathmandu
Nepal, health systems strengthening, financing, Global Fund
Case study analysis
To assess the extent of integration of national HIV, tuberculosis (TB) and malaria programmes with the general health system; the integration of the Global Fund-portfolios within the national disease programmes; and system-wide effects on the health system in Nepal.
Literature review and use of a Systematic Rapid Assessment Toolkit (SYSRA) for gathering information about structures and modes of operation of complex health systems. 29 interviews with government health officials, partners and civil society actors at national, regional and district levels. The SYSRA toolkit proposed six health systems functions: stewardship and governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. These were subdivided into 25 elements, for which the level of integration was classified as not integrated, partly integrated or fully integrated, through iterative analysis and triangulation of the collected data.
The wider effects of disease-specific initiatives on health systems can be viewed as positive in a resource-constrained environment, especially by strengthening disease structures and systems and facilitating civil society involvement.