Aisling Walsh and Ruairi Brugha1
Global HIV/AIDS Initiatives Network (GHIN): Early lessons from a network
approach to global research
If global networks are ‘dynamic and flexible types of connections between individuals,
groups and organisations that criss-cross the world . . . (and) are a sign of ‘human
accomplishments’ and global openings, they also expose the costs of globalisation.
(Rogers et al, 2001, iii).
1. Background to GHIN and rationale for the network approach
1.1 What is GHIN?
Global funding for HIV/AIDS has increased dramatically during the past five years.
Three global HIV/AIDS initiatives (GHIs) are together contributing two thirds of the
direct external funding to scaling up HIV/AIDS prevention, treatment and care in
resource poor countries. Evidence is crucial in understanding the effects these initiatives
are having on country systems, at national and sub-national (district) levels. The three
GHIs are:
The World Bank’s Global HIV/AIDS Programme including the Multi-country AIDS
Programme (MAP)
The Global Fund to Fight AIDS, TB and Malaria (GFATM)
The United States President’s Emergency Plan for AIDS Relief (PEPFAR).
A network of researchers in 21 countries was established in March 2006 by researchers
based at the London School of Hygiene and Tropical Medicine (LSHTM) and the Royal
College of Surgeons in Ireland (RCSI), in collaboration with researchers in 15 countries
across sub-Saharan Africa, Eastern Europe, Asia and South America, supported by five
institutions in Europe and the US. Members of the Global HIV/AIDS Initiatives Network
(GHIN) are researching the country effects of these global HIV/AIDS initiatives at
1
Royal College of Surgeons in Ireland (RCSI)
1
national and sub-national levels2 (www.ghin.lshtm.ac.uk3 – see annex A for membership).
Funding for coordination of the Network is from Irish Aid and DANIDA.
Objectives and plans for national and district level data collection across the GHIN
countries, 2007-08, depend on country contexts and the issues prioritised by the country
researchers as relevant to their countries. There are several common research themes
across the Network, some or all of which individual country studies are addressing. The
Network is facilitating comparative work and plans to synthesise findings around these
themes, which include the effects of global HIV/AIDS initiatives on: sub-national scaleup of services; health systems capacity, including availability of human resources;
national and district level coordination; and equitable access to services (see Annex B for
further information on research themes).
The primary focus of GHIN country studies is on sub-national (district) level data
collection. However, most of the studies have a national component, primarily in the
form of national context mapping (desk reviews and qualitative stakeholder interviews).
District level data collection is being conducted in several districts in each country,
during 2007-08. District mapping of facilities and relevant initiatives is being followed
by quantitative and qualitative surveys of district stakeholders. Several country studies
will encompass district baseline and follow-up fieldwork (up to one year later).
1.2 Research Networks
The need for research partnerships at a global scale has been emphasised over the last 20
years, encompassing collaborations between the North and the South (KFPE, 2001).4
Participants at a KFPE conference concluded that “strong networks improve the situation
of many countries in the south. South to south partnerships, as well as national and
international networks, must be supported and new ones promoted” (KFPE, 2001, p39).
2
Some countries may also research the effects of other global health initiatives
A new website is being constructed www.ghinet.org which will be launched in at the Dublin international
dissemination workshop, November 2007. Co-funding from UK DfID has enabled compilation of a
database of research-based evidence, which will be accessible on the new GHIN website.
4
We also use the terms ‘north’ and ‘south’, the former to denote the high income countries (and
institutions) of Europe and North America. In many respects it is a misnomer. GHIN studies are being
conducted in the Far East (Vietnam and China), in the Former Soviet Union and in Peru.
3
2
While the term network has entered global development discourse in the last decade,
there is no clear consensus about what is meant by adopting a ‘network approach’ in
health research, which limits our understanding of its strengths and weaknesses (Scott &
Hofmeyer, 2007). Many definitions of Networks exist, for example: Fricker & Lentin eds
2007; Global Networks Journal; Holton 2005; Rogers et al, 2001.
Examples of global research and development networks5
Acronym
GARNET
GHPRN
Géant(1)(2)(3)
Full name
Global Applied Research Network
Global Health Policy Research Network
A collaboration between 26 National Research and Education Networks
GDNET
GRP
INRUD
INDEPTH
HealthNet
SOMA-NET6
(NRENs) across Europe, the European Commission, and DANTE.
Global Development Network
Global Research Project on Explaining Growth
International Network for Rational Use of Drugs
International Network of Demographic Surveillance Sites
Health Netwoks
Social Science and Medicine Africa Network
1.3 GHIN’s approach
GHIN aims to embody a responsive model, which moves beyond the traditional model of
northern institutions channelling funds to and supervising research conducted in the
‘south’. GHIN is novel in some respects in that funding to country institutions is
independent of the network (see Annex A for relationships between funders and partners).
