Partnerships for health development
There is a tension between the often short-term goals of donors, who require quick and measurable results on their investments, and the longer-term needs of the health system. That tension has only heightened in recent years, where the surge in international aid for particular diseases has come with ambitious coverage targets and intense scale-up efforts oriented much more to short-term than long-term goals. Though additional funding is particularly welcome in low-income contexts, it can often greatly reduce the negotiating power of national health system leaders in modifying proposed interventions or requesting simultaneous independent evaluations of these interventions as they roll out.
Harmonizing the policies, priorities and perspectives of donors with those of national policy-makers is an immediate and pressing concern – though with apparent solutions. In addition, the selective nature of these funding mechanisms (e.g. targeting only specific diseases and subsequent support strategies) may undermine progress towards the long-term goals of effective, high-quality and inclusive health systems.
Even where this funding has strengthened components of the health system specifically linked to service delivery in disease prevention and control – such as specific on-the-job staff training – the selective nature of these health systems strengthening strategies has sometimes been unsustainable, interruptive and duplicative. This puts great strain on the already limited and overstretched health workforce. In addition, focusing on "rapid-impact" treatment interventions for specific diseases and ignoring investments in prevention may also send sharply negative effects across the system’s building blocks, including, paradoxically, deteriorating outcome on the targeted diseases themselves.
Many of these issues have been recognized internationally, and a number of donors have agreed to better harmonize their efforts and align with country-led priorities – as outlined in the 2005 Paris Declaration on Aid Effectiveness (see figure). However, although some progress has been made in applying the Paris Declaration principles, it has been slow and uneven. Change in the process and the nature of the relationship between donors and countries requires time, focused attention at all levels, and a determined political will.
This section of the health system profile is structured as follows:
Local and international partners make a significant contribution to the health sector in the Gambia, providing an estimated 66% of funding. However, the priorities of the different actors often differ and this results in vertical health programmes, inefficient utilization of health services and lack of coordination at the implementation level. In order to maximize effectiveness of partners, there needs to be a policy on partner/donor coordination.
There are positive moves at the intersectoral level, especially within the education sector, through health programmes and the recently established multisectoral Health and Nutrition Committee by the Ministry of Education. Achievements of this collaboration include, but are not limited to:
- implementation of deworming of schoolchildren
- hand washing
- immunization campaigns in schools
- the WHO Health Academy Project jointly implemented by the Ministry of Health and Social Welfare and the Ministry of Education.
The health sector also works closely with water resources and community development sectors to provide safe water and sanitation.
The private sector, faith-based organizations, civil society organizations, nongovernmental organizations and government agencies work with the Ministry of Health and Social Welfare in health care delivery at all levels. At community level, primary health care structures, such as the village development committees and the multidisciplinary facilitation team, serve as the main coordination mechanism for health care delivery. Technical advisory committees also serve as useful structures for coordination at regional level. Through these committees, global initiatives are translated into activities at the implementation level.
Currently, funding from international donors (e.g. bilateral and multilateral agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI Alliance) is channelled directly to the intervention programmes through the Ministry of Health and Social Welfare. This has led to better outcomes since continuation of such funding is based on achievement of mutually agreed targets.
The Gambia has benefited from the International Health Partnership (September 2007) and other similar global initiatives aimed at promoting a more coordinated approach to developing and implementing national health plans and strategies, and addressing health system constraints.
Despite an increasing commitment of the global community to health goals, the Gambia still experiences shortfalls in funding to strengthen its health systems, particularly human resource development. The health sector has been advocating for the establishment of a sector-wide approach that will contribute significantly to service delivery through effective utilization of donor funds.
Public–private sector partnership also involves implementation of key national events such as polio national immunization days and commemoration of international health days. Banks, local musicians, artists and petroleum companies are some of the major contributors to the health sector. There is, as yet, no explicit policy on private sector involvement per se but the Directorate of Health Services has the oversight function of ensuring that this contribution is properly managed.
There are formal agreements between the Gambia and China, Cuba, Egypt, Nigeria, Spain, Taiwan and Venezuela in the delivery of health care in training, provision of expertise and, most outstandingly, in the setting up of the first and only medical school. Another training programme for community doctors is being implemented in four regions of the country. This is a novel venture for the Gambia and it is hoped that populations that were previously underserved will be provided with locally trained doctors who understand the environment they will work in.
Partenariat pour la santé et mécanismes de coordination
Harmonisation et alignement avec l'approche des SSP
Approches sectorielles (SWAp)
Partenariat Public-privé et société civile
Notes de fin: sources, méthodes, abréviations, etc.
- ↑ Systems thinking for health systems strengthening (pdf 1.54Mb). Geneva, World Health Organization, 2009
- ↑ The Paris Declaration on Aid Effectiveness (2005)
- ↑ Harmonization for health in Africa (HHA). An action framework (pdf 71.22kb)
- ↑ Joint Assistant Strategy 2008─2011. The Gambia, African Development Bank–World Bank, Regional Department West 2, February 2008