Effects of the Global Fund on reproductive health in Ethiopia and Malawi: baseline findings.

This report is part of the System-wide Effects of the Fund (SWEF) research initiative which aims to assess the effects of the Global Fund to Fight AIDS Tuberculosis and Malaria (GF) and the activities it supports on reproductive health and family planning programs in Ethiopia and Malawi. The main research objectives are to consider the effects of GF activities on the policy process human resources the public/private mix and pharmaceutical and commodity procurement and management with relation to reproductive health and family planning services. Findings are that reproductive health players have not participated extensively in GF planning processes and GF activities are not integrated with reproductive health family planning or other preventive care services. Health workers have increased responsibilities with GF activities and work in resource-constrained environments. In Ethiopia health workers are shifting out of the public sector in search of better working conditions at non-governmental organizations (NGOs) bilateral aid agencies and international organizations and in Malawi there is evidence of resource shifts away from community health programs like reproductive health and family planning in favor of activities related to the three focal diseases of AIDS tuberculosis and malaria. While both public and private facilities offer reproductive services they are available in almost all public health facilities but in fewer private facilities. The number of private NGOs has grown while the involvement of the private nonprofit sector remains limited. Systems for commodity procurement and disbursement have improved in Ethiopia while fewer improvements to the system have occurred in Malawi as GF activities have been implemented. In order to bolster reproductive health and family planning services in future GF activities reproductive health advocates and providers should make a case for integrating services for these focal diseases with reproductive health and family planning and become more involved in the planning process for GF activities. (authors)