Only three of the country studies are directly funded through the GHIN Coordinators in
Dublin and London. Participation in GHIN is voluntary and open to research groups that
can subscribe to the principles and purpose of the Network. The intention from the start
was to move beyond the traditional ‘hub-and-spoke’ model, to a more organic
knowledge-driven approach, where different types of linkages – including ‘south-tosouth’ ones – can evolve. Relationships and roles within GHIN aim to be dynamic,
responsive and flexible.
5
6
This list is not exhaustive
This is a regional network
3
The aim of this paper is to describe early lessons learned from this network approach to
researching global HIV/AIDS initiatives. Specific objectives are to describe the role of
the Global HIV/AIDS Initiatives Network (GHIN) in:
a. promoting and enabling research capacity building and research ownership
b. research governance
c. generating multi-country comparisons and generalisable lessons, and supporting
advocacy and dissemination to global and country stakeholders
This paper focuses on the practical lessons learned from GHIN and does not contain a
theoretical analysis of the applications of network theory to health research networks and
GHIN. As GHIN was established in March 2006, lesson learning is ongoing. This paper
is written from the Network Coordinators’ perspectives. Perspectives of country
teams/network members and other stakeholders will be obtained over the coming months
and on an ongoing basis over the next two years.
2. The genesis and birth of GHIN
2.1
Global Fund Tracking Study and SWEF studies
GHIN has its origins in two sets of multi-country studies on the Global Fund that were
conducted between 2003 and 2006, and in the relationships established between global
and country researchers, and between the researchers and funding agencies. The Global
Fund 4-country Tracking Study was conducted in 2003-04 by Brugha and Walt, based at
the London School of Hygiene and Tropical Medicine (LSHTM), working with
researchers based in Mozambique, Tanzania, Uganda and Zambia (Brugha et al 2004,
Brugha 2005). Irish Aid and DANIDA were the first two of four European bilateral donor
agencies who funded the study.
In 2003, Bennett and Stillman, based at Abt Associates in the US, developed a research
protocol and framework for studying the ‘System-wide effects’ of the Global Fund
(SWEF) on countries (SWEF 2003). They organised a workshop in Oxford, UK, in late
2003, attended by researchers from Ethiopia, Benin, Malawi, Georgia, Nicaragua and the
UK (LSHTM). At this consultative meeting, a network approach was agreed and a
common research protocol developed. During 2004, Bennett obtained funding from
USAID and the EU to support studies in these countries (Stillman and Bennett 2005).
4
SWEF, unlike the Tracking Study, constituted a Network approach in that ‘southern’ and
‘northern’ researchers participated in its genesis; and in many ways SWEF was the
precursor to GHIN. See annex A for a background to funding for the country studies.
Communication with global stakeholders also took place from late 2003-2005.7
2.2 The launch of GHIN
Maselli et al (2006) have outlined the importance of a broadly-based consultative
process, which should precede any research collaboration. An international workshop was
held by the LSHTM in London in March 2006 to which the different country research
teams were invited. Participants expressed the need for and committed themselves to
forming a network for tracking global HIV/AIDS initiatives. Eleven country teams were
represented at this workshop, including three from the Former Soviet Union (FSU) and
five groups from sub-Saharan Africa (sSA). During the workshop, researchers worked in
groups that reflected the types of HIV epidemics they would be studying – generalised
(sSA) and concentrated (FSU).
Lessons learned from other networks (Maselli et al, 2006) show that coordination is
crucial. Participants at the London workshop agreed that the Network should have the
following aims:
Promote comparability through common research protocols and tools
Share expertise across country study teams and build research capacity
Generate multi-country comparisons and context-specific policy lessons
Coordinate dissemination of findings and recommendations and streamlining
communication with global stakeholders
A half day was set aside at the London workshop to inform global stakeholders
(representatives of the GHIs and bilateral donors) and to get their inputs about the
7
After initial difficulties in communication between LSHTM and the Global Fund Secretariat, relationships improved following the
appointment of Schwartlander to head up the Fund’s Evaluation division in December 2003. Bennett, with the support of other
stakeholders in WHO, organised a meeting in Geneva in June 2003 to present and discuss the SWEF approach. Bennett and Brugha
participated in a meeting of the Global Fund’s Technical Evaluation Reference Group (TERG) in Glion in April 2004, which was
planning the Global Fund’s Five Year Evaluation. Both kept in close touch with the Global Fund during 2004 and 2005, regularly
briefing the Fund on the genesis and birth of GHIN.
5
proposed GHIN network and studies. Representatives present were from the Global Fund
and four bilateral donors: Irish Aid, DANIDA, USAID and UK DfID.
