An assessment of interactions between global health initiatives and country health systems

By now, the becoming business-like of nonprofit organizations (NPOs) is a well-established global phenomenon that has received ever-growing attention from management and organization studies. However, the field remains hard to grasp in its entirety, as researchers use a multitude of similar, yet distinct, key concepts. The considerable range and complexity of these overlapping notions create major challenges: Scholars struggle to position their work in a larger context; it is not easy to build on previous findings and methodological developments; and research gaps are difficult to identify. The present article presents the first systematic literature review to confront those challenges by reviewing 599 relevant sources. In a first step, various key concepts are clarified. Second, the field is mapped according to three research foci: causes of NPOs becoming business-like, organizational structures and processes of becoming business-like, and effects of becoming business-like. From this, we draw conclusions...

Nonprofit Organizations Becoming Business-Like A Systematic Review

EndNote Database of literature reviewed for the article: Nonprofit Organizations Becoming Business-Like: A Systematic Review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30856-X.pdf

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward. Considerably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too – among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts. Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both. The evidence is mixed – mostly positive but some negative – as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems.

/pdf/investment-in-hiv-aids-programs-does-it-help-strengthen-4u1iuxo0yr.pdf

Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries?

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.

https://www.who.int/alliance-hpsr/resources/alliancehpsr_spicerghin2010.pdf

National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments.

Although civil society advocacy for health issues such as HIV transmission through injecting drug use is higher on the global health agenda than previously, its impact on national policy reform has been limited. In this paper we seek to understand why this is the case through an examination of civil society advocacy efforts to reform HIV/AIDS and drugs-related policies and their implementation in three former Soviet Union countries. In-depth semi-structured interviews were conducted in Georgia, Kyrgyzstan and Ukraine by national researchers with representatives from a sample of 49 civil society organizations (CSOs) and 22 national key informants. We found that Global Fund support resulted in the professionalization of CSOs, which increased confidence from government and increased CSO influence on policies relating to HIV/AIDS and illicit drugs. Interviewees also reported that the amount of funding for advocacy from the Global Fund was insufficient, indirect and often interrupted. CSOs were often in competition for Global Fund support, which caused resentment and limited collective action, further weakening capacity for effective advocacy.

/pdf/has-global-fund-support-for-civil-society-advocacy-in-the-118o6xmc49.pdf

Julia Aleshkina

Papers

National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments.

Has Global Fund support for civil society advocacy in the Former Soviet Union established meaningful engagement or ‘a lot of jabber about nothing’?

Tracking Global HIV/AIDS Initiatives and their Impact on the Health System: the experience of the Kyrgyz Republic