Research

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

Neil Spicer¹ , Julia Aleshkina² , Regien Biesma³ , Ruairi Brugha³ , Carlos Caceres⁴ , Baltazar Chilundo⁵ , Ketevan Chkhatarashvili⁶ , Andrew Harmer¹ , Pierre Miege⁷ , Gulgun Murzalieva² , Phillimon Ndubani⁸ , Natia Rukhadze⁶ , Tetyana Semigina⁹ , Aisling Walsh³ , Gill Walt¹ and Xiulan Zhang⁷

¹  Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

²  Health Policy Analysis Center, Togolak Moldo 1, Bishkek, 720045, Kyrgyz Republic

³  Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland

⁴  School of Public Health, Cayetano Heredia University, Avenue Armendariz 445, Lima 18, Peru

⁵  Departamento Saude da Comunidade, Universidade Eduardo Mondlane, Praça 25 de Junho, Maputo, 257, Mozambique

⁶  Curatio International Foundation, 37d Chavchavadze Avenue, Tbilisi, 0162, Georgia

⁷  Beijing Normal University 19 Xin jie kou wai da jie, Beijing, 100875, China

⁸  Institute of Economic and Social Research, University of Zambia, Lusaka, P.O. Box 32379, Zambia

⁹  School of Social Work, Kyiv-Mohyla Academy, 2 Skovorody Vul, Kyiv, 04070, Ukraine

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Globalization and Health 2010, 6:3doi:10.1186/1744-8603-6-3

Published:	2 March 2010

Abstract

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.