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Press Release

Is Donor AIDS Money Strengthening Health Systems? New Study Finds Missed Opportunities

August 4, 2008

nameWASHINGTON,D.C.(August 4,2008)- Billions of dollars in donor money being spent in developing countries to fight HIV/AIDS can be much more effective if the big donor programs pay more attention to their effects on the health systems of host countries, according to a new report from the Center for Global Development (CGD).

As donors expand their programs in developing countries, they draw on the resources of domestic health systems, sometimes weakening them, the report says. Fortunately, the report notes, there are many specific opportunities to both strengthen host country health systems and increase the effectiveness of internationally backed AIDS programs.

The report, Seizing the Opportunity on AIDS and Health Systems, will be launched with a high level panel discussion at the International AIDS Society Conference in Mexico City, from 6:30pm-8:30pm on August 6, 2008.

It documents the interactions between the world’s three major HIV/AIDS donors -- the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. President’s Emergency Plan for AIDS Relief, and the World Bank’s Africa Multi-Country AIDS Program -- and national health systems in three countries: Mozambique, Uganda, and Zambia. Globally, the three big programs have spent over $20 billion to fight AIDS since 2000. In some poor countries, health spending on AIDS is greater than spending on all other health problems combined.

Nandini Oomman, lead author of Seizing the Opportunity on AIDS and Health Systems and the director of CGD’s HIV/AIDS Monitor Program, says that poor integration between donors and host country health systems risks undermining international efforts to prevent and treat AIDS.

“The big HIV donors are creating AIDS-specific systems that compete for health workers and administrative talent, share the same inadequate infrastructure, and further complicate already complex flows of information,” Oomman said.

“While each donor’s approach is unique, all three donors have helped establish AIDS-specific systems and processes at the operational level that are distinct from those used for other health programs,” Oomman said. “The challenge now is how to integrate these AIDS activities into the broader public heath work in a way that will strengthen both.”

While Oomman lauds the tremendous efforts of donors and in-country health systems, she warns that given the use of common resources, the three global AIDS donors duplicate much of the same work.

“There is a lot of duplication of effort that could be avoided with better coordination,” Oomman said. “For example, reports to AIDS donors and reports for the health ministries are often completed separately by the same health facility staff. This extra effort takes away time from helping AIDS patients or providing other health services.”

The report recommends that donors take action by focusing on three components of the health system:

To improve health information systems:

  • Coordinate government and donor information needs and flows through national health management information systems-- to reduce information system fragmentation, minimize duplicative and burdensome reporting, and improve data quality.
  • With governments and other stakeholders, jointly design and invest in information technology solutions for data capture, management and analysis in health ministries, districts and facilities.
  • Create data collection and reporting incentives through information feedback systems.

To improve supply chain systems the report recommends the donors:

  • Pursue strategies that will allow antiretroviral drugs and essential medicines to be distributed jointly and to be managed using the same logistics management information system

To strengthen the health workforce the report recommends the donors:

  • Provide more support to train new health workers.
  • Prioritize the financing of new health worker hires over top-ups for current health workers.
  • Work with host country governments to improve public sector human resource policies.

On Wednesday August 6th the three donors and key stakeholders will respond to the report’s findings and policy recommendations. Panelists include: Mark Dybul, US Global AIDS Coordinator and PEPFAR Administrator; Michel Kazatchkine, Executive Director of the Global Fund; Simon Mphuka, Executive Director of the Churches Health Association of Zambia; and Debrework Zewdie, Director of Global HIV/AIDS Programs of the World Bank Human Development Network.


CGD’s HIV/AIDS Monitor program aims to improve the ability of donor countries to respond effectively to the HIV/AIDS pandemic through systematic research and analysis of major aid delivery mechanisms in three countries in Africa, coupled with complementary research and assessment at the global level. Through targeted analysis and policy outreach, it seeks to strengthen the organization, management, and delivery of external assistance to HIV/AIDS programs. This program is sponsored by the Bill & Melinda Gates Foundation, The International Development Research Center, the Swedish International Development Cooperation Agency, the William and Flora Hewlett Foundation, and the David and Lucile Packard Foundation.

The Center for Global Development is an independent think tank that works to reduce global poverty and inequality by encouraging policy change in the United States, other rich countries, and international institutions, through rigorous research and active engagement with the policy community.