Parceria para o desenvolvimento sanitário
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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.
Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:
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The largest external donor in Botswana's health sector is the United States of America through:
- the United States President's Emergency Plan for AIDS Relief;
- BOTUSA (Botswana─USA, a partnership between the Centers for Disease Control and Prevention and the Government of Botswana to help stop the spread of tuberculosis and HIV/AIDS in southern Africa;
- the Bill & Melinda Gates Foundation;
- the African Comprehensive HIV/AIDS Partnerships.
Other donors are the European Commission, United Nations agencies, especially the United Nations Children's Fund and United Nations Population Fund, the Japan International Cooperation Agency and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Within the area of HIV/AIDS where development partners’ contribution to health is greatest, a framework that stipulates each player’s area of focus has been developed. The main areas/goals are:
- capacity-building and health systems strengthening
- information management to enhance evidence-based planning
- treatment, care and support.
The United States President's Emergency Plan for AIDS Relief supports research in prevention, treatment and care, as well as capacity-building for local civil society and private sector. Other AIDS donors are:
- The African Comprehensive HIV/AIDS Partnerships, which has shifted its focus from treatment to prevention;
- World Bank, which also supports prevention;
- the European Commission, which supports human resource development, multisectoral participation in AIDS response and strengthens local nongovernment organization governance;
- United Nations agencies, which support prevention, treatment and care, and give technical assistance;
- the Clinton Foundation, which supports antiretroviral programmes, including treatment for children;
- international academic institutions, including Harvard, Baylor and the University of Pennsylvania, who support the Government of Botswana in AIDS research, clinical care and training.
Through the use of a single health policy, a single strategy for health delivery implementation framework, a single monitoring and evaluation framework, and established national health priorities, all under the leadership and governance of the Government, the Ministry of Health ensures that programmes that partners are interested in are within the framework of national priorities and are well coordinated.
The Government of Botswana has established a National AIDS Coordinating Council that coordinates all AIDS-related work in the country and a national partnership framework that guides participating organizations with regards to their roles and relationships.
Under the revised National Health Policy of 2011, the Government of Botswana is in the process of forming a national health council to coordinate all activities of the health sector, including strategic partnerships. The council will have representation from all sectors of the economy, private sector, developmental partners and nongovernmental organizations, as well as the community.