Browsing by Author "Cailhol, Johann"

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    Analysis of aid coordination in a post-conflict country : the case of Burundi and HRH policies
    (University of the Western Cape, 2015) Cailhol, Johann; Lehmann, Uta; Gilson, Lucy
    Aid coordination in the health sector is known to be challenging in general, but even more in post-conflict settings, due to the multiplicity of actors of development, to the sense of emergency in providing health services, combined with the so-called weak institutional capacities‘ at local level, resulting from the conflict. This study sought to analyze broad determinants of aid coordination using the example of HRH policies in Burundi, during the post-conflict period. Burundi is a country in Central Africa, which experienced cyclic ethnic conflicts since its independence in 1962, the last conflict being the longest (1993-2006).Determinants of coordination were analyzed using the policy-analysis triangle (Gilson et Walt), using data from documents and semi-structured interviews, conducted in 2009 and in 2011, at national, provincial and facility-levels. A conceptual framework, combining organizational and social sciences theories, was devised in order to assess the organizational power of MoH, the one supposed to act as coordinator in the health sector. Findings showed a lack of coordination due to post-conflict specific context, to competition over scarce resources between both donor and recipient organizations and to an insufficiently incentivized and complex coordination process in practical. Most importantly, this research demonstrated the crucial role of post-conflict habitus and mistrust in the behavior of MoH and their influence on organizational power, and, in turn on their capacity to coordinate and exert an appropriate leadership. These findings, together with the growing body of literature on organizational sociology and collective trust, point at the crucial need to rebuild some of the wounded collective trust and organizational leadership in Burundi and in other fragile states.
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    Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM AND Pepfar-funded HIV-activities
    (BioMed Central -The Open Access Publisher, 2013) Cailhol, Johann; Craveiro, Isabel; Mathole, Thubelihle; Parsons, Ann Neo; Lehmann, Uta; Sanders, David; Madede, Tavares; Makoa, Elsie; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; Dussault, Gilles; Van Damme, Wim
    BACKGROUND: Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. METHODS: A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. RESULTS: In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. CONCLUSION: Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.