HSS and CSS can be achieved by providing support for State/Community/Grass root level policy and strategy development and implementation planning as well as building the capacity at the grass root on stewarship, services delivery etc to coordinate Aid and harmonise plans with donors.

 

In addition, it is also important to develop and implement human resources for health strategies for meeting service delivery needs, establish systems for financial risk protection for the poor and the vulnerable, and for procurement and distribution of essential commodities such as ITNs and ACTs etc.

 

Finally the involvement of credible NGOs with strength in health system to assist the States/ LGA and Community to deliver TB/HIV Malaria interventions through a strengthened primary health care (PHC) system by these there will be improvement in many outcomes such as population coverage of effective measures for the prevention of Malaria TB/HIV/AIDS; improved access of the population to effective treatment for the diseases; and increased community awareness and demand for effective malaria treatment and prevention

I appreciate the interest taken by the Global Fund in strengthening health care systems at national and community level and glad you invited me to put forward my suggestion in improving the utilization of available support in the island of Sri Lanka in an effective way.

 

Malaria

 

It is a known fact that the malarial parasitic infection is of very low prevalence in the island now. However, we experience sporadic cases of malaria from time to time in identified areas. To use the Global Fund support for the complete eradication of the infection, I suggest more realistic active surveillance, identifying the plasmodium species involved in molecular level, determination of sensitivity and resistance levels of anti malarial regimen available and looking for effective control are the needs of the hour.

 

 

As a clinician-cum-scientist, I believe that the effective management of diagnosed cases is equally important as the early detection and prevention of the disease as well. I have observed the Directly Observed Therapy (DOT) which is strongly recommended by the National TB treatment guidelines is for no reason is superior to the inward management of open TB cases. Open cases have higher chances of spreading the infection among the family and the society. No assurance can be given that the patient is regularly taking the treatment for the recommended period. There is no proper way to trace multi drug resistance. No effective feed back or monitoring system in place. No effective arrangements are made to screen contacts or the family members of an open TB patient on DOT. I personally believe that the global fund should have the initiative and the interest in addressing these questions in patient management. I suggest that the intervention of global fund in detection of cases is a timely need as most of the rural health care facilities in the country lack tools to diagnose a TB patient at a very early stage. I have learned after discussing with some of the clinicians across the country that most of the current infections are caused by atypical bacilli. Emphasis should be made to identify these atypical bacteria and if the prevailing drug resistance is linked with it. I feel the Global Fund team should take the lead in finding answers to these questions. I doubt if at least the National directives have identified these issues in TB infection control.

 

HIV/AIDS

 

According to the National STD/AIDS Control Programme (NSACP), reported number of cases by end 2007 was 923. But, neither descriptive data to explain the subtype distribution patterns nor information about the subtypes imported to the island was described in terms of HIV infection in Sri Lanka, to date. To fill this gap in the National HIV Information, I propose an elaborative study on reported HIV cases to NSACP. Further, I feel statistical data shown by NSACP of confirmed cases is as looking only at the tip of an iceberg. Therefore, an active surveillance to determine the actual number of individuals infected with HIV is a timely requirement. For my knowledge, everyone who utilizes government and international funds shows their interest in population based awareness programmes. But, I strongly feel Global Fund should be more realistic addressing questions pertaining to HIV/AIDS. I suggest taking an active role in determining the subtypes circulating in island, checking the effectiveness of treatment by viral load testing and helping the interested parties to estimate the HIV infection in the community by means of active surveillance of risk groups should be the Global Funds motive if it show a real interest in strengthening health care system in this beautiful island.

 

Nalaka Kanakaratne

To, e-Forum 2008,

 

Received reminder. In preceding discussion I detailed scope of GF various component for less health infrastructure countries, & community structure.In developing countries,country's community structure including state& peripheral communities,urban,rural, tribal,labour,marginalised groups can not represent systematic organisation functions.E.g. structure,technology,economy,construction enterprize approaches.For systematic organisation functions,urban infrastructure & rural infrastructure should be collectively responsible for integration of national health system up to grass root level.In above socio-demographical factors,GF financial instrument could give CSS& CCM ,balanced & contribution support program to community structure in developing countries. In South-East Asian region-India, I have taken number of institutional& procedural measures like establishment of rural organisation,institutional mechanism, private& govt.health system accessment to grass root level & multi-objective education mechanism. Community structure could include co-operation between affected population,employers(social organisation,government),third party carriers& NGO's for constant surveillance cost-effective approaches for drugs& health system. Community structure could provide socio-economic aspects of health infrastructure to affected population by inclusion of social intervention of medical services, biological& behavioural services. In GF, CCM,& CSS have complete structure of representation of social intervention,integrated with medical services,biological & behavioural science through various institution mechanism . Developing countries with differ cultural, traditional, rituals & practices could use CCM & CSS for better support of GF in health system strengthening. In accessibility of national budget for health infrastructure,harmony between govt& affected population could use GF framework in less GDP& developing countries. GF's innovative financing ,distribution of funding , expenditure could give financial support to health system& evaluation of infrastructure,accessibility limitation in less health system infrastructure countries.

 

Thank you

 

ASHISH SRIVASTAVA

Dear friends,

 

In the recent world the control of diseases such as HIV/AIDS, TB, Malaria has concentrated attention on intervention that need to be scale up such as anti-retroviral therapy, TB and Malaria treatment or intermittent treatment of pregnant women for Malaria. However, the great majority of interventions depend in some way on basic infrastructure of services that provides resources and supervision. The success of efforts to improve health in developing countries depends in large part on the strength of their health systems. While these countries possess a range of capacities to enhance the functioning of their systems, low–income countries face considerable constraints in doing so, not the least of which is poorer access to health resources.

