Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Glob Health Res Policy. 2021 Aug 9;6(1):27. doi: 10.1186/s41256-021-00212-4.
The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs).
We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar's health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach.
We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector.
There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund's funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.
全球基金一直是缅甸艾滋病毒/艾滋病规划的主要资金来源。在这项定性研究中，我们旨在了解全球基金在千年发展目标（MDG）时代对缅甸国家艾滋病毒/艾滋病应对的影响。
我们通过有目的的滚雪球抽样，招募关键信息提供者，进行个人深入访谈。受访者参与了缅甸国家/国家艾滋病应对工作，并在联合国机构、非政府组织（NGO）和民间社会工作。访谈问题围绕全球基金在加强缅甸卫生系统的六个组成部分中的国家艾滋病毒/艾滋病应对方面的作用组织。通过演绎方法，从关键信息提供者那里合成的转录本被综合成具体的主题。
我们发现，全球基金为（1）为缅甸的国家艾滋病毒/艾滋病应对提供了大量资金支持，（2）通过改善协调和合作，加强了中央一级的领导和治理，包括更多的利益攸关方（如民间社会、非政府组织）参与决策过程，并推动了扩大关键干预措施的政策变化。然而，它在满足乡镇一级快速扩大艾滋病毒干预措施和公共部门服务提供权力下放所带来的能力建设、人员配备和医疗供应方面的新需求方面的作用仍然有限。
缅甸有机会利用全球基金的资金加强卫生系统，但没有充分利用这一机会。需要精心规划，以优化这些稀缺资源的利用，为艾滋病毒/艾滋病提供普遍覆盖。
