PMID- 20680864
OWN - NLM
STAT- MEDLINE
DCOM- 20101228
LR  - 20100803
IS  - 1360-0451 (Electronic)
IS  - 0954-0121 (Linking)
VI  - 22 Suppl 1
DP  - 2010
TI  - The impact of Global Health Initiatives at national and sub-national level - a 
      policy analysis of their role in implementation processes of antiretroviral 
      treatment (ART) roll-out in Zambia and South Africa.
PG  - 93-102
LID - 10.1080/09540121003759919 [doi]
AB  - Global Health Initiatives (GHIs), such as the President's Emergency Plan For AIDS 
      Relief (PEPFAR) and the Global Fund to Fight AIDS, TB and Malaria (the GFATM), 
      have emerged as new mechanisms for development assistance in health. By 2008, 
      GHIs were providing two-thirds of all external funding for HIV/AIDS globally. In 
      Zambia and South Africa over the past five years, PEPFAR and the GFATM have 
      provided significant funding for the public sector provision of anti-retroviral 
      treatment (ART). GHIs are a feature of a new global health governance. A study of 
      their role in implementation helps to explore some of the challenges of this new 
      system of governance at national and sub-national level. This paper draws on 
      policy analysis research that involved 150 interviews with policy-makers at 
      national, provincial and district level in both countries, conducted as part of 
      Ph.D. fieldwork between August 2007 and June 2008. Research findings show that 
      GHIs impacted on policy-implementation processes at national and sub-national 
      level, on aspects of the ART programme and the wider health system. Study results 
      highlight GHIs impact both through funding and the mechanisms, and processes by 
      which their support is provided. Evidence suggests that while GHIs have 
      contributed significantly to enabling the rapid scale-up of ART in both the 
      countries, they may also have had a negative impact on coordination, the 
      long-term sustainability of treatment programmes and equity of treatment access. 
      In addition, their programmes may have contributed to disconnect between HIV 
      prevention and treatment initiatives. The comparative findings from Zambia and 
      South Africa highlight some of the challenges in implementation of GHI programmes 
      at country and sub-country level that need to be addressed urgently, to mediate 
      against negative consequences for the health systems and policy processes in both 
      countries.
FAU - Hanefeld, Johanna
AU  - Hanefeld J
AD  - Health Policy Unit, London School of Hygiene and Tropical Medicine, University of 
      London, London, UK. Johanna.hanefeld@lshtm.ac.uk
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - AIDS Care
JT  - AIDS care
JID - 8915313
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Anti-Retroviral Agents/economics/*therapeutic use
MH  - HIV Infections/*drug therapy/economics
MH  - Health Planning
MH  - Humans
MH  - *International Cooperation
MH  - National Health Programs/*organization & administration
MH  - Policy Making
MH  - South Africa
MH  - Zambia
EDAT- 2010/08/14 06:00
MHDA- 2010/12/29 06:00
CRDT- 2010/08/04 06:00
PHST- 2010/08/04 06:00 [entrez]
PHST- 2010/08/14 06:00 [pubmed]
PHST- 2010/12/29 06:00 [medline]
AID - 924968227 [pii]
AID - 10.1080/09540121003759919 [doi]
PST - ppublish
SO  - AIDS Care. 2010;22 Suppl 1:93-102. doi: 10.1080/09540121003759919.