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Negative health system effects of Global Fund's investments

In a systematic review published in JRSM Short Reports, Josip Car and colleagues collated and critically evaluate the available scientific evidence on the negative health system effects of global health initiatives in developing countries. They identified 24 studies commenting on adverse effects on health systems arising from Global Fund investments. Sixteen were quantitative studies, six were qualitative and two used both quantitative and qualitative methods, but none explicitly stated that the studies were originally designed to capture or to assess health system effects (positive or negative).

Only anecdotal evidence or authors’ perceptions/interpretations of circumstances could be extracted from the included studies. Dr Car and colleagues concluded that that much of the currently available evidence generated between 2002 and 2009 on global health initiatives potential negative health system effects is not of the quality expected or needed to best serve the academic or broader community. The majority of the reviewed research did not fulfil the requirements of rigorous scientific evidence.

While this insight into the field is valuable in informing short-term decision-making, it should only serve as an initial step before acquiring more rigorous research. The weight of the current debate around the should move away from non-peer reviewed materials, such as organizational reports, commentaries and ‘descriptive’ discussion papers without verifiable data. The lack of methodological standards for reporting health system effects of complex interventions in developing countries also contributes to the subsequent suboptimal level of quality of reporting observed in this review.

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