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• W2167914799 abstract "Abstract Objective: The purpose of the study was to explore and provide feedback on local stakeholders’ experiences with the Global Fund to Fight AIDS, 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 Resume Objectif : Nous avons voulu analyser et rendre compte de l’experience vecue par les intervenants locaux a l’egard du renforcement des capacites 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. Methode : Au moyen d’une approche ethnomethodologique, nous avons recueilli les experiences de trois groupes : les fournisseurs de services, les beneficiaires de services et les decideurs. Pour recueillir les donnees, nous avons examine des documents ecrits et des releves preexistants, observe des participants et tenu des entretiens en profondeur et des groupes de discussion dans des municipalites rurales et urbaines. Resultats : Selon les intervenants, le projet du Fonds mondial au Nicaragua a ameliore la prophylaxie de la tuberculose et renforce les capacites des ressources humaines et la participation communautaire aux programmes de lutte contre la tuberculose; plusieurs menaces contextuelles et structurelles a un renforcement durable des capacites nous ont cependant ete signalees. Comme l’evaluation du Fonds mondial etait axee sur le rendement, l’aspect qualitatif etait moins accentue, ce qui a parfois pousse les intervenants a respecter les objectifs chiffres aux depens de qualite. Les difficultes contextuelles ont souvent determine ou limite la durabilite potentielle des activites. Nous presentons ici deux exemples (la formation d’agents de sante benevoles et la fondation de clubs de patients tuberculeux) tires de l’etude complete pour faire ressortir ces difficultes du point de vue des systemes de sante et des municipalites. Conclusion : Les methodes actuelles d’evaluation et de responsabilisation du Fonds mondial pourraient compromettre les effets positifs de son projet sur le renforcement des capacites au Nicaragua. Il faudrait etudier de plus pres les moyens d’assurer une evaluation plus complete de la mise en œuvre du projet. Mots cles : Nicaragua; secteur des soins de sante; tuberculose; cooperation internationale" @default.
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• W2167914799 date "2008-07-01" @default.
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• W2167914799 title "The Global Fund and Tuberculosis in Nicaragua" @default.
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• W2167914799 doi "https://doi.org/10.1007/bf03403771" @default.
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