Earmarking for global health: benefits and perils of the World Bank's trust fund model.
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SUBMITTER: Winters J
PROVIDER: S-EPMC5594414 | biostudies-literature | 2017 Aug
REPOSITORIES: biostudies-literature
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Earmarking for global health: benefits and perils of the World Bank's trust fund model.
Winters Janelle J Sridhar Devi D
BMJ (Clinical research ed.) 20170831
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Project description: Not available
| S-EPMC5594420 | biostudies-literature
Project description:BackgroundIn the nearly half century since it began lending for population projects, the World Bank has become one of the largest financiers of global health projects and programs, a powerful voice in shaping health agendas in global governance spaces, and a mass producer of evidentiary knowledge for its preferred global health interventions. How can social scientists interrogate the role of the World Bank in shaping 'global health' in the current era?Main bodyAs a group of historians, social scientists, and public health officials with experience studying the effects of the institution's investment in health, we identify three challenges to this research. First, a future research agenda requires recognizing that the Bank is not a monolith, but rather has distinct inter-organizational groups that have shaped investment and discourse in complicated, and sometimes contradictory, ways. Second, we must consider how its influence on health policy and investment has changed significantly over time. Third, we must analyze its modes of engagement with other institutions within the global health landscape, and with the private sector. The unique relationships between Bank entities and countries that shape health policy, and the Bank's position as a center of research, permit it to have a formative influence on health economics as applied to international development. Addressing these challenges, we propose a future research agenda for the Bank's influence on global health through three overlapping objects of and domains for study: knowledge-based (shaping health policy knowledge), governance-based (shaping health governance), and finance-based (shaping health financing). We provide a review of case studies in each of these categories to inform this research agenda.ConclusionsAs the COVID-19 pandemic continues to rage, and as state and non-state actors work to build more inclusive and robust health systems around the world, it is more important than ever to consider how to best document and analyze the impacts of Bank's financial and technical investments in the Global South.
| S-EPMC8449994 | biostudies-literature
Project description: Not available
| S-EPMC5960987 | biostudies-literature
Project description:BackgroundMillions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities.MethodsWe operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion).ResultsAccording to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding.ConclusionsThis study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system.
| S-EPMC3750586 | biostudies-literature
Project description:ObjectivesThe impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives.MethodsThis study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence.ResultsOur analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund's financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants.ConclusionsGlobal Fund financing can help deepen health governance at multiple levels. Future work will need to explore how the financing of civil society by the Global Fund and other donors influence policy agenda-setting and institutional innovations for increased civic participation in health governance and accountability to citizens.
| S-EPMC3474152 | biostudies-literature
Project description: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.
| S-EPMC11563383 | biostudies-literature
Project description:The Global Fund to Fight AIDS, Tuberculosis and Malaria has proven highly effective at fighting the world's major killers. Strong governance and robust development institutions are necessary, however, for improving health long-term. While some suggest that international aid can strengthen institutions, others worry that aid funding will undermine governance, creating long-term harm. The Global Fund is a unique aid institution with mechanisms designed to improve transparency and accountability, but the effectiveness of this architecture is not clear. This study seeks evidence on the effects of Fund financing over the past 15 years on national governance and development. A unique dataset from 112 low- and middle-income countries was constructed with data from 2003 to 2017 on Global Fund financing and multiple measures of health, development, and governance. Building a set of regression models, we estimate the relationship between Fund financing and key indicators of good governance and development, controlling for multiple factors, including the effects of other aid programs and tests for reverse causality. We find that Global Fund support is associated with improved control of corruption, government accountability, political freedoms, regulatory quality, and rule of law, though association with effective policy implementation is less clear. We also find associated benefit for overall adult mortality and human development. Our data are not consistent with recent claims that aid undermines governance. Instead our findings support the proposition that the Global Fund architecture is making it possible to address the continuing crises of AIDS, tuberculosis, and malaria in ways that improve institutions, fight corruption, and support development. Amidst the complex political economy that produces good governance at a national level, our finding of a beneficial effect of health aid suggests important lessons for aid in other settings.
| S-EPMC6634388 | biostudies-literature
Project description:IntroductionEnvironmental Health in a Global World at New York University was re-designed as a class participatory effort, challenging undergraduate students to understand environmental hazards and the resultant adverse health outcomes by embracing the inherent complexity of environmental risks and proposing solutions.MethodsFollowing introductory lectures, students are placed into teams and assigned a specific perspective, or avatar, which includes learning to see the challenge from the perspective of a technical expert such as a biologist, an engineer, or an anthropologist. The teams then design specific systems maps to visualize the complex interactions that lead to adverse health outcomes after a given environmental exposure. The maps highlight potential leverage points where relatively minor interventions can provide a disproportionate benefit in health outcomes. The teams then explore potential interventions and identify the potential unintended consequences of those actions, develop and advocate for innovative new strategies to mitigate risk and improve outcomes.Results and discussionOver the past 5 years, we have taught this methodology to over 680 students with strong, student-oriented results. The teams created and presented more than 100 strategies, addressing a diverse set of environmental challenges that include water contamination, gun violence, air pollution, environmental justice, health security, and climate change. Developing the strategies helped the students understand environmental threats in a more holistic way, provided them with some agency in finding solutions, and offered an opportunity for them to improve their presentation skills. The responses in course evaluations have been enthusiastic, with many students reporting a deep impact on their college experience.
| S-EPMC10297959 | biostudies-literature
Project description: Not available
| S-EPMC1239969 | biostudies-literature
Project description:BackgroundThis study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor-recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability.MethodsWe conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998-2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010-2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson's health policy analysis model and the World Health Organization's health system building blocks. We used process tracing for analysis.ResultsAccording to the collected data, our case study identified three reemergent, interrelated aspects of donor-recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases.ConclusionsGiven the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor-recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international-domestic expert partnerships to identify and respond to contextual enablers and barriers.
| S-EPMC10838425 | biostudies-literature