 

It depend country to country Health Policy and socio-economic conditions. Strengthening health system required action – simultaneously or appropriately sequenced – on a number of fronts. The administrators may need to pay attention to the health system’s functions as well as relationships between the health system, its clients, partners and their community. About 1.4 billion people live in South Asia, the world’s second most populous region. The proportion of people whose income is less than $1 a day has decreased greatly since 1990. Primary school enrollment is up; mortality rates for children under age five are down. Despite this progress, more people live in extreme poverty here than in any other region. GF as a global partner in the health service to the low-income countries has a important role to support to strengthen the health system. Thank you all. Asima Chakraborty General Secretary TOPER, India

According to World Health Organization, Health is a complete state of mental, physical and psychological well being of an individual and not merely the absence of disease or infirmity.

 

To strengthen a healthy system the Human and Material resources must come into play. For this to be achievable:-

 

- There must be proper application of management principles ie: Planning, Organizing, Communication, Decision Making, Financing, Budgeting, Directing, Coordinating etc.

 

- There must be proper Monitoring and Evaluation. This is an important component in any project, it is the wheel that drives an Organization to success.

 

- Equity and Accountability in dealing with issues.

 

Having established the above, the Global Fund and partners should ensure that:-

 

- Funds are extended to appropriate channel, for appropriate project that will benefit the targeted appropriate persons. The reason for the above is to ensure probity, accountability all in view to Goal attainment. To do the above there will be need for appropriate Training (capacity building) of project  implementers (CSOs) to ensure project  attainment.

 

The Global Fund should adopt the use of Grass root resource personnel who will be responsible for project monitoring, evaluation and reporting, to ensure detailed and explicit project implementation.

Global fund and its partners can improve the health sectors at a country level out of their funding by working hand in hand with the ministry of health of the beneficial country. The important area they should focused are:

 

The Global Fund could assist more by funding the people or organisations working directly with HIV/AIDS and assist sub sahara countries more with their Health facilities such as the Hospitals where in SA there is no long term chronic care in Govt Hospitals and this is then done by organisations like ourselves who are a Hospice and Children's Home with 94 adults and 277 children and we only received enough funding for 5 adults patients for this year from the Health Dept and this is why we need to have the Global fund like PEPFAR deal directly with some organisations where they can produce figures and facts on the work they are doing.

 

We also have an Outreach in the Communities of 140 organisations caring for the sick and the children due to lack of Children's Homes and Hospice care this is over 10 000 children and adults in Gauteng (one Province) and we get calls daily for help but due to lack of funding cannot assist in some cases. We supply food parcels, clothing, children toys, stipends and assist in any way we can. The Coporate Sector in SA is inundated with calls for help and also cannot support all the NGO's and NPO's in the country (140 000 of them).

 

In South africa it is a Pandemic and a Crisis with over 2.5 million people dying from AIDS and AIDs-related diseases over the last year. We must strengthen our Health Systems more to cope with the dying and terminally ill and the way to do this is through accredited organisations such as ourselves allowing us to expand our services and Hospice Care.  But for this we need funding.

 

DAWN BELL

Funding Manager

To, e-forum 2008,

 

For strengthening community level in countries,GF & partners have CSS components.These CSS components should consider socio-economic ,socio-demographical factors in countries. Inclusion of international plan panel including human right groups,constitutional support, welfare agencies ,social intervention with legal status,grants consolidation of under investment in health system ,gender factors with evaluation of cultural,traditional ,ritual challenges for prevention of mortality,could give better use the broad support available from the GF's CSS components.

 

In health system strengthening of CSS,national& international partner's health program could integrate with GF's community system strengthening for providing operational,technical guidelines, integrated management&intervention in less GDP countries.These integrated management& intervention could give analysis of community resistance,counter the ineffective & false influence in community, community vulnerable to endemic conditions,community differential resistance& differential response ,resources mobilization for affected population ,education for community with less resources of livelihood,about essential basic health system, providing community action cycle approaches,community biological risk factors link with diseases. GF's community structure& mechanism have already given significance in differ socio-demographical & human development conditions.Countries could expand their own community structure by inclusion of CSS& CCM in government's inability& accessibility.

Dear Robson,

 

I have the impression that poverty alleviation contributes effectively to better health outcomes including in HIV and AIDS infections.

 

First, it is evident from the annual UNAIDS reports on the global HIV and AIDS situation that high and middle-income countries have fewer AIDS deaths in comparison to the low income countries. In my opinion, this has to do with access to health care and nutrition, the two critical factors in containing disease progression. In this sense poverty in developing countries limits access to health care and the poor do not often have access to adequate nutrition.

 

The implication of this to global fund in terms of health systems strengthening is that systems strengthening at health facility level is desirable for improved programme delivery but is not adequate. It is critical to invest in national health systems strengthening and i feel that the potential of the private sector to produce public goods (including Faith Based health services) has not been entirely tapped. Public Private partnerships (PPPs) therefore is an important leverage for strengthening health systems in developing countries and could address the traditional problems of equity, access and quality of health care services. The role of the civil society could be improved through deliberate institutional capacity building processes.

 

I strongly believe that Global Fund's decision to work with LFAs is a good approach to institutional capacity building, however there is usually a large segment of community-based organizations that cannot meet the minimum institutional capacity standards set by the Global Fund, yet they immensely contribute to programmatic interventions at the grassroots. The proposal here is to include broad-based technical support in health systems strengthening that could support institutional capacity building with a view to scaling up programmatic interventions.

 

Cavin