3. Principles of GHIN
The philosophy under-pinning GHIN is that its principles and processes should not be
predetermined by Network Coordinators from the ‘north’, and that shared responsibility
and transparency should be promoted from the outset. This is in keeping with other
global guidelines for promoting successful research partnerships (KFPE 1998). At the
London March 2006 workshop, Network members discussed and agreed a core set of
principles for the GHIN Network, which were subsequently written down by the
Coordinators, disseminated to members and approved by them:
Participation: Network members are encouraged and will be facilitated to
participate in major Network events, including the international workshops
planned for November 2007 (Dublin) and end of 2008 (Geneva). Members will
have the opportunity and will be supported to take on other roles such as
participating in Network coordination activities, technical assistance and peer
review, communication with global stakeholders and global dissemination of
research findings.
Fairness: ‘Southern’ and ‘northern’ Network members will have the opportunity
to contribute to decision-making and guiding the overall direction of the Network.
‘southern’ and ‘northern’ Network members will have access to Network
resources. Opportunities for authorship, including journal articles, will be
allocated among Network members.
Accountability: There are complex layers of accountability. Network members,
including the Coordinators, are accountable to the Network; each is accountable
to its funder (Irish Aid and DANIDA, in the case of the Coordinators); and
country researchers and the Coordinators have a responsibility to disseminate
findings to their respective stakeholders who are in a position to utilise and act on
study findings, at the global and country levels.
Transparency: Network members, including the Coordinators, will inform each
other of developments relevant to the aims of the Network, at global and country
6
levels. The Coordinators will report regularly to Network members regarding
forthcoming decisions and those taken; and will enable members to take part in
decision-making. Country teams are encouraged to share research methods, tools,
lessons learned and findings with Network members. The Network will also
communicate with stakeholders beyond the Network; and about activities and
outputs from country studies, thereby making the Network more transparent.
4. Network governance: beyond the ‘hub and spoke’ approach
GHIN aims to promote collaboration and partnership by giving an equal say to ‘southern’
and ‘northern’ partners in governance of the network. At the March 2007 London
workshop, Network members agreed that there was a need for an institution or
institutions to take on the role of Network Coordinator. They agreed that LSHTM and
RCSI should adopt this role.
Strong central coordination needs to be balanced with responsiveness to the views and
needs of Network members in accordance with the Network principles. Hence, the role
needs to be facilitative and enabling rather than managerial in orientation. From the
outset, there was an attempt to distribute coordination responsibilities amongst Network
member institutions. For example, Network members were given the opportunity to take
on a particular role such as leading on or coordinating agreed Network activities at the
regional level, participating in regular coordination teleconferences, or participating in a
proposed Steering Group.
Initially it was proposed that coordination of GHIN activities would take place through a
number of working groups, including a) a generalised epidemic group and a concentrated
epidemic group, b) a coordination group and c) an advisory group. It was proposed that
the concentrated and generalised HIV epidemic groups would each nominate a country
team as Regional Coordinator, and that this role would rotate annually. Country teams
were to be given the opportunity to put themselves forward and the final choice would be
made by network members.
7
This was discussed at the two regional workshops in Lilongwe and Kyiv, September and
October 2007, where country teams were invited to become regional Coordinators or
members of a GHIN Steering Group. Country research teams indicated that they were
happy for the full-time Coordinators from RCSI and LSHTM to take on all the
coordination activities, allowing country research teams to focus their efforts on their
studies. Most country researchers were fully occupied with several other studies and had
limited capacity to take on other roles.
Does this mean that unequal participation and unequal power relations exist within
GHIN? According to Scott & Hofmeyer, the perspective that Networks are membercontrolled “…. is intriguing as it implies a formal structure somewhat akin to the notion
of networks as organisations. This level of formality is not always the case.” (Scott &
Hofmeyer, 2007, p13). It is known that Networks make heavy demands on partners. It
appears that competing demands for their time have constrained southern researchers
from participating more actively in GHIN (the GHIN Coordinators indicated that they
would make financial resources available to southern research to take on additional roles,
but discussions did not proceed in this direction).
Each team has been represented at international and regional workshops. The Malawi and
Ukraine country teams were funded to coordinate the regional workshops in Lilongwe
and Kyiv. All teams participated in the programme development and chairing of sessions
at these workshops; and almost all are attending the November 2007 Dublin workshop.
5. Research capacity building and the role of GHIN
The importance of research capacity strengthening in global health research has been well
documented over the last 20 years, as evidenced by an abundance of literature, training
tools, programmes, grants, task forces, conferences and guidelines (Maselli et al, 2006;
Nchinda, 2002; Nurse & Wight, 2006; KFPE, 1998; Paraje, Sadana & Karam, 2005;
Nuyens, 2007). However, recent evidence (Paraje, Sadana & Karam 2005) suggests that
the knowledge gap between the North and the South, particularly low-income developing
countries, is growing ever wider. There are challenges in using the network approach
8
when it comes to capacity building. Capacity issues and needs vary from country to
country, requiring different strategies and levels of support.
