Abstract
BackgroundThe Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs).MethodsWe conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach.ResultsWe found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector.ConclusionThere was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.
Highlights
The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar
Study framework We investigated the role of the Global Fund in Myanmar’s HIV/AIDS response from a health system perspective
The final themes were constructed into a logical structure through an Results Key informants articulated that the Global Fund’s financing has allowed the national HIV/AIDS response “to grow, to expand, and to learn”, but stakeholders had to work on the process “with a lot of pain, headaches, [and] hiccups” (R04)
Summary
The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). The Global Fund has intended to support programs for targeted diseases “in ways that will contribute to strengthening health systems” [1], and health system interventions were usually added to or embedded into disease-specific proposals [2, 3] Despite these intentions, the Global Fund’s investments in supporting health systems were sometimes constrained by its poor alignment and harmonization with the existing systems [4]. The five-year grant was soon terminated in August 2005 due to restrictions imposed by the Myanmar government on international agencies, non-government organizations (NGOs) and civil society organization (CSOs) [13] This included travel restrictions and the installation of lengthy and time-consuming procedures to obtain domestic travel permits [14] as well as formal or informal restrictions at the field level. The Global Fund returned to Myanmar to support implementation of the National Strategic Plan on HIV/AIDS (NSP) (2011–2015) through Round 9 (2011–2015, $157.7 million requested) and New Funding Model (2013–2016, $210.8 million requested) See Fig. 1 for a historical timeline of the national response to HIV/AIDS in Myanmar
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