The Impact of Global Health Initiatives on the Health System: Kenya
Kabiru, Ephantus W.
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There has been an increasing interest in understanding the effects that GHIs, such as the Global Fund and PEPFAR, have had on nations’ overall health systems. We sought to evaluate the impact of these two GHIs on Kenya’s health system. We conducted semi-structured interviews with 37 key informants from across the health sector and examined documentary material. Interviews were recorded and transcribed. The data was then coded and analyzed using qualitative data analysis software. Informants reported that PEPFAR and the Global Fund had an overall positive effect on Kenya’s health system. Informants identified PEPFAR’s governance, procurement systems, and monitoring and evaluation (M&E) systems as key drivers of its achievements. Informants identified the Global Fund’s ability to coordinate funding with government priorities as a key driver of its positive effects. Informants also identified opportunities for maximizing GHIs’ positive effects on the health system and minimizing negative effects. PEPFAR’s lack of coordination with government decision-making processes and the constraints it imposes on the use of funding were described in unfavourable terms. Similarly, the Global Fund’s complex grant funding process and its perceived lack of oversight and accountability were described unfavourably. Although GHIs such as the Global Fund and PEPFAR have successfully strengthened the Kenyan health system, there are opportunities for them to have a greater positive effect.