One of the primary roles of GHIN is to provide support to country studies, where country
research groups have identifiable capacity gaps. “Promoting focused collaborative
networks for sharing information and experience at the national, regional and global
levels is a pre-requisite of approaches to building research capacity” (KPFE, 2001, p.37).
The consensus among participants at the London workshop in March 2006 was that the
most appropriate means of harnessing the collective technical experience of southern and
northern research teams was to hold regional workshops at key stages of development of
country studies, which GHIN did in September – October 2006. Workshop objectives
were to discuss and agree research methods and plans for national and district data
collection, identify and promote cross-country comparability, review and standardise data
collection tools and prepare analysis plans.
Technical assistance to developing countries has been experienced as “heavily
overpriced, under evaluated and stubborn to change” because “too much of it continues to
be identified, designed and managed by donors themselves, tied to donor countries’ own
firms, poorly coordinated and based on a set of often untested assumptions about
expatriate expertise and recipient ignorance” (ActionAid International, 2006, p3). Nurse
& Wight (2006) have postulated a paradigm for research capacity strengthening, which
involves the north and the south working towards a framework of engagement built on
principles such as Southern-driven priorities and ownership, demand-led research, a focus
on development relevance, and mutually beneficial working relationships (Nurse &
Wight, 2006).
One of the central tenets of GHIN is that country teams’ technical support needs are
demand- rather than supply-driven. At the Lilongwe and Kyiv regional workshops in
2006, country teams identified areas where they felt they needed research capacity
strengthening. Members led various methods sessions, utilising their particular strengths;
and the Network Coordinators mainly played facilitating and technical resource roles.
9
The different time-sequences of country studies8 has benefited not only the ‘late starters’.
For example, the INCO (EU) consortium is the most recent addition to the network, but
other teams are expected to benefit from their guidelines and tools for national level data
collection in 2008. The longitudinal nature of the research means there are multiple
opportunities for lesson-learning as the research progresses from baseline to follow-up.
Lessons learned from the Global Research Project (GRN) on Explaining Growth (Maselli
et al, 2006) showed that researchers from industrialised countries who were less familiar
with certain regions or countries benefited by learning about institutional and historical
aspects of growth in the countries concerned. Nchinda (2002) has documented the
importance of partners from the North spending periods of time with their colleagues in
the South to gain a better idea of the context in which the research is taking place
including the constraints of southern institutions in accessing field work sites. Traditional
‘north-to-south’ capacity building has been an important component of GHIN in that
GHIN Coordinators have travelled to Southern institutions to support country study fieldwork. This has enhanced the capacity of the GHIN Coordinators to understand the
complexities of generalising the effects of HIV/AIDS initiatives within the specific
country contexts. It has also enabled ‘south- to-south’ lessons learned to be passed on to
others country teams within the sSA and other regions. The Coordinators have also
played a role in terms of follow-up visits to countries, as well as remote support such as
feedback on written materials, whether research design or analysis or findings.
South-to-south capacity building is reckoned to be important for promoting research
capacity strengthening. KFPE (2001, pp.36-37) has recognised that “exposure to different
knowledge systems and mutual learning in collaborative structures are a highly effective
means of building research capacity….Such collaboration is most profitable in
international terms, relying on North-South and South-South partnerships and working in
a problem oriented and transdisciplinary way. Promoting collaboration in such terms
implies a programme approach that combines sustainability with flexibility.” GHIN has
supported research exchange between country teams within Ukraine, Georgia and
8
Some country teams have already completed both baseline and follow-up district level field work,
whereas others have not yet begun national level fieldwork.
10
Kyrgyzstan. This proved to be particularly educative for the researchers, and provided a
comparative view as well as field work experience on a number of aspects of the
research.
The Health Research System Analysis Perspective (WHO/RPC, 1998) has outlined
characteristics of an enabling environment for researchers, one of which is to establish
teams of researchers including a variety of health research disciplines ranging from basic
science and health systems to social science and epidemiology. GHIN aims to
demonstrate such characteristics. The benefits of this were demonstrated in the regional
workshops, where for example social scientists were able to benefit from the medical
doctors in understanding terminology and the application of HIV/AIDS services within
the clinical setting. Medical doctors have been able to benefit from the qualitative skills
of some of the social researchers.
6.
Promoting cross-country comparability and generalisability
One of the primary aims of GHIN is to maximise comparability; and to facilitate
comparisons, analyses and the production of cross-country syntheses of findings and
lessons learned across countries, regions, epidemics and health systems contexts. All of
the studies have incorporated elements of the original SWEF protocol, which has
facilitated this. Hence, a key activity of the Network is to generate comparative outputs
on key themes and to synthesise findings from multiple country studies, so as to inform
policy across countries as well at the global level.
