Funded health projects no cure for Kenya’s ailing systems

A survey done in Kenya has established that disease-specific initiative, such as the Global Fund and Pepfar are having mixed impacts on recipient countries’ health systems, and should be retooled to become less disruptive.

The finding is likely to fuel the debate on the most effective ways of channelling support to poor countries’ health systems.

Disease-specific initiatives, commonly known as Global Health Initiatives (GHIs), have gained prominence over the past decade or so.

The Global Fund, a multilateral pool established by rich countries at the turn of the millennium for example, targets HIV/Aids, malaria and tuberculosis.

Pepfar, or the President’s Emergency Plan for Aids Relief, an initiative of former US president George W. Bush, is meant to help about a dozen poor countries hard-hit by HIV/Aids deal with the pandemic.

According to the survey, which was conducted by the non-governmental organisation Groots Kenya between November 2008 and March 2009, GHIs are having both positive and negative impacts on recipient countries extending far beyond their primary targets.

The Groots survey involved interviews with more than 1,400 players in the health sector at various levels, ranging from community-based workers to policy-makers.

The survey established that the inflow of huge amounts of funding from GHIs can distort effects on weak public health systems in countries such as Kenya, with a key problem being the diversion of qualified personnel from public health institutions to better-paying funded programme jobs. This, the report noted, essentially amounts to an “internal brain drain.”

Notes the Groots report: “Significant opportunities to maximise positive synergies have been missed in Kenya, in particular in the area of training and retention of additional professional health workers, modernising and equipping health infrastructure, and compensating and recognising community health workers and home-based care providers.”

On the positive side however, the survey established that GHIs can help expand health workers’ training, and contribute to an overall reduction in the number of deaths from the targeted disease.

In Kenya, for example, analysts say the provision of anti-retrovirals to nearly 250,000 HIV-infected people, as well as support for awareness campaigns has seen both the death and infections rates fall dramatically over the past five years, turning HIV into a chronic infection and not a death sentence.

The other negative is the duplication of programmes due to poor co-ordination between the national public health system and GHI-sponsored programmes.

This also led to scenarios where specific community priorities are often ignored as some diseases are neglected, and local community-based organisations frequently side-lined as new entrants are better-funded.

Other positive effects of GHIs has been the raising of capacity of health facilities in the rural areas to respond to priority diseases, for example through the employment of additional community health workers and nurses. GHIs also fund the construction of health facilities in public health institutions.

Elsewhere, benefits for communities include the improvement of living standards for affected people, such as HIV/Aids orphans and widows, as well as the greater involvement of community-based organisations in the implementation of local projects.