Global health initiatives and delivery of health care: the case of the Global Fund to fight AIDS, TB and Malaria

This study aims at assessing the impact of Global Fund-supported activities on the delivery of non-HIV services, health worker availability, workload, incentives and motivation and drug management, focussing on Malawi.

Two rounds of data collection took place in December 2006/January 2007 and June/July 2008 at 52 randomly sampled health facilities in nine districts where 524 respondents including health service managers and service providers were interviewed. Records of clients accessing the services were also collected for the period spanning the last quarter of 2005 to the first quarter of 2008.

The findings from the study show:

• 10% increase in clinical staff in urban and district level hospitals
• three- to six-fold increase in the numbers of health surveillance assistants in the district and sub-district facilities
• workload had risen three to five times resulting in most staff (68%) working beyond normal hours and facilities resorting to task shifting
• no tangible incentives were identified that could be associated with Global Fund-supported activities
• drug management and processes of requisition and replenishment had improved resulting in a reduction of drug stock-outs by 35-60% between 2006 and 2008
• client volumes for antiretroviral therapy (ART), HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) services rose three to seven times in the period
• there were no concomitant declines that could be attributed to Global Fund in client numbers for the non-HIV services.

It is evident that increased funding for HIV has been associated with a mix of both positive and negative effects on the wider health system. Overall, the Global Fund is seen as having had a positive effect on health systems in the country.