It is expected that cross country syntheses will primarily focus within regions and
epidemics – generalised and concentrated. Wider lesson-learning will be considered at a
later stage. GHIN workshops in Malawi and Ukraine in 2006 have helped to focus this
comparability, where teams developed common detailed research questions relevant to
their HIV epidemics, while also adapting these to specific country contexts. GHIN
Coordinators have developed generic tools for generalised and concentrated epidemics,
which have been built on and improved by various countries, leaving scope for them to
be adapted to suit country contexts.
11
In lessons learned from a case study, ‘SPP-E, Module 7 Environment and Development’,
it was reported that much progress was made in methodological approaches, but most of
these were never put down on paper and never communicated and therefore never made
accessible to others (Masseli et al, 2006). The November 2007 GHIN International
Workshop will dedicate significant time to allow country teams to discuss lessons learned
from baseline fieldwork. Similarly, country field visits (‘north-to-south’ and south-tosouth’) have resulted in methodological problems being shared. For example, tools which
were developed by GHIN Coordinators (adapted from the Tracking and SWEF studies)
were further adapted and developed by Malawi, Zambia and Tanzania. Apart from
obvious lessons learned from one country to another, this will also lead to enhanced
ability to compare results across countries.
Grouping the transition countries of Eastern Europe with sub-Saharan African countries,
Peru and China is an over-simplification that can cause difficulties. “The differences
between the least developed and the ‘newly industrialised’ and ‘threshold’ countries are
often larger than the differences between the latter and the industrialised countries”
(KFPE, 1998, p.2). This is the challenge for GHIN going forward, but has partly been
addressed by adopting a regional approach. There have been challenges in coordinating
GHIN studies with other GHI studies, for example the Global Fund Five Year Evaluation,
which is currently underway. The team undertaking the evaluation will be represented at
the November 2007 Dublin workshop.
7. Role of GHIN in advocacy and dissemination with key stakeholders
The devastating nature of the HIV/AIDS epidemic and the large amounts of funds
flowing into countries make this research highly sensitive. Countries are under pressure
to be accountable to GHIs for funds received and performance, and hence have a
significant interest in whether studies produce positive or negative accounts. They are
also accountable to the intended beneficiaries. Early and ongoing dialogue and
engagement with key stakeholders has been critical in promoting their buy-in. Presenting
results at the end of the studies alone will not effectively influence policy; therefore
12
GHIN has aimed to put advocacy and dissemination on its agenda, since its inception, at
both the global and country level.
7.1 Global level
An important role of the Network is to coordinate and streamline communication with
global stakeholders at the outset, in order to achieve greater impact on policy change. The
transaction costs for global research users in engaging with a single Network of studies
are lower than with multiple uncoordinated studies. Indeed, the collective power of the
messages emerging from many complementary studies is likely to be much greater than
any one individually, thereby increasing the prospects of influencing global policies.
Lessons learned from the Global Research Project on Explaining Growth showed that a
weakness was that it postponed the adoption of a dissemination strategy aimed at the
broader policy and development community until research activities were completed
(Maselli et al, 2006). The strategies employed by the global HIV/AIDS initiatives are
constantly evolving, and the questions that the researchers within the Network are
addressing are live ones. GHIN members recognise that findings from the studies need to
be channelled into policy debates at the country and global levels on an ongoing basis.
Discussions were held with senior staff at the Global Fund from January 2006 who were
kept informed about network developments. They expressed support for the network
approach to supporting country studies. Contact was also made with senior staff of the
World Bank MAP and PEPFAR. The GHIN Coordinators are taking steps to ensure that
communication is established and coordination is promoted with other large, multicountry evaluations of the major global HIV/AIDS initiatives, including the Global Fund
Five Year Evaluation (5YE) and studies by the Centre for Global Development (CGD).
All of these stakeholders will be represented at the Dublin November 2007 workshop.
Regular ongoing interactions will inform decision makers, continue to shape research
questions, enable lesson-learning and sharing of tools; and, ultimately, the generation of
larger cross-country comparisons. Findings from the individual GHIN studies will be
synthesised across countries and packaged into short policy briefs that focus upon
13
ongoing country and global debates of particular relevance to policy makers,
representatives of multilateral (including UNAIDS) and donor agencies, and of global
HIV/AIDS initiatives.
GHIN has opened global dissemination opportunities to country teams by notifying
members of upcoming relevant conferences and have supported one of the country teams
to attend the Global Forum for Health Research Conference in Beijing (Oct/Nov 2007).
