1. Health Systemwide Effects of the Global Fund in Benin and Ethiopia XV International AIDS Conference Bangkok July 12, 2004 Owen Smith, Abt Associates Inc., Presenter Sara Bennett, Abt Associates Inc., Principal Investigator Kate Stillman, Abt Associates Inc. Pia Schneider, Abt Associates Inc.

2. Scale of Donor Support Examples from Sub-Saharan Africa Sources: GF, WB/WDI 2001, WHO/WHOSIS 2001 Average annual GFATM, MAP, and PEPFAR funding as a share of annual public health spending

3. Motivation and Background Funding mechanisms such as the Global Fund may have a variety of direct and indirect effects upon health care systems. While increased funding to fight HIV/AIDS, TB, and malaria is equitable, just, and necessary, it is unclear how this money could be best spent. To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems.

4. Research Objectives To document the effects on health care systems of applying for and receiving a Global Fund grant, and implementing Global Fund-supported activities To derive lessons for: Country level stakeholders Global Fund Board and Secretariat Broader global health community

5. Thematic Areas and Conceptual Framework Conceptual framework suggests that effects may be intended or unintended, and they may enhance health system performance or detract from it Studies focus on four thematic areas, namely effects on: Policy Environment Human Resources Public / Private Mix Pharmaceuticals and Commodities

6. Research Approach Research conducted through the Systemwide Effects of the Fund (SWEF) research network Collaborative network of research organizations and individual researchers from the South and North SWEF partners seek to measure systemwide effects through a series of country studies SWEF partners are implementing components of the study in Benin, Ethiopia, Malawi, Georgia, Nicaragua, Zambia*, Uganda*, Mozambique* * Not confirmed

7. Methodology Based on a SWEF core research protocol, adapted to fit country context and information needs Facility surveys Provider interviews Key informant interviews Document review, routine HIS, other sources Use of common protocol helps ensure quality and comparability

8. Emerging Issues Early observations from Benin and Ethiopia Decentralized vs. centralized approaches Integration vs. verticalization Shortage of health workers Extensive training and capacity building Alignment with existing pharmaceutical procurement systems or creation of parallel systems Harmonization with existing cost recovery policies or new policies Lab strengthening

9. For more information: www.phrplus.org/swef SWEF Network Members Partners for Health Reform plus London School of Hygiene and Tropical Medicine Institute for Tropical Medicine Antwerp Curatio International Foundation (Georgia) Instituto Centroamericana de la Salud (ICAS, Nicaragua) Miz-Hasab Research Center (Ethiopia) Health Systems Trust (South Africa) Measure Evaluation & Rational Pharmaceutical Mgt plus Projects IBF Consulting Independent researchers Thank you