Health Policy and Planning
Volume 27 Issue 3 May 2012
http://heapol.oxfordjournals.org/content/current

Editor’s Choice: 10 best resources on … the current effects of global health initiatives on country health systems
Neil Spicer and Aisling Walsh
Health Policy Plan. (2012) 27(3): 265-269 doi:10.1093/heapol/czr034

Extract
The last decade has seen momentous shifts in the global development assistance architecture for health. Actors at global level are changing. In addition to the WHO, UNICEF, the World Bank and donor governments, new actors including philanthropic trusts and other civil society organizations, private-for-profit organizations, global health initiatives (GHIs) and partnerships are becoming increasingly significant (Brugha 2008; Walt et al. 2009). GHIs are mobilizing substantial new resources for disease control programmes in low- and middle- income countries (LMICs) leading to dramatic scaling up of services, especially for HIV and AIDS. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Emergency Plan For AIDS Relief (PEPFAR) and the World Bank’s HIV and AIDS programmes including the Multi-Country AIDS Program (MAP) collectively contribute more than two-thirds of all external funding for HIV and AIDS-related programmes in LMICs (Global Fund 2007; Oomman et al. 2007).1 They have also introduced new forms of governance, engaged non-traditional actors—private-for-profit actors and civil society—and promoted increased political support around focal diseases and public health issues.

Due to the magnitude of funding there is a growing interest in the effects of these and other major GHIs, including the GAVI Alliance (Global Alliance for Vaccines and Immunisations).2 Among the concerns expressed about GHIs are the unintended negative effects of disease-specific programmes (often perceived as ‘vertical’ programmes) including whether they undermine efforts to improve donor harmonization (co-ordination between donors) and alignment (co-ordination between donors and recipient government policies and programmes),3 place increased burdens on already weak health systems and unintentionally weaken the delivery of services for non-focal diseases (Brugha 2008; WHO Maximizing Positive Synergies Academic Consortium 2009).

Evidence is beginning to emerge from empirical studies conducted in several countries on GHI effects on country health systems. Much of …

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