The second GHIN international workshop will be the first opportunity to disseminate
country level results to global stakeholders. The new GHIN website, www.ghinet.org will
prove useful in disseminating research outputs. Linkages with country research institution
websites will promote these institutions, both within countries and globally.
7.2 Country level
As Nchinda (2002) and others have documented: “There has often been complete rupture
between the scientist in the South with the policy makers in the Ministries. Results of
research are hardly ever passed on for implementation. Even when this is done, policy
makers complain that they are submitted in highly technical language with no clear
recommendations that would facilitate implementation” (Nchinda, 2002, p.1701).
Country dissemination is the responsibility of country researchers within GHIN. Country
teams have been encouraged to take the lead in establishing within-country links and
communication channels for dissemination of updates and findings at regular intervals to
policy makers and other key research users, in order to maximise opportunities for
country policy influence. In many countries, the National AIDS Councils have been a key
initial contact. Country groups have also contacted bilateral donor country offices and
who have acted as a conduit to other relevant country partnerships on HIV/AIDS. A
number of country teams have developed advocacy and dissemination strategies. A
central element of these strategies is to disseminate results as research progresses and
importantly at the sub-national level.
There may be considerable sensitivities about the research process within countries since
GHI resources represent a large proportion of country budgets for health. Country
14
stakeholders such as policy makers are likely to see the research as more beneficial and
less threatening if their country study is part of a network of coordinated studies.
Researchers have emphasised to country stakeholders that studies will raise common
issues and problems experienced across multiple countries relating to GHIs, as well as
country specific issues. This should help alleviate sensitivities about the impact the study
findings may have on GHI funding within countries. Teams are giving national
stakeholders the opportunity to comment on written drafts of country reports before they
are circulated to global stakeholders.
There is also a role for the country researchers to work with other networks at country
level, for example the Health and Development Network (HDNet), who can assist with
advocacy and dissemination strategies. Not all network members have the same
experience in publishing results. Care must be taken to ensure that all partners can take
part to the proper extent in the dissemination of results, particularly publications in
journals. The forthcoming international workshop will involve teaching and interaction
sessions on how to advocate, writing policy briefs etc. There has also been two-way
communications between the GHIN Coordinators and country teams to promote within
country coordination with other evaluations. Several of the country teams are members of
AIDS Platforms established by the Global Fund to support in-country ownership and
design of the 5YE and interpretation of outputs.
Conclusion
Lesson learning from GHIN is in the early stages and will continue to evolve over the
next two years. GHIN has aimed to embody an alternative model to the traditional
research partnership model by country and global stakeholder ownership of the research,
cross-country comparability, research capacity-building and sharing of expertise amongst
groups; and coordination of dissemination of findings. This is a working paper, written
from the perspective of the Coordinators of the Network. The Coordinators plan, over the
next two years, to systematically collect and record perspectives from network members,
including country research teams and funders, and other stakeholders.
Questions and challenges for GHIN in 2008-09 include:
15
-
Country teams expressed the need for a strong regional dimension to the Network.
What is the added value of having one global network over two or more regional
networks?
-
How to assess research capacity and how to address capacity-weaknesses,
particularly using south to south capacity building?
-
How equitable is GHIN’s research governance model and what lessons can GHIN
learn from other (earlier and current) Networks, particularly around governance
and coordination?
-
What is the appropriate balance between maintaining independence and engaging
more intensively and seeking to meet the needs and concerns of global and
country stakeholders?
-
What communication and dissemination strategies will best enable research-intopolicy at the country level?
To address these questions would enable us to consider GHIN not only as a
straightforward “global opening” (Rogers et al, 2001), but also to look at the costs of
running a Network to assess to what extent GHIN “exposes the costs of globalisation.”
(Rogers et al, 2001)
16
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Author Information
Aisling Walsh is researcher and one of the coordinators of the Global HIV/AIDS
Initiatives Network (GHIN), which is a network of researchers in 15 countries across subSaharan Africa, Eastern Europe, Asia and South America, supported by five institutions
in Europe and the US that are researching the country effects of global HIV/AIDS
initiatives at national and sub-national levels. The Network is facilitating comparative
work and plans to synthesise findings around these themes, which include the effects of
global HIV/AIDS initiatives on: sub-national scale-up of services; health systems
capacity, including availability of human resources; national and district level
coordination; and equitable access to services.
