1. Global HIV/AIDS Initiatives Network Presentation to third expert consultation on positive synergies between health systems and Global Health Initiatives Ruairí Brugha www.ghinet.org 2 nd October 2008

2. Research Funders Country Studies Research Partners Network (GHIN) Funders OSI Kyrgyzistan Ukraine Zambia LSHTM (UK) EU INCODEV Mozambique Angola South Africa x 2 Lesotho RCSI (Ireland) Belgium Portugal Vietnam Sweden Alliance for Health Policy and Systems Research Tanzania Uganda Peru China Georgia Malawi Ethiopia Benin Malawi Irish Aid DANIDA USAID SWEF Health 20/20 RCSI LSHTM

3. Network Aims 1.Promote comparability through common research protocols and tools 2.Share expertise across country study teams and build research capacity 3.Generate multi-country comparisons and context specific lessons 4.Coordinate dissemination of findings/recommendations at global level

4. Research methods 1.National Level  Context mapping/country literature/ document reviews  In-depth qualitative interviews with key stakeholders 2.Sub-national/district level – Quantitative methods  Resource tracking?  District mapping  Facility surveys and analysis of facility / District Health Management records  Structured health worker questionnaires  Structured client questionnaires 3. Sub-national/district level – qualitative methods  In-depth sub-national stakeholder interviews  In-depth client interviews

5. Preliminary findings 1.Scale-up and access to HIV/AIDS services + – GHIs have supported increases in HIV/AIDS services, but health worker numbers have not kept pace with needs +Little evidence to show that scale-up of HIV/AIDS services has had a negative effect on non-focal disease coverage – Concern over preference given to funding for treatment over prevention –Differential access - geographical distribution of services, esp in Africa. - stigma and discrimination, esp in concentrated epidemics

6. Preliminary findings 2.Human Resources – Some increases in staff numbers, but these have not kept pace with increased workload in sS Africa + Many staff received training funded by GHIs + – Incentives often given to health staff providing HIV related care + – Staff motivation differed from country to country: – Low due to work overload + Raised by opportunities for ‘top ups’ to salaries, additional training and work satisfaction

7. Preliminary findings 3.The challenge of coordination + Most countries have made some effort to address need for greater coordination at national level BUT – Incentives for coordination are weak and practice falls far short of policy intent, especially at the sub-national levels + – Harmonisation of donor policies and alignment with national policies variable across countries – Coordination of M&E poor in most countries

8. Health Systems Framework GHI Investment Government Expenditure Private Expenditure Other External Expenditure Epidemiological Demographic Political SocialLegal Technological Environmental Economic Governance / Coordination Financing Health Workforce Monitoring & Evaluation Health Technologies Communities/ Civil Society DELIVERYDELIVERY Health Outcomes Fairness of Financing Responsiveness Historical