IMPACTS OF GLOBAL HEALTH INITIATIVES ON HIV/AIDS

IMPACTS OF GLOBAL HEALTH INITIATIVES ON HIV/AIDS

1. Introduction

Good health is a matter of the essence in everyone’s wellbeing. For a long time, having sound health systems has been a priority in almost all countries around the globe. The main reason being, without good health, then the economy is most likely going to fail. A growing and prosperous country starts with the health of its citizens. Health systems in most countries are not as stable as they should be. Therefore, health care initiatives have been established that help in mostly funding health. Take, for instance, a country that has been affected by war will most likely have weak health systems and structures (GCT, 2020). Access to health care is essential. If they are no good hospitals, then the country’s economy is also likely to fail. Maternal health care is one of the most critical systems. If the government cannot provide for its people maternal care, then they risk having death related to this. Affecting the country’s population and exposing its citizens to infections transmitted through birth.

In the recent past, HIV/AIDS emerged and became a global disaster (Oomman et al., 2007). Within a short time, the disease spread across the globe, causing death leaving children orphaned. The epidemic hard most governments worried that they set funds aside to deal with this menace. Some country, those in world countries, however, had challenges dealing with this single-handedly and thus asked for help in bodies such as PEPFAR, Global Fund and GAVI. These programs came in existence to help deal with diseases such as HIV/AIDS that were difficult to contain due to financial crisis in countries.

With the introduction of these initiatives came new regulations and the emergence of other issues. Researchers have done studies regarding the effects of global initiatives. However, there are parts of this research that are yet to be discovered. They have gone in-depth for finding the impact that these initiatives brought to these countries, but still, the epidemic is present.

As of the year 2015, over 36 million people were living with HIV/AIDS (UNAIDS, 2019). A majority of those infected being the youths in sub-Saharan Africa. Due to this, the availability of antiretroviral treatment and mortality rates increased. However, with the invention and establishment of organizations that support the treatment of HIV/AIDS, there has been significant improvement. Therefore, this paper will sort to find other issues that have not been researched or have limited studies done.

Background Information

HIV/AIDS is one of the worse epidemics that ever happened to humankind. According to data collected by the United Nations Program on HIV and AIDS (UNAIDS), about 25 million people were receiving antiretroviral therapy by 2019 mid-year (UNAIDS, 2019). This is a huge number as compared to 2010 when the number was less than 10 million.  In the previous year, about 40 million humans were living with HIV and about 1.5 million people were newly infected. The majority of people living with HIV are adults who have recorded over 75% of the population infected. Children below the age of 15 infected with the infection are less than 3 million.

In terms of accessing treatment, by the end of 2018, slightly over 60% of the population affected with HIV had access to treatment (UNAIDS, 2019). Of the 60%, adults aged 15 years and above had an overall population of about 50% accessing treatment and children below 15 years were less than the overall population. New infections have reduced greatly as compared to the year 1997 when it recorded over 3 million new infected. The rate has declined greatly, 2010 recorded a 16% decline and by the end of 2018, the population had dropped to less than 2 million people.

By the end of 2018, over one million people were reported dead the main cause being AIDS-related infections. In 2004, the number of deaths recorded was over 2 million. In 2010, the population reduced to about 1.6 million. There is a gradual decrease in the number of deaths as 2018-recorded fewer numbers (UNAIDS, 2019). The rate has decreased by 33% since 2010. Over rally, over 75 million people have been infected with HIV and over 30 million have passed on since the HIV massacre started.  However, people living with the infection are prone to getting other diseases such as tuberculosis.

In 2017, of the population that had TB infections about 10% were infected with HIV/AIDS. There is a need for people living with HIV to be issued with TB preventive treatments as this greatly reduces the mortality rate by about 40%. In 2017, US$ 20.0 billion was invested to deal with AIDS response in the low developed countries, this amount is less than what was offered in 2018. It has been approximated that about US$ 26 billion will be needed for AIDS-related issues by the year 2020 (UNAIDS, 2019).

With the rise of effects caused by HIV/AIDS global initiatives has been one of the most influencers in helping countries across the globe with providing funds to help eradicate the infections and provide funds to support treatment. Global initiatives have come to help deal with global challenges for instance the problems that come with climate change (Patel, Cummings, & Roberts, 2015). Global health initiatives are the key role players in global health. They play a significant role in countries having adverse effects due to disputes. Countries affected by clashes often have feeble health structures and this leads to high rates of communicable diseases. Fortunately, global initiatives such as GAVI Alliance, the Global Fund and The President’s Emergency Plan for AIDS Relief (PEPFAR) come in aid to help curb such problems. Organizations and other private sector institutes come together to form a partnership for funding and executing disease control programs in less developed regions around the world. These initiatives provide vaccinations, anti-retroviral therapies, and insecticides in these regions.

PEPFAR was launched in 2003, by the US president, George W. Bush, to deal with the HIV/AIDS scourge and to aid protect the lives of those already infected (MInority HIV/AIDS Fund, 2019). This initiative has been the most substantial among health programs in supporting a single disease. PEPFAR has contributed to over $80 billion in the treatment, prevention, and analysis since it was launched. Most of its funding is focused in the sub-Saharan part of African with a presence in over 50 countries.

Some of the programs supported by PEPFAR are the prevention of mother to child transmission, safe blood transfusions, and injections, and also sponsors counseling and education. PEPFAR gives a hand in supporting the ABC viewpoint that is Abstain, Be faithful and Continuous use of condoms. With the prevalence of HIV/AIDS, come opportunistic diseases such as malaria and tuberculosis. PEPFAR donates to prevent and treat these diseases (MInority HIV/AIDS Fund, 2019). In education, it endorses the training of physicians and giving salaries to them. Without good facilities, the efforts made are of no importance. PEPFAR has also contributed to providing laboratory equipment, drugs, renovating health facilities and other services. Counselors are trained and later give counseling services to individuals.

The global fund is an initiative that issues funds in the form of grants through its offices at Geneva. The global fund does not have specific areas it supports instead, countries bid for the grants through submitting a proposal that is analyzed carefully in terms of the evidence provided and performance. In terms of a decline in mortality rate, the initiative has been a contributor. On the other hand, the GAVI Alliance has its success attributed to strengthening health structures and greatly supports vaccines and immunization of diseases through the provision of grants. The three initiatives provide training of staff involved in counseling and treating patients (Patel, Cummings, & Roberts, 2015).

Purpose of the Research

Global health initiatives have been recorded to provide sustainability and reducing the mortality rate of HIV/AIDS.  There has been great improvement in health structures in terms of services offered and structures as these initiatives have greatly helped in establishing and renovating laboratories and providing equipment. PEPFAR, for instance, has greatly contributed its funds in less developed countries by providing treatment, training personnel and providing drugs. This has gone a long way in increasing the number of people accessing treatment and in return has reduced the number of deaths associated with HIV/AIDS greatly.

In conflict-affected countries, take, for instance, Democratic Republic of Congo, health systems have greatly improved through the provision of antiretroviral therapy and the issues of treatment of diseases such as tuberculosis, which are opportunistic diseases that are associated with the infection of HIV (Patel, Cummings, & Roberts, 2015). In less developed counties and despite affected countries health practitioners have been an issue but initiatives like GAVI and the global fund have provided training and payment of this personnel to motivate them. Most of these people were working in poor environments with low payments, fortunately, grants have come to aid in paying them to motivate them to continue working and training them. Despite all these efforts, there is still a gap in dealing with management issues and capacity development. New ways of dealing with these infections are arising day by day, if these practitioners are continuously taught then the massacre will still be in existence.

Moreover, the grants offered are mainly focused on providing drugs, renovating laboratories and building health systems. More funds are also channeled towards providing training to practitioners. Despite all these efforts, there are still newly infected patients annually and there are deaths related to HIV/AIDS. Efforts to determine the root causes of these causes have to be examined. Such efforts require financing through special training of researchers and the building of laboratories for these researchers. Dealing with HIV/AIDS has to start from the root to aid in completely eradicating its effects globally.

Countries with effective leadership are likely to be issued these grants as they are reported to be progressing greatly in terms of performance. According to an analysis (Patel, Cummings, & Roberts, 2015), bad governance, corrupt leaders are the issues affecting the effectiveness of grants. There is still no study showing how effective global initiatives have contributed to helping in escalating administration and superintendence. Grants are either directly issued to the government or a third-party organization such as UNDP.  There is likely to be a problem in transferring these funds, especially in dispute-affected countries. There is no report showing how effective these efforts have been to these countries. Therefore, this paper will focus on how global initiatives can best distribute funds effectively while concentrating on how leadership can be improved in disputed affected areas.

Objectives

The long term objective of this research is to evaluate other impacts of global health initiatives on HIV/AIDS. It aims to find out what other studies have found out and unveiling areas that have not been addressed by these studies that will greatly contribute to what global initiatives are doing now. Particularly, the thesis’ sub-objectives are:

1. To identify effective ways that global initiatives can contribute to leadership and governance in the countries they are financing.
2. To encourage funding of HIV/AIDS-related research to enable researchers to get to the root cause of HIV/AIDS and to find a cure.
3. To depict ways in which funds can be distributed effectively especially in dispute-affected countries/regions that are the direct channels that can be used in distributing grants.
4. To review the problems that have not been addressed by other scholars in their pieces of journals concerning global initiatives and the influence it has on HIV/AIDS
5. Literature Review

Literature review is a chapter that uncovers the known and unknown in past studies. A literature review is very instructive, reproving and important in synthesizing a particular topic (Bolderston , 2008). For instance, in the topic impact global health initiatives to HIV and AIDS, this chapter will help in identifying areas of debate and help in formulating questions that need attention or need to be researched into detail. In this paper, a systematic review format will be used in reviewing and analyzing past case studies. That is the paper will critically review several reports with the aim of finding new advancements that will help other scholars and organizations in planning. One advantage of systematic reviews is that it makes tracking of information easier as it condenses other large reports into short documents that help in easily finding breaches (Bolderston , 2008). Therefore, the main aim of carrying out this research is finding new information that is relevant to the topic in question.

World Health Organization Health System Framework

According to the World Health Organization (WHO), a health care system is a unit with different institutions and resources geared up together with the aim of producing positive results in the health actions they perform (WHO, 2007). World Health Organization has divided its activities into six fragments that are believed to influence the health sector significantly. They include governance/leadership, health workforce, service delivery, vaccines and technologies, medical products and information (WHO, 2007).

A flourishing health workforce is that that which has adequate staff members who are proficient, high-yielding and receptive. A workforce that is fair and effective achieve best health results given they have sufficient resources. Leadership gives room for accountability through the provision of regulations that are strictly followed (WHO, 2007). With effective leadership comes an effective financing system that has adequate funds that are protected by law and used for the right projects such as funding health systems to make sure people have these services wherever they are required.

Impact of PEPFAR on the Nigerian Health System

Among the journals presented to the Pan African Medical Journal is an article in the year 2016. The study found out Nigeria is one of the African Countries not recognized as one of the AIDS belt areas (Odekunle & Odekunle, 2016) that in turn has affected the number of infections in the country (Alubo, 2017). A global initiative, US President’s Emergency Plan for AIDS Relief (PEPFAR) is among HIV and AIDS programs that have been effected in the Nigerian Health System. Due to political reasons, a diagnosis of HIV and AIDS was established in Nigeria in 1986. As of 1991, the rate of HIV/AIDS transmission was found to be at 1.6% higher. During this time about 3 million people were already living with the disease.

With the increasing rate of the infection in most African countries Nigeria has had to also up its game in controlling the infection by raising awareness among its people. As a result, the Nigeria government has established a program to help in corresponding to the calamitous effects of the disease that has influenced both social and economic development. PEPFAR serves as one of the programs that have been established in Nigeria. Nigeria has served as among the first beneficiaries of PEPFAR intervention with the Centers for Disease Control and Prevention (CDC), the Defense Department and the USAID helping in coordinating the program. PEPFAR requires every country to follow its policy which is ABC (abstinence, be faithful and use condoms). The impacts of PEPFAR in Nigeria are measured using the World Health Organization six building blocks.

PEPFAR has largely contributed to service delivery in Nigeria. According to USAID, the most valuable resource that PEPFAR has brought in Nigeria is the availability of free antiretroviral therapy (ART) that has improved care services for people living with HIV and AIDS (PLWHA). The mortality rate has also reduced significantly due to this and hospital beds have been freed for other patients that need attention (Odekunle & Odekunle, 2016). Besides the availability of ART, PEPFAR has introduced counseling and laboratory services to those not infected and for those who do not know their status. To reduce transmission of the virus PEPFAR has introduction several preventive measures and have created awareness around the country.

PEPFAR has provided health practitioners with training in providing health care for HIV/AIDS patients. It impacts workers with the right skills that help them improve health services greatly. As a result, there has been increased confidence in the workforce and tremendous improvement. However, the government has over-concentrated on this issue living other health sectors unattended to. Most health workers have shifted gears to working with organizations that have scaled up their programs leaving other areas unattended to or with the insufficient workforce (Odekunle & Odekunle, 2016).  Financing is one of the WHOs building blocks had been provided by PEPFAR. In spite of the funds helping curb this disease, the country now over depended on funds from donors to run their health care services. It shouldn’t have been the case as this directly affects the countries operation.

Additionally, PEPFAR’s main purpose is providing medical products and supporting new technology that is geared to help in development. Most of PEPFAR’s funds have been spent on medication (Alubo, 2017). This has made sure that all patients get these drugs free through a very efficient logistic in supplying ART and laboratory equipment. Due to these programs, the sharing of information among stakeholders has improved. However, this has brought controversies with other global health initiatives due to duplicative reporting forms. Global health initiatives are not working in harmony as they fear they might lose the right of self-government. The problem was, as a result, escalated correspondent and demoralization of services.

With PEPFAR’s invention, the government has become more aware of HIV and AIDS prevalence. Before the program, ART was not free it entirely depended on the citizens’ fees.  With the program, the government gave this section of health care priority. Health system productivity depends on the governance of a country. With PEPFAR that increased significantly other collaborators such as non-governmental organizations and faith-based bodies like the Christian Health Association of Nigeria. These bodies aid in promoting access to medicine that includes ARV drugs especially for women. The move reduces the rate of health inequality.

On the flip side, these programs weakened coordination endeavor’s to strengthen the health system collectively. Planning, management, monitoring and evaluation systems realigned the countries health system to concentrating on PEPFAR HIV and AIDS program. Fragments such as the reproductive health system greatly affected as NGOs also changed gears to chasing AIDS money and the government prioritizing HIV/AIDS over other health issues. Funds are directly disbursed from Washington DC to countries. There are no regulations in these countries as policies are outlined by the US. These had direct consequences for the national government Case in point, PEPFAR’s ABC policy. Many advocates have disdained PEPFAR’s advance towards emphasizing abstinence and being faithful leaving out the use of condoms. As discussed, PEPFAR has had a number on Nigeria’s prevalence of HIV/AIDS and has opened doors for other discussions.

Compared to how Nigerian’s health system was before PEPFAR, there have been major refinements in terms of delivery of services with regard to making ART easily accessible for people living with HIV/AIDS. The program has increased political consciousness and gave a response to HIV/AIDS precedence. With this, the mortality rate decreased significantly as people infected with the virus are leading comfortable lives and some have resumed to their places of work. This has a direct impact on the country’s economy. The countries health workforce improved a great deal with the training of personnel that was introduced by the PEPFAR program. These improved skill set and confidence in health workers. Resources have been scaled up by PEPFAR. Laboratories have been equipped that has increased service delivery within the country.

However, the program has brought about non-alignment in the country’s health system. The government has prioritized HIV/AIDS leaving other emerging cases such as the reproductive health sector draining. The mortality rates due to poor maternal health are among other problems that have been left behind. Over-dependence has also been as a result of the PEPFAR and other health initiatives that are funding the health system in Nigeria. This impacts the country economy as well. Consequently, as PEPFAR has funded training, the training is mostly based on HIV and AIDS. Most health workers have moved to NGOs that deal with HIV/AIDS as they are more skilled in this area. This has brought about insufficient staff in other areas that in return affect the strength of Nigeria’s health system. Disbursement of funds is also a challenge as it is directly given to the government measures to monitor the funds have not been put in place.

The research focused on Nigeria, a sub-Saharan country. The issues covered were the transformation Global Health Initiative (PEPFAR) has brought into the country. This involved carefully analyzing its impacts in line with the WHOs six building blocks of a good health system. The study illustrates the impact it has on the six blocks both positively and negatively.

This case study has clearly illustrated what PEPFAR (a global health initiative) has done for Nigeria. However, they are issues that still need to be addressed for the program to be effective in the country. HIV and AIDS is a global epidemic that needs to be handled effectively to eradicate it completely. Its effects are felt in every part of the continent socially and economically. HIV/AIDS has led to deaths leaving children orphaned and homeless. Therefore, it still remains a threat to development as the study was done a few years ago and times are changing. New ways of dealing with this epidemic have to be established to effectively curb this issue.

Health system reforms in five sub-Saharan African countries

This is a study that was done by several scholars in five countries in sub Saharan Africa (Chol , et al., 2018). These countries include Rwanda, Angola, Mozambique, Eritrea and Ethiopia. Sub Saharan Africa has had a disaster as regards war. Health institutions have been greatly affected by this action. The study sought to find out the reforms that have been put in place to rebuild healthcare systems in these countries. It had been a major problem as at least 1000 people lost their lives as a result of war (Human Security Research Group, 2017). Women and children are the populations most affected as maternal health services have declined in quality. As a result, the maternal mortality ratio (MMR) increased (Muganda, 2008).

Maternal mortality ratio was still high from year 1995 to year 2015, but despite that, there were some countries that had a good record on the rates reducing by over 50%. Among the countries is Mozambique that has had the recent wars that ended in 1992. Angola is also among the countries whose MMR reduced significantly. War in Angola came to an end in 2002.  Rwanda had a brutal genocide that consumed lives of almost 1 million people. This was in 1994. Eritrea and Ethiopia have also had the longest war disaster. This literature review inspected these five countries that had a significant change in the reduction of maternal mortality ratio.

This study will seek deep insight into finding the methods that have been put in place in the department of health of five countries in Africa that have aided in reducing the maternal mortality rate. The study used the WHO six health system building blocks. The data collection techniques these scholars used to collect information and also evaluate the result. By the end of the study, gaps that the research leaves will be evaluated.

There are many countries that have been affected by war in the sub-Saharan Africa. Through, an inspection the study settled for five countries. The counties are Mozambique, Rwanda, Angola, Ethiopia and Eritrea. The method used was the counties that experienced conflicts between the year 1990-2015 and those that despite the wars have had a significant reduction of greater than 50% in maternal mortality ratio. The maternal mortality rate reduction is a reflection that the health systems performance is strong (Brown, Newby, Chou, & et al, 2013).

As used by Gabrysch and Campbell the research conducted selective literature as the study was exploratory in nature and thus there were no specific questions that the study aimed at answering (Gabrysch & Campbell, 2009). The literature review aimed at articles that have been published in English. In this search, different databases were searched. The databases include PubMed, Google Scholar and web of science among other sites.  Even though the focal point was English articles, unpublished documents were found from Angola that was written in Portuguese. The search was done in four categories. The first one was aimed at searching healthcare terms such as pregnancy, health provision etcetera. Secondly, the scholars searched for termed according to the WHO six health system building blocks that are health personnel, health information, finance, leadership and governance and medical equipment that involve drugs. The next step was to search the five countries in question. That is Mozambique, Rwanda, Angola, Ethiopia and Eritrea. Finally, the effects were combined and articles that met criteria chosen were later taken to the next step which is analysis.

A total of 1176 articles were found. In this, about 87% were peer-reviewed articles while the rest were grey literature. Out of the total, 70 articles, with 72% being peer-reviewed articles.

Results of the Study

The analysis showed that Rwanda among the five countries is the most densely populated and Angola is the least heavily populated country. Ethiopia recorded the highest percentage of 72% in the maternity mortality rate. Among the five countries, the health strategies that were common in all were innovation, health systems decentralization and health financing. All three reforms are related to the WHOs building blocks.

Decentralization efforts were made to help create a basic convention for the National Health Service that had the public contributing a fee to the public health sector. Health services were provided by several bodies which are the Military Health Service, National Health Service and health services of large cooperatives. Then the ministry of health managed all these bodies. By 2010, about 40% of the total municipalities had decentralization implemented and infrastructure was still being improved in other regions (UNDP Angola, 2013).

Angola opened institutions to train health workers. By 2015, these institutions both public and private had produced about 1500 graduates. Between 2005 and 2010, records show that the number of doctors and nurses increased significantly and the country also contracted Cuban doctors (WHO, 2016). Despite these efforts, Angola still records insufficient access to health care services among the rural populations.

80% of the funding is provided by the government. Health financing that comes from donors is less than 14% and the private health sector contributes barely 20% of the funding in healthcare.

Before Eritrea got independence they already had a decentralization policy with the goal of refining healthcare facilities. The Ministry of Health annually reviews the policies put in place which has seen the number of health facilities increase. There are no privately owned clinics in this country. Several initiatives have been put in place. As of 2017, there was the introduction of community health insurance, tax funds, individual health insurance and private health insurance. However, there is still no evidence as to how all these initiatives have contributed to the development of Eritrean’s healthcare system (WHO, 2010). By 2014, the country had had an increase in the number of healthcare workers. They contracted doctors from Cuba and trained more nurses and doctors in the county.

After decentralization was implemented, there was an increase in the use of contraceptives among the poor. By 2010, there were a number of policies introduced to make sure decentralization is in effect. Currently, maternal care is given in levels that are the lowest level offers first aid; the second level offers primary vital maternity care and the high-level hospitals offer thorough care. Introduction of Health Extension Program increased the number of people accessing health services significantly. However, there was still a shortage in the number of health professionals’ personnel that has seen the country training people on all-inclusive emergency obstetric care. 40% of the funds used in health are from external donors while the rest is provided by household payments, the government and other development partners. The county still faces a challenge in sustainability.

50% of funds in Mozambique are donor-funded. Due to this most services are at no cost for the less fortunate allowing a larger population to access health care. There is a disparity in the health system as donor funding is blamed on not contributing enough funds to strengthen the health system of Mozambique. Donor funding has created an unequal distribution of resources and noncooperation. Despite the war that led to high numbers in HIV, TB and malaria spread, Mozambique has taken initiatives to decentralize its health system. Decentralization still remains a problem in spite of the improvements seen in the healthcare systems (Chol , et al., 2018).

Mozambique was among the first countries to introduce schooling of healthcare workers including midwives, community healthcare workers and nurses. By 2010, 90% of operations were being done by community health care workers. This has seen the healthcare task force increase greatly.

Efforts made by the country were reflected by the number of community health workers by the end of 2014 that we’re mobilizing the community and attending emergencies where health facilities had not reached (Chol , et al., 2018). This move also saw the number of doctors, midwives and nurses increase.  After the 1994 genocide, the government implemented decentralization as part reuniting the country. The country introduced a program that helped strengthen the health system through Performance-Based Financing (PBF). PBF’s role was to ensure funds are not mismanaged.

This study does not reveal the strategies regarding health information, medical amenities and distance to healthcare services in the five countries. Its main focus is on the reforms that have majorly contributed to mortality rate reduction leaving other parts uncovered. In regard to HIV/AIDS, any health care system whose maternal health system is underperforming directly relates to other sectors failing. Poor maternal health care is a threat as it contributes to the rise in numbers of HIV/AIDS patients mainly through mother to child transmissions, breastfeeding and blood transfusion. Therefore, it is vital to make sure maternal health care is at its best to curb the HIV/AIDS epidemic. The study does not show how funds are distributed and how medicine is distributed to the patients. The quality of equipment has not been discussed in the study.

The research has seen how the three building blocks have reduced the rate of maternal mortality rate in war-affected countries that are in sub-Saharan African. Poor health systems also risk the rate of transmission of HIV/AIDS. Thus, this study is important in unveiling the problems that health systems face that if not sorted will also influence the spread of HIV/AIDS.

Interactions between Global Health Initiatives and Country Health Systems: The Case of a Neglected Tropical Diseases Control Program in Mali

This is a case study done in Mali to find out the impacts Global Health Initiatives have heard on dealing with neglected diseases. GHIs became a governing international aid game plan about two decades ago. With its main aim being to effectively control specific diseases and providing resources to increase accessibility to global health. However, issues have been raised as pertains to the effects they are bringing this including to the inability of health institutions to deal with the population’s general health needs. That is, with the introductions of GHIs the health system structure has been distorted. There has been the creation of new policies and organizations that are compromising how the health systems are working. GHIs have also realized that their involvement is limited to countries that have unstable or poor health structures.

GHIs and health systems work collaboratively that is they affect each other. However, these two bodies have different views because of the two different approaches in which consideration is given. The horizontal approach looks into long term solutions such as building health care facilities that are, its basis is on dealing with health challenges as a whole unit. The vertical approach deals with health problems as a single unit. That is they are directed and executed wholly as a unit using health practitioners (Mills, 2005). In 2008, a WHO synergetic group was appointed to evaluate the interconnection between GHIs and health systems. The feedback they got was later used the next year in a dialogue meeting in Venice. Analysis trails focus to the scarcity of proof to aid in comprehending the interconnection between GHIs and health institutions. It was found out that more efforts have been on HIV/AIDS control as more than half of the funds that were channeled to poor countries have been used pipelined in the direction of HIV/AIDS (Biesma , et al., 2009). The study in question did not focus on different GHIs because these bodies have diverse policies and objectives therefore their effects on health systems may differ. Also, most researchers focus on the effects of the GHIs on the national level meaning there is little evidence on the effects at a lower level (Biesma , et al., 2009).

With this, there emerged awareness on the importance of Neglected Tropical Diseases that led to new global initiatives coming up. For instance, WHO Neglected Tropical Disease Program, the Neglected Tropical Disease Initiative (NTDI), the Global Network for Neglected Tropical Diseases (GNNTD) among other programs came to existence. The main goal of these programs is on effective drug management and administration. These programs, however, are a threat to public health. Programs such as mass chemotherapy that have been conducted over the years are one strategy to reduce or completely remove NTDs. On the other hand, the efficiency of the program to reduce the widespread of NTDs is based on certainty that drugs are provided by pharmaceutical organizations and then distributed by community health workers.

Mali, a country in Africa, became the initial country to establish an NTD control program with the USAID providing financial aid. This study analyzed the interaction between the NTD program and the health structure in Mali with the main center of an intervention being on the districts and the service delivery quality. According to the paper, there a network of healthcare centers widely spread with each center having a qualified staff member with about three helpers. Each district has an executive team that provides technical assistance. The main goal of this paper was to evaluate and analyze the constructive and the apathetic effects on health care systems with the establishment of several programs that help to improve services.

This study used a qualitative study, a familiar slant to study circumstances that have less information and very few precise theories (Patton , 2014). The research did observation on NTD campaign with health services in operational structures to not hinder their finding to the failures of low-level health care systems. Through sampling, the study settled on two rural districts from two geographical areas that had a good record in terms of their output.

The study used three data collection methods which were interviews, document analysis and participant observation. Interviews are of the essence in gaining insights on people’s behavior, opinions, feelings, preferences and attributes. However, responses are other terms biased and may lack awareness and recall errors. They are also important in describing events (Patton , 2014). Alternatively, participant observation comes in handy as it an appropriate method to better comprehend issues, occurrences and procedures. Participant observation has its limitation which includes unconventional behavior of the population being observed and discriminating points of view of the observer. Document analysis better gives a wider range of valuable information and their logic but they may at times be discriminating. However, they do not necessarily reflect what is currently happening. Therefore, the researchers using different types of method collection is to for the purpose of compensating what another method may not give. These make the data collected and analyzed more substantial.

The observation was done by personnel who had a background on public health. It took about two weeks with the observer covering 16 health facilities, that is, 8 facilities from the two districts that were decided upon. The reason for choosing a researcher that had knowledge of public health was because it could be easier for her as they would be familiar with health systems and procedures in the country. During the two weeks, the observer would follow the medical officers and the staff that was responsible for following up on campaign activities. This exposed the observer to drug administration in the 16 health systems. Observation mainly focused on seeking insights on the behavior of staff members and the community while still looking at processes and events in the background. The research would ask questions on the spot being informal to make sure people did not feel uncomfortable and give biased answers.

Interviews were conducted among Ministry of Health officers and support agencies. Due to time constraint, interviews were done to a few individuals. The individuals chosen were gotten through sampling. Information that could not be gotten through observation was gained through the interviews. Information collected through this method was in regard to campaign procedures, financing and planning and how decisions were made in accordance to those campaigns. The interviewers also sought to find the relationship between the NTD control program and the community health utilities.

Document analysis was done by gathering information from different websites and literature reviews. The study later did an analysis that was based on the interactivities of other GHIs with health structures that were found in pieces of written works. The analysis evaluated implementation processes, how tasks were distributed and the effects of service delivery. The researchers looked at emerging patterns and differences that arose from the events observed and people interviewed. After analysis vital information was generated.

Results of the study

Results were reported according to the WHO frameworks that is health service delivery, information system, financing and governance, drug distribution (supply management system) and health workforce. Health service delivery, there was positive feedback from all interviewees (Cavalli, et al., 2010). Some sources complained on the NTDs only focusing on drug administration and health education. They suggest that this program should also consider looking at curative care as one of a disease control strategy. Some interviewers complained about the attention that is given to specific diseases that compromise routine care delivery. Observation also gave the same result as it was observed in the health centers visited that interrupted normal operations as nurses had been given other duties and there were no replacements in their areas.

The campaigns were introduced so as to reach a larger population that had no access to health facilities. However, according to the results observations presented, this was not the case. The observer found out that there were still children suffering to get drugs and these have exposed them to other illnesses that were not recognized by the staff members. 90% of the health center operations were disrupted with only 2 centers not affected by the campaigns as they made sure curative and immunizations services were still running smoothly. It was, however, observed that the two health facilities had enough staff members and there were no vacant positions. The nurses in the facilities were also qualified with experienced ranging over 5 years.

There was a negative effect as several sources highlighted that patients were now not seeking care as they were waiting for the next free distribution of drugs. They feared to incur costs in visiting health care facilities so they opted to wait. This exposes these patients to risks. The campaign gave training to the stakeholders involved. That is NTD coordinators would train district authorities who late train nurses and nurses would train volunteers. It was a positive effect as it impacted knowledge on diagnosis and treatment but other sources complained that the training was a repetition of what they already knew.

Stakeholders were given allowances. Sources cited that this was one way to retain the staff members as it motivated them to stay and work. However, it is a negative effect as some may lose focus on their main role and concentrate on monetary benefits. Allowances motivated more people to volunteer. The challenge was on the inconsistencies that came as a result of donor funding not being consistent. On the health information system, the NTD campaign inaugurated a system to keep an eye and assess its operations. For each drug administered a report was presented at the village, health center and district level. This was per the regulations that donors presented.

Drugs were donated by pharmaceutical companies (Cavalli, et al., 2010). A system was implemented to monitor drug distribution. The main was to make sure that drugs move from the national level to district level swiftly. Some informants highlighted a major problem with imbalances in drug availability. For example, Azithromycin was available for other patients while other patients had to seek an alternative that was not free. The money that was budgeted for 5 years was about US $ 12 million. This covered training of staffs, drug distribution, education, supervision and evaluation. When preparing the budget other areas of concern were not looked into. For instance, there were insufficient storage facilities that trucks had to be hired to the drugs. The budgeter did not also allocate funds for procurement purposes that the programs were limited to the use of motorbikes for transportation. Additionally, the programs do not budget for how the campaign will be managed in the future.

In the Malian Ministry of Health, a program to coordinate structures was established. It has been of great assistance as it brought coordination among independent programs (Cavalli, et al., 2010). The program, however, had to be in handy with the regulations set up by donors and grantees as funding was aided by programs such as USAID. Other sources were more concerned with the effects the program would have on national priorities. The result gained insight on the essence of NTDs and Mali’s occurrence with mass operations focusing on specific NTDs. Donors insist that they have aided in leveling up the country to greater levels but informants said that some achievement is as a result of preceding external financial support.

The study highlights important issues on the state of health systems in Mali and how the National Tropical Disease program has influenced the distribution of drugs and generally the growth of the country in terms of workforce information gain, service delivery and also in terms of governance. The study is important as it unveils both the constructive and apathetic effects of the introduction of these programs. The programs deal with specific diseases and how effectively they have been successful in curing and administering drugs. The study is essential in this paper as it introduces gaps that are brought about as a result of focusing on one specific disease and the negative and positive outcomes that come with the initiative. It has also pointed out the interconnections between GHIs and health amenities.

The Effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS

This is a literature on an article that was done by a number of researchers on the impacts that global health initiatives have heard on health structures (Biesma , et al., 2009).  According to the research, GHIs have leveled up the authority of crucial communicable diseases, more importantly HIV/AIDS. GHIs are mainly known for their efforts to call to arms funds from different sources that have an impact on the performance of health systems and channel its resources to non-governmental civil society groups. In the prevention of HIV/AIDS, there are three initiatives that contribute largely through the provision of funds. The initiatives are Global fund to fight AIDS, TB and Malaria, The President’s Emergency Plan for AIDS Relief (PEPFAR) and the World Bank’s Multi-country HIV/AIDS Programme (MAP). There are a few studies that have been done on the impacts that GHIs have on health amenities. This research, therefore, sought to systematically review debate and give suggestions for worldwide and country schemes determinants on future implementations. The effects the study focused on was on the impacts of organizations and resources that work closely to improve health outcomes have with regard to health systems performance. Stakeholders in questions include public, non-profit and for-profit sectors, donors and voluntary organizations that are included in funding and improving health activities.

One of the methods of data collection used in this study was reviewing documents. The documents that were review were from six databases using search terms that were related to the study on the influence of Global Health Initiatives. Name of GHIs selected was also used as key terms in the search. The databases searched were AIDS portal, CAB Direct, Web of Knowledge, PubMed and ELDIS.  Grey literature was also done on the websites of the GHIs selected and on research archives. To get more information some informants were contacted to give their suggestions on where some other important references might be.

After gathering of documents, the selection was done as not all documents could be used (Biesma , et al., 2009). So in this article, three researchers were given the mandate to analyze the references conjured. The researchers discarded those documents that did not have a wide range of secondary materials and those that had data collection limited to global levels only. The papers selected represented data at the country level and had apprehension on how data was collected and analyzed. The researchers also looked for research that displayed some form of originality through based on the primary qualitative finding and evaluations of global health initiatives at a country level both internally and externally.

The results of this study were broken down into three elements; scheme development, implementation, and utility delivery. The three elements are according to conceptual framework systems that were developed by Bennett and Fairback. At the time of this study, there were little studies done on the effects of this that the researchers settled for two elements which are policy development and implementation. About 31 reports met the criteria that were used to select data.

National Policy Development

The study reported that there were negative results related to GHIs. For instance, the government’s efforts to strengthen health systems were distracted as GHIs policies had been thrust to the government. Donors require that the conditions they impose on the countries are followed (Brugha, et al., 2004). Global Fund is supposed to give aid in prioritizing local programs and by this; they need to fit in their policies to match that of the country. However, on the ground, this is not affected. Case in point, Global Fund denied Uganda’s 2002 first cross-cutting system. With regard to this, the government has to set up a different department unit that disrupted Uganda’s policies. In Tanzania, a country in Africa, World Health Organization disrupted the government’s arrangements to funds orphans and children and shifted focus to Global Fund’s program of funding anti-retroviral treatment (Spicer, et al., 2010).

On the hand, GHI’s have inflicted funding as some countries’ systems were undermining their efforts in fighting against AIDS. This was because these countries lack planning and as a result MAP’s efforts were slower. By 2007, Uganda had reported positive feedback as GHI’s approaches had influenced their government. Slowly, Global Fund and PEPFAR have adopted to align their funding according to countries systems. This is evident in Ethiopia as it was seen to have been more supportive by 2006. PEPFAR was working with the government and it aligned its funding according to the government plans. In Benin, when Global Fund adapted to the country’s systems improvements were also reported (Menon, 2008).

When GHI’s were introduced, they reported negative effects. Most countries were not accommodating to such programs and they didn.t understand their roles and responsibilities in promoting what GHI’s were fighting take, for instance, the Global Fund. It was at the beginning very hard to bring harmonization among different GHIs as much they were all willing to adapt to new systems. In this bid, World Bank’s Map suggested that all GHIs have one deliberate framework, one national control and one monitoring and evaluation systems against HIV/AIDS. Despite that being recommended it was still hard to implement (World Bank, 2004). Research shows that global fund efforts towards harmonization were different in different countries. The global fund supported harmonization in Nigeria and Namibia while it weakens these efforts in other countries such as Sri Lanka as it required contrasting transaction reports.

PEPFAR is among the GHIs who have shown little efforts towards harmonization of donors. PEPFAR is not transparent and is unwilling to get involved in planning processes with other GHIs. Also, PEPFAR’s requisite of US Federal Drugs Administration acceptance of medical products (antiretroviral drugs) has blocked PEPFAR from using the regulations put in place by WHO that other GHIs depend on. Other GHIs such as Global Fund has reported having allowed their funds to be channeled to other programs such as the Common Fund in Mozambique setting an example to other programs dealing with specific diseases on how to effectively adapt and strengthen country’s system. Oomman et al. (2007) report that in spite of PEPFAR not directly adding to Mozambique’s Sector Wide Approach (SWAp), they are active in partnering with other global initiatives in promoting harmony and aligning donor requirements with that of the countries.

In coordination and planning structures, McKinsey (2005) reports that Tanzania and Congo have committees supervising HIV/AIDS control. There is stiff competition between the ministry of health and the Aids commission for authority and funds in Uganda. In Malawi, there are many bodies that are coordinating HIV/AIDS. However, they do not meet the requirements set by the government. There are reported testifying that on planning and coordination global health initiatives have played a big role (Mtonya & Chizimbi , 2006).

GHIs have positively increased stakeholder engagement. They have effectively been able to bring together different participants such as NGOs and faith-based organizations allowing them to access financial aid (McKinsey, 2005). World Banks MAP has stretched the scope of the faith-based organization and community organizations in responding to HIV. PEPFAR achievements have been on greatly relying on US NGOs. In Benin, the global fund has become recognized through its effort to include stakeholders and the result of this is the initiation of new opportunities which have strengthened collaborations and involved of NGOs that have helped in channeling funds.

GHIs are funds are channeled through various mediums. Though the method has an advantage of diversity, it brings complexities in the long run. PEPFAR channels its funds through NGOs which are US-based in the various countries. World Bank’s Map routes its funds through the ministry of planning in Malawi instead of the ministry of health. Complexities are brought into considerations when a number of NGOs are present in a country and not all are considered and hence those not considered become weak and unaccounted for. There is minimal research on whether private sectors profit from GHIs apart from Malawi where privately owned hospitals are also given antiretroviral drugs at no cost (Stillman & Bennett , 2005).

III. Methodology

This study was both a quantitative and a qualitative research study. The methods used to focus mainly on diving deeper into the problems found and giving insights to these problems. Therefore, I used a 10 question online survey and systematic reviews. The purpose of the study was to inspect on the impacts of global health initiatives on HIV/AIDS. The study was well researched with the help WHO’s six building blocks that illustrate the factors that are considered to be of the essence in any health facility. Over the years research has been made on the effects of global health initiatives but there still exist potential problems in the solutions provided that are the hindrance to health initiatives fully exploiting their potentials. The findings that are being illustrated will help in better solving the gaps in the health facilities in regard to HIV/AIDS.

Research Methodologies

Between November 2019 and January 2020,250 people participated in an online survey. The population that participated in this exercise was randomly selected from different institutions. The link was shared in different social media platforms. On Twitter, WhatsApp, Facebook and Instagram. Only, those willing to participate in the survey answered. For this reason, we tried to keep the name of the people filling the survey confidential to make people comfortable when answering the questions. The questions were both open and close-ended. The reason for this was to increase the quality of the results and for easy interpretation of the results. The challenge to the online survey is that after sharing the link, you cannot evaluate on how people perceived the questions. For instance, did they really understand the survey’s purpose or did they answer for fun just to add the numbers. However, in all this, we hope the findings of the survey will be an opener to the impacts facing Global Health Initiatives with regard to HIV/AIDS.

The main aim of the survey was to answer a few questions on how accessible GHIs are and how it has impacted the development of HIV/AIDS. The questions asked in the survey included;

• Question one: Has any of your family member been affected with HIV/AIDS? If Yes, How accessible were anti retrieval drugs to him/her?
• Question two: Have you heard of Global Health Initiatives like PEPFAR, GAVI and The Global Fund? If yes, how has it influenced your country in terms of containing HIV/AIDS?
• Question Three: What are the changes your country has had after the establishment of these initiatives?
• Question Four: how would you rate the positive effects of GHIs?
• Question Five: How would you rate the negative effects of GHIS?
• Question six: What do you suggest needs to be adjusted to fully realize the impacts of GHIS on HIV/AIDS?
• Question seven: Should GHIS continue supporting HIV/AIDS in providing drugs and care or do you think as a country that can be dealt with by the government?

These survey questions are the basis of what this study is about. They give in-depth information and progress of GHIS in various countries and reveal the gaps that GHIS have on treating and providing care for HIV/AIDS patients. The responses are further evaluated and better reviewed in the next chapter.

In systematic reviews, I reviewed a number of articles on HIV/AIDS online and books that have been published on Global health initiatives. Some of the libraries I visited source for information was PubMed and Medline. Systematic reviews are important in analyzing and summarizing the results of multiple papers. It is an essential tool in finding out the depth of how a certain aspect has been researching on and in that reveal the underlying gaps of these studies. The keywords used in the search were HIV/AIDS, Global Health Initiatives, impacts and health systems. The results of these will also be further analyzed and discussed in the next section of this paper.

Research Design

Data were collected from different regions in the US and in some parts of Africa. However, we cannot ascertain the numbers of how many US citizens participated and how many African participated because we collected these data using an online survey. I luckily have friends in Africa hence the link was shared among them and I also shared it in the US. Carrying out an online survey is an appropriate way of getting a larger population within a short time and it does not require IRB approval as it does not entail interacting with the human subject and the information given is not private information.

The survey has eight questions which have both open and close-ended questions. Some questions give the respondent an opportunity to fill in a text box, others have multiple choices, and ratings that have five options. There are multiple choices that have “Yes” or “No” and others have up to five options to choose from. Question one requires one to choose either yes or no. if the answer is yes one is required to fill in a comment box. Question two is also a multiple choice with five options and an “Other” label that one can write down there response that is not specified in the multiple-choice. Questions three has a text box that one can fill up to 100 characters. Questions four and five have a star rating of scale 1 to 5. Question 6 requires one to write in a textbox in 100 characters. The last questions is a multiple choice with “Yes” or ”No” and also has a comment section below it that will allow the respondents to jot down what they think. All these questions highlight important factors of the project and will help establish gaps for previous researches and five deeper reviews on how people perceive Global Health Initiatives.

Data Analysis Plan

For online surveying, survey monkey an online platform was used to collect responses and to analyze data. One each question, pie charts, tables and figures are generated to help analyze the questions. That is, survey monkey gives percentages and provides a pictorial representation of the data. For question one, being both a multiple choice and below it a text box. The results are summarized in a bar chart for the open-ended question. Question two and seven also require one choice from multiple options and thus its results are represented in a bar chart. Question three and six are close-ended questions and thus they require an answer of not more than 100 characters and thus the responses are not analyzed in a bar chart using survey monkey but instead, they were analyzed with other soft wares such as Excel. Lastly, question four and five required a star rating and its summary is automatically generated by survey monkey.

For systematic reviews, data was analyzed using Excel and later presented using table and bar charts. This phenomenon is well explained in the results sections. The two methodologies were used to examine the factors that have contributed to both the negative and positive effects of global health initiatives and to know if people from different backgrounds recognize the efforts made by these initiatives. To find out the challenges that have been brought up by the development of initiatives and to what extent they have impacted health systems. The analysis method used will help understand these trends through statistics.

Part of this research paper seeks to find out measures that have been put in place and whether they need to be improved or completely changed to improve their performance. The analysis also strives to find out the research gaps of previous studies and how efficient they can be solved. The results of the data collected are well explained in the results section using bar charts and tables.

Limitations of the study

Despite the study being a resourceful part in gathering information, there are also challenges in the study. For instance, in conducting an online survey, getting the right population is a challenge. This is because the link was shared in various social media platforms thus controlling who to answer was a challenge. Additionally, in reviewing literature review, the articles were so many and given the limited time of the study I was forced to review a few articles and based on that the results have been illustrated in the next section. The responses were also a bit of a challenge to analyze given some questions were open-ended. Some respondents’ answers were not well articulate and some were hard to comprehend. Time to research was also a limitation to the study given the few weeks given for the paper to be written and answers analyzed.

1. Results

Introduction

The purpose of this study was to examine the impacts of Global Health Initiatives on HIV/AIDS. To find answers different methods were used to collect data. The methods used were an online survey that was shared in social media platforms and an analysis of previous studies. Anonymous personnel who were willing to take part conducted the survey. Thus, the answers presented are anonymous and are based on what people around Africa and the United States feel. This chapter seeks to explain the findings from the data collected from the two methods in chapter four. The findings will be well evaluated in bar charts and tables.

Online Survey on Survey Monkey Results

Question 1: Has any of your family member been affected with HIV/AIDS?

Question 1 was used to find out whether the respondent has had experience dealing with a family member who was infected with HIV/AIDS. The main reason for this question was to make the respondent familiar with what other questions will focus on. Most members indicated that they had an experience. A majority of the population (n=211, 84.4%) that participated in the survey had a family member affected with HIV/AIDS. There was a follow up question if the answer to Question 1 was yes. The question was “How accessible were anti retrieval drugs to him/her”. For some the drugs were easily accessible and for some the drugs were not easily accessible to them. Unfortunately, these resulted to death of their loved ones. All the respondents answered this question. The results of this question are illustrated in the table below.

Question 2: What Global Health Initiatives are currently in your country? If two, right them on the other label

The purpose of the question was to find out whether the members know what global initiatives are present in their country. Most people acknowledged knowing more than one GHI in their country. Above 50% of the total respondents (n=147, 58.8%) stated, that all the initiatives mentioned in the quiz was present in their countries. About 30% stated that their country had two initiatives (n=78) and the rest of the population (10%) stated that they had one global initiatives. Zero respondents said there were no Global Health Initiatives in their country. The answers were based on the knowledge people had on global health initiatives.

Question Three: What are the changes your country has had after the establishment of these initiatives? If any

For this question, a textbox was provided for respondents to jot down their response. In this question, none of the respondents skipped to answer. The answers highlighted were that drugs were now accessible easily as almost every hospital is equipped with the drugs. The number of deaths have reduced significantly since the initiatives were introduced. There has been better management of the disease and more doctors and nurses have been trained to deal with HIV/AIDS. Through the establishment of GHIs there has been awareness in the community. The rates of stigmatization has reduced and instead strategies to accommodate those infected have been put in place. Most respondents’ answers were correct and they showed the efforts that have been made since the establishments of GHIs. Very few correspondents stated how the initiatives have led to the establishment of HIV/AIDS centers for testing and training.

Question Four: How would you rate the positive effects of GHIs?

The purpose of the question was to get the degree of how important GHIs are. The rate recorded was above four. Which can be translated as above average. That is, positive effects of Global Health Initiatives are above threshold.

Question Five: How would you rate the negative effects of GHIs?

The rate recorded in this question was below two, meaning the negative effects are at a minimum. The purpose of the question was to find out whether there are negative effects that have been brought about by the establishment of Global Health Initiatives. Everyone who participated in the survey answered this question.

Question Six: What do you suggest needs to be adjusted to fully realize the impacts of GHIS on HIV/AIDS?

None of the respondents declined to answer this question. A number of suggestions were highlighted. Among them were the funding of existing research bodies and establishment of new laboratories to aid in research for coming up with a cure of the disease. Another suggestion that was stated was that the initiatives should work hand in hand with the countries governments to fully understand problems faced in different regions. Some suggested that the GHIs should come up with one bodies that controls them to harmonize their activities. Lastly, some members suggested that countries should have a body that handles finances that have been donated from GHIs to reduce the risk of the funds being misused or used for personal gain.

Question Seven: Should GHIS continue supporting HIV/AIDS in providing drugs and care or do you think as a country that can be dealt with by the government?

This question sort to answer whether Global Health Initiatives should continue with their work in the various states. The majority of the respondents answered yes and some gave comments on what they think about GHIs. In the comment section, most respondents said that the initiatives should continue operating but they should change they operations to be independent of the countries as that would ruin their purpose. Most of them said that the initiatives have been of great help in dealing with the epidemics and therefore they should just readjust their structures to the extent of having their permanently employed health practitioners.

Systematic Reviews

In reviewing of previous articles, several interesting facts were discovered. Among over 10 articles reviewed, the study settled for four studies that were more closely related to the study. In reviewing literatures HIV/AIDS, impacts and Global Health Initiatives were the keywords used during the research. Most articles pointed out the establishment of GHIs having brought both negative and positive outcomes. Most articles attributed to using the WHO six building blocks in their health systems  (WHO, 2007).

Impact 1: Governance

All the four articles (n=4,100%) reviewed and summarized in chapter two attributed to GHIS affecting governance and leadership of several countries. It was discovered that other initiatives such as PEPFAR had their own regulations and they were not willing to compromise that in order to accommodate this country’s needs. As much as other initiatives came up with reforms to help them perform better they still had issue in leadership from specific countries.

Some countries in the sub Saharan countries such as Democratic Republic Of Congo had been in war for some time. This greatly affected their governance and when leadership is not strong then health systems are more likely to be in poor condition. So with global healthy initiatives coming to the picture the first step was to first deal with leadership before they could resort to giving heath funds. As a result, initiatives have been linked to enabling peaceful reforms in various countries that were affected greatly with war.

Impact 2: Health Workforce

All the four articles reviewed attributed to GHIs significantly aiding in improving quality and increasing quantity of workforce in various health systems. This is the greatest achievement that came with initiatives. That is, they trained doctors and nurses and gave an upper hand in training other community personnel on how to handle HIV/AIDS patients effectively. The result of this is that patients had enough human workforce to help them in the healing process that is through acceptance of their conditions and giving them words of encourage. Mortality rate reduced significantly and more people were now leading normal lives.

Impact 3: Provision of Health Equipment

Provision of health equipment improved health facilities and made drugs more accessible to the various communities. As a result, death rates related to HIV/AIDS have significantly reduced. The economy is now at a better place as children are now supported by their parents in schooling and their parents can work effectively in industries to get an income. All the four articles attributed to this fact.

Impact 4: Overdependence in donations

Some governments have forgotten their role in the society and they now seem to find it difficult to operate without external funds to support their health system. This has result to poor health systems in other countries despite initiatives efforts to support them. This is one of the negative effect of GHIs that was discussed in the various articles.

Impact 5: Misuse of funds

Donor funded initiatives funds are not well accountable for. Some people have resorted in using these funds for personal gain. Hence, the less fortunate are not well catered for. This can not only affect patients but the economy and the government at large. As a result of such greedy individuals the good deeds of this initiatives are not fully seen.

Summary

The sole purpose of the study was to evaluate the impacts of global health initiatives on HIV/AIDS. This section was majorly focused in explaining the data collected and representing it in statistics that one can easily comprehend. The results show how there are a number of influence that GHIS have on HIV/AIDS and health systems. The results show how positive impacts of GHIS have surpassed negative impacts. Using statistics, the results have shown how well people have knowledge in what GHIs do and what they have brought in their respective countries. The survey results has exposed important factors that can be used to improved health initiatives for countries to fully realize their efforts. The results have also shown how people perceive the establishment of GHIS and how they still want them to be operational. The next chapter is the discussion chapter that further discusses the results, giving limitations to the study and recommendations for other research.

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