18
ANNEX A:
The GHIN Network – Funders and Researchers
Research
Funders
OSI
Country Studies
Kyrgyzistan
Ukraine
Research
Partners
GHI Network
Funders
LSHTM (UK)
Zambia
INCODEV
SIDA
Alliance
(AHPSR)
USAID
Mozambique
Angola
South Africa
RCSI (Irel)
Vietnam
Karolinska
(Sweden)
Tanzania
Uganda
Peru
China
Georgia
Malawi
Ethiopia
Benin
Malawi
Belgium
Portugal
Irish Aid
DANIDA
SWEF / Health
Systems 20/20
Funding for country studies
The process of obtaining funding for the GHIN studies started with six months of
negotiations between Walt and Brugha of LSHTM and the Open Society Institute (OSI)
from November 2004, which resulted in OSI funding a three-country study. An approach
to Irish Aid and DANIDA in March 2005 resulted one year later in a three year grant,
which funded coordination costs of the GHIN Network. In April 2004, Brugha met in
Geneva with Van Damme of the Institute of Tropical Medicine Antwerp and Ferrinho of
the Institute of Hygiene and Tropical Medicine Lisbon to discuss a proposal to the EU for
a three country study in Southern Africa, which was eventually funded in late 2005.
19
Of crucial importance to the direction GHIN has taken was a call to country researchers
for proposals, based on the SWEF framework (SWEF 2003), issued by the Alliance for
Health Policy and Systems Research (AHSPR) in late 2005. Six country research groups’
proposals were funded. Bennett moved from Abt Associates to become the manager of
the AHSPR) in early 2006 and since then has been overseeing funding and contributing to
coordination of these studies. In early 2007, Stillman of Abt Associates who was
overseeing and supporting the SWEF studies received confirmation that Abt Associates
would receive funding from USAID for the new Health Systems 20/20 Project, which
might support further country studies.
Five of the country research groups who had been previously funded under the Tracking
Study (Mozambique, Uganda, Zambia) and the SWEF Network (Malawi and Georgia),
all of which had existing links with northern researchers, were now in receipt of funds for
new studies on the global HIV/AIDS initiatives.
20
Network members
COUNTRY RESEARCH TEAMS are headed by:
Mário Fresta, Centros de Estudos Avançados em Educação e Formação Médica, Angola:
mariofresta@netcabo.co.ao
Sourou Gbangbade, Independent Researcher, Benin: sgbangba@yahoo.com
Xiulan Zhang, Beijing Normal University, China: zhang99@bnu.edu.cn
Aklilu Kidanu, Miz-Hasab Research Centre, Ethiopia: miz_hasab@telecom.net.et
Ketevan Chkhatarashvili, Curatio International Foundation, Georgia:
k.chkhatarashvili@curatio.com
Gulgun Murzalieva, Centre for Health System Development, Kyrgyzstan:
gulgun@manas.elcat.kg
Brian Mtonya, The Alliance Group, Malawi: alliancegroup@malawi.net
Victor Mwapasa, College of Medicine, Malawi: vmwapasa@medcol.mw
Baltazar Chilundo, Universidade Eduardo Mondlane, Maputo, Mozambique:
chilubal@yahoo.com
Carlos Caceres, Cayetano Heredia University, Peru: ccaceres@upch.edu.pe
David Sanders, University of the Western Cape, Cape Town, South Africa:
dsanders@uwc.ac.za
Eric Buch, University of Pretoria, South Africa: eric.buch@up.ac.za
Innocent Semali, Muhimbili University College of Health Sciences, Tanzania:
innosemali@yahoo.com
William Bazeyo, Makerere University, Uganda:
HREF="mailto:n.rukhadze@curatio.com" MACROBUTTON HtmlResAnchor
sengooba@iph.ac.ugHREF="mailto:n.rukhadze@curatio.com" MACROBUTTON
HtmlResAnchor wbazeyo@iph.ac.ug
Tetyana Semigina, National University of Kyiv-Mohyla Academy, Ukraine:
tv_sem@ukma.kiev.ua
Nguyen Thi Kim Chuc, Hanoi Medical University, Vietnam: ntkchuc@yahoo.com
Phillimon Ndubani, University of Zambia, Zambia: pndubani@yahoo.co.uk
21
NORTHERN RESEARCH TEAMS are represented by:
Sara Bennett, Alliance for Health Policy and Systems Research: bennetts@who.int
Ruairi Brugha, Aisling Walsh, Sam McConkey and Regien Biesma Royal College of
Surgeons, Ireland: HREF="mailto:rbrugha@rcsi.ie" MACROBUTTON HtmlResAnchor
rbrugha@rcsi.ie, aislingwalsh@rcsi.ie, HREF="mailto:smcconkey@rcsi.ie"
MACROBUTTON HtmlResAnchor smcconkey@rcsi.ie and rbiesma@rcsi.ie
Anna Thorson and Anastasia Pharris Karolinska Institutet, Sweden:
Anna.Thorson@ki.se and Anastasia.Pharris@ki.se
Kate Stillman and David Hotchkiss, Health Systems 20/20:
kate_stillman@abtassoc.com and hotchkis@tulane.edu
Wim van Damme, Institute of Tropical Medicine, Antwerp, Belgium: wvdamme@itg.be
Gilles Dussault, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa,
Portugal: gillesdussault@ihmt.unl.pt
Gill Walt and Neil Spicer, London School of Hygiene and Tropical Medicine:
gill.walt@lshtm.ac.uk and neil.spicer@lshtm.ac.uk
Irish Aid, DANIDA and DfID provide support for Network activities. Support for the
country studies is provided by the Open Society Institute, the Alliance for Health Policy
and Systems Research, USAID and the EU (INCO). Funding for all of the studies and
the GHIN Network is independent of the initiatives being studied.
For further information, please visit our website: www.ghin.lshtm.ac.uk
Alternatively please contact: Neil Spicer, neil.spicer@lshtm.ac.uk or Aisling Walsh,
aislingwalsh@rcsi.ie, or any of the individual country researchers.
22
Annex B: GHIN Briefing Sheet
Global HIV/AIDS Initiatives Network:
Researching the national and sub-national effects of global HIV/AIDS initiatives at
the country level
Global funding for HIV/AIDS has increased dramatically during the past five years.
Three global HIV/AIDS initiatives are together contributing most of the direct external
funding to scaling up HIV/AIDS prevention, treatment and care:
The World Bank’s Global HIV/AIDS Programme including the Multi-country AIDS
Programme (MAP)
The Global Fund to Fight AIDS, TB and Malaria (GFATM)
The United States President’s Emergency Plan for AIDS Relief (PEPFAR).
In the high HIV prevalence, low-income countries of southern and eastern Africa, the
combined commitments from these initiatives can amount to over half of countries’ total
health budgets. In the context of the concentrated epidemics of middle-income countries
the scale of funding is less, but the potential impacts on containment of the HIV epidemic
are still significant.
A network of researchers was established in 2006 to track the effects of this scale-up.
Members of the Global HIV/AIDS Initiatives Network (GHIN) are researching the
country effects of these initiatives at national and sub-national levels9. This network
builds on two earlier studies: the Tracking Study, led by the London School of Hygiene
and Tropical Medicine (2003-2004) and the System-Wide Effects of the Fund (SWEF)
Research Network (since 2003) coordinated by the Partners for Health Reformplus
project.
9
Some countries may also research the effects of other global health initiatives
23
Unlike earlier studies, which focused primarily on the Global Fund, the new Network is
examining the effects and the inter-relationships of these three major global HIV/AIDS
initiatives. National and sub-national data collection is taking place in 2006 and 2007;
and in most cases follow-up studies are planned for 2008.
GHIN countries undertaking 2-4 year studies include: Angola, Benin, China, Ethiopia,
Georgia, Kyrgyzstan, Malawi, Mozambique, Peru, South Africa, Tanzania, Uganda,
Ukraine, Vietnam and Zambia.
GHIN will provide added value to individual country studies by:
Promoting comparability through common research protocols and tools
Sharing expertise across country study teams and building research capacity
Generating multi-country comparisons and context-specific policy lessons
Coordinating dissemination of findings and recommendations and streamlining
communication with global stakeholders
Research Themes
While the research protocols developed for individual country studies reflect the needs
and contexts of these countries, there are several common themes across the Network,
some or all of which individual country studies are addressing. The Network is
facilitating comparative work and plans to synthesise findings around these themes,
which include the effects of global HIV/AIDS initiatives on:Sub-national scale-up
The levels and types of HIV/AIDS services delivered – including prevention,
treatment and support services – demonstrating trends over time
Quality of HIV/AIDS services
Non-focal (non-HIV/AIDS) priority services
Health systems capacity
24
Human resources for health, including effects on the public-private mix
National and sub-national coordination, harmonisation and alignment
Supply of commodities and equipment
Equitable access
Accessibility and patterns of utilisation of HIV/AIDS services
Institutional/programmatic factors and household/community factors that determine
service accessibility
Communicating Findings, Influencing Policy
The strategies employed by the global HIV/AIDS initiatives are constantly evolving, and
the questions that the researchers within the Network are addressing are live ones. GHIN
members recognise that findings from the studies need to be channelled into policy
debates at the country and global levels on an ongoing basis.
Country research teams have been interacting with country stakeholders, including
policymakers and civil society organisations, from an early stage to help ensure the
policy-relevance of their studies. The GHIN Coordinators have been interacting in the
same way with global stakeholders, also taking steps to ensure that communication is
established and coordination is promoted with other large, multi-country evaluations of
the major global HIV/AIDS initiatives.
Regular ongoing interactions will both inform decision makers and continue to shape
research questions. Findings from the individual studies will be synthesised across
countries and packaged into short policy briefs that focus upon ongoing country and
global debates of particular relevance to policy makers, representatives of multilateral
(including UNAIDS) and donor agencies, and of global HIV/AIDS initiatives.
25