Abstract
Objective
The purpose of the study was to explore and provide feedback on local stakeholders’ experiences with the Global Fund to Fight AIDS
Objective
Tuberculosis and Malaria (GFATM) as it related to capacity building for tuberculosis (TB) services in Nicaragua.
Methods
An ethnomethodological approach was used to capture the experiences of three different groups: service providers, service recipients, and decision-makers. Data collection involved reviewing secondary texts and records, participant observation, and in-depth interviews and focus groups in both rural and urban municipalities.
Results
Stakeholders felt that Nicaragua’s Global Fund project improved TB control, built human resource capacity and strengthened community involvement in TB programming; however, they noted several contextual and structural threats to sustainable capacity development. The nature of the GFATM’s performance-based evaluation de-emphasized qualitative assessment and, at times, created pressure to meet numeric targets at the risk of decreasing quality. Contextual challenges often determined or limited the potential sustainability of activities. Two examples (training volunteer health workers and establishing TB Clubs) from the broader study are offered here to highlight these challenges from health systems and community perspectives.
Conclusions
Current approaches to GFATM evaluation and accountability may compromise its positive impacts on capacity building in Nicaragua. Greater consideration needs to be given to ensuring more comprehensive evaluation of project implementation.
Key words: Nicaragua, health care sector, tuberculosis, international cooperation
Résumé
Objectif
Nous avons voulu analyser et rendre compte de l’expérience vécue par les intervenants locaux à l’égard du renforcement des capacités des services de lutte contre la tuberculose au Nicaragua dans le cadre d’un projet du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme.
Méthode
Au moyen d’une approche ethnométhodologique, nous avons recueilli les expériences de trois groupes: les fournisseurs de services, les bénéficiaires de services et les décideurs. Pour recueillir les données, nous avons examiné des documents écrits et des relevés préexistants, observé des participants et tenu des entretiens en profondeur et des groupes de discussion dans des municipalités rurales et urbaines.
Résultats
Selon les intervenants, le projet du Fonds mondial au Nicaragua a amélioré la prophylaxie de la tuberculose et renforcé les capacités des ressources humaines et la participation communautaire aux programmes de lutte contre la tuberculose; plusieurs menaces contextuelles et structurelles à un renforcement durable des capacités nous ont cependant été signalées. Comme l’évaluation du Fonds mondial était axée sur le rendement, l’aspect qualitatif était moins accentué, ce qui a parfois poussé les intervenants à respecter les objectifs chiffrés aux dépens de qualité. Les difficultés contextuelles ont souvent déterminé ou limité la durabilité potentielle des activités. Nous présentons ici deux exemples (la formation d’agents de santé bénévoles et la fondation de clubs de patients tuberculeux) tirés de l’étude complète pour faire ressortir ces difficultés du point de vue des systèmes de santé et des municipalités.
Conclusion
Les méthodes actuelles d’évaluation et de responsabilisation du Fonds mondial pourraient compromettre les effets positifs de son projet sur le renforcement des capacités au Nicaragua. Il faudrait étudier de plus près les moyens d’assurer une évaluation plus complète de la mise en œuvre du projet.
Mots clés: Nicaragua, secteur des soins de santé, tuberculose, coopération internationale
Footnotes
Acknowledgements: We acknowledge the tremendous support provided by Dr. Anne Fanning (Professor Emeritus, Department of Health Sciences, University of Alberta), and our Nicaraguan partners, without whom this study would not have been possible. Funding for this project was provided by the Community & Population Health Research Training Program (a CIHR Strategic Training Initiative).
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