Ambitions and realities: Are Global Fund investments designed to achieve resilient and sustainable systems for health? Findings from the Global Fund Prospective Country Evaluation.

Autor:	Salisbury N; Health Systems Team, Primary Health Care Program, PATH, Seattle, Washington, United States of America., Nawaz S; Health Systems Team, Primary Health Care Program, PATH, Seattle, Washington, United States of America., Abenaitwe J; Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda., Batzel A; Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR), Guatemala City, Guatemala., Grapa E; Health Systems Team, Primary Health Care Program, PATH, Seattle, Washington, United States of America., Casas FR; Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America., Cerezo V; Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR), Guatemala City, Guatemala., Cooper M; Euro Health Group, Copenhagen, Denmark., Duber HC; Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America., Gaye I; Institut de Santé et Développement (ISED), Université Cheikh Anta Diop (UCAD), Dakar, Senegal., Hernandez B; Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America., Kingongo C; DRC Country Program, PATH, Kinshasa, Democratic Republic of the Congo., Lush L; Euro Health Group, Copenhagen, Denmark., Macintyre K; Euro Health Group, Copenhagen, Denmark., Manika E; DRC Country Program, PATH, Kinshasa, Democratic Republic of the Congo., Nagasha SN; Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda., Ndoye T; Institut de Santé et Développement (ISED), Université Cheikh Anta Diop (UCAD), Dakar, Senegal., Orozco R; Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR), Guatemala City, Guatemala., Osterman A; Health Systems Team, Primary Health Care Program, PATH, Seattle, Washington, United States of America., Shelley KD; Health Systems Team, Primary Health Care Program, PATH, Seattle, Washington, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Nov 14; Vol. 4 (11), pp. e0003914. Date of Electronic Publication: 2024 Nov 14 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003914
Abstrakt:	Strengthening resilient and sustainable systems for health (RSSH) is central to the Global Fund's strategy, however questions persist about the Global Fund's role in the health systems strengthening space, and the extent to which investments are designed to achieve strengthening objectives, or just fill in gaps in the system. This paper reports on findings from the Prospective Country Evaluations (PCE), a multi-country multi-year evaluation of Global Fund support. We adapted a framework from Chee et al. (2013) to assess whether Global Fund investments were designed to strengthen or support the health system. Per this framework, 'systems support' refers to improvements in health systems functioning primarily driven by increases in inputs, whereas 'systems strengthening' refers to activities that drive changes in how the health system operates (often related to policies, regulations, governance structures, behavior change, and resource optimization). In the 2017 and 2019 funding cycles, we found that despite calls from the Global Fund to invest more strategically to strengthen health systems, a high proportion of RSSH funding was directed toward activities that support the health system. Factors underlying this pattern include limitations imposed by the three-year grant cycle, a lack of clear guidance on how to design strengthening investments, a persistent need for funding to address input gaps, and minimal feedback during the funding request process related to RSSH design. For the Global Fund, and indeed other global health initiatives, to contribute to sustained strengthening of health systems, is likely to require enhanced guidance and technical assistance, as well as improved measurement of outputs and outcomes. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Salisbury et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu