Our conceptual framework suggests that Global Fund supported activities may have intended and unintended effects upon the broader health care system and that these effects may enhance health system performance (in terms of improving accessibility, sustainability, efficiency, and equity) or detract from it. Based upon the conceptual framework, there are multiple levels at which the effects of the Global Fund upon the broader health care system could be measured. These include:
- Process effects upon the functioning of the health care system;
- Measures of health system performance such as equity, efficiency, access, quality, and sustainability of non-focal services;
- Impacts upon utilization of services and coverage of non-focal diseases; and
- The burden of disease from non-AIDS, TB, and malaria illness.
The research will focus upon identifying and measuring process effects within the health care system and measures of health system performance, and to some degree, service utilization and coverage of non-focal diseases.
The study will focus upon four thematic areas, namely:
- Effects upon the policy environment - Global Fund proposal and planning processes are designed to enhance the range of actors involved in informing policy and implementing disease control activities. The study will assess the extent to which this occurs. The development and implementation of Global Fund supported activities interfaces with other planning and aid frameworks such as sector wide approaches (SWAps) and poverty reduction strategy papers (PRSPs), as well as other new financing mechanisms (such as MAP) targeted at HIV/AIDS. The study will assess the effect of Global Fund support upon the broader pattern of health system funding, and the extent to which the policy and operations pursued by the Global Fund are in alignment with existing structures.
- Effects upon the Public/Private Mix - The Global Fund explicitly welcomes innovative approaches to expanding service coverage and approaches that draw private sector actors into the health care system; accordingly a greater role for private sector actors may evolve. The study will evaluate the effects of Global Fund support upon the number, distribution, and organization of different types of providers (public, private for-profit, private non-profit) and relationships between public and private sectors (such as the number of public/private partnerships in non-focal areas, and the degree of trust and cooperation between sectors). In addition, the study will explore the implications of these changes for overall health system performance.
- Effects upon Human Resources - Many Global Fund proposals include training activities for health workers, and some address issues of staff retention and motivation. Where health workers are in short supply, Global Fund supported-activities may overburden capacity. Global Fund-supported activities may also affect the skills, motivation and distribution of health workers, and may cause shifts in the distribution of health workers from non-focal disease programs/functions. The study will evaluate the extent of these effects and identify the mechanisms through which they were affected.
- Effects upon Pharmaceuticals and Commodities - Approximately 50 percent of Global Fund money already committed will procure pharmaceuticals and commodities. This injection of funding may affect procurement, supply and distribution systems, and the quality and prices of other drugs and commodities. The study will use the drug management framework (procurement, distribution, utilization/rational use, and monitoring and evaluation) as well as the access framework (geographic access, physical availability, financial affordability, quality, and specific issues of pricing/subsidies) to investigate the effects of the Global Fund upon pharmaceuticals and commodities.