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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
National and subnational HIV/AIDS coordination: Are global health initiatives closing the gap between intent and practice?
Globalization and Health, Volume 6, Article 3, Year 2010
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Description
Background: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP).Methods: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems.Results: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness.Conclusions: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address. © 2010 Spicer et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Spicer, Neil
Unknown Affiliation
Aleshkina, Julia
Unknown Affiliation
Biesma, Regien G.
Unknown Affiliation
Brugha, Ruairí F.
Unknown Affiliation
Cáceres, Carlos F.
Unknown Affiliation
Chilundo, Baltazar G.M.
Unknown Affiliation
Chkhatarashvili, Ketevan
Unknown Affiliation
Harmer, Andrew
Unknown Affiliation
Miege, Pierre
Unknown Affiliation
Murzalieva, Gulgun
Unknown Affiliation
Ndubani, Phillimon
Unknown Affiliation
Rukhadze, Natia
Unknown Affiliation
Semigina, Tetyana
Unknown Affiliation
Walsh, Aisling
Unknown Affiliation
Walt, Gill
Unknown Affiliation
Zhang, Xiulan
Unknown Affiliation
Statistics
Citations: 83
Authors: 16
Affiliations: 10
Identifiers
Doi:
10.1186/1744-8603-6-3
ISSN:
17448603
Research Areas
Infectious Diseases
Study Approach
Qualitative
Study Locations
Multi-countries