Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Global Health. 2010 Mar 2;6:3. doi: 10.1186/1744-8603-6-3.
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).
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.
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.
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.
对艾滋病毒/艾滋病的协调应对仍然是当今决策者面临的“重大挑战”之一。全球卫生倡议（GHIs）有可能促进和加剧国家和国家以下各级的协调。全球卫生倡议对协调的影响的证据开始出现，但迄今为止仅限于单一国家的研究和广泛的审查。迄今为止，没有一项研究对多个国家的国家和国家以下卫生系统受到全球卫生倡议的影响提供了重点综合分析。为了解决这一不足，我们审查了关于三项全球卫生倡议（全球抗击艾滋病、结核病和疟疾基金、总统防治艾滋病紧急救援计划（PEPFAR）以及世界银行艾滋病毒/艾滋病方案，包括多国艾滋病方案（MAP））对艾滋病毒/艾滋病方案协调影响的七个国家研究的原始数据。
2006 年至 2008 年期间，在欧洲、亚洲、非洲和南美洲的七个国家进行了国家和国家以下各级（分别为 179 次和 218 次）的深入访谈。研究探讨了国家和国家以下各级艾滋病毒协调结构的发展和运作情况，以及艾滋病毒/艾滋病协调工作在多大程度上与国家卫生系统保持一致并加强了国家卫生系统。
全球卫生倡议的积极影响包括为多部门参与创造机会，增加政治承诺，提高大多数合作伙伴的透明度。然而，参与的质量往往有限，一些全球卫生倡议绕过协调机制，特别是在国家以下各级，削弱了其效力。
本文确定了剩余的国家和国家以下各级的障碍，以有效协调和最佳利用重点全球卫生倡议的资金，这些全球卫生倡议、其他捐助者和国家伙伴需要共同解决这些问题。
