A Global fund audit team has commended Rwanda for its accountability on funds but recommended the need to adopt data base entry and possibly do this by acquiring up-to-date systems unlike the manual ones used in the health system today.
Rwanda has been at the fore front of implement policies in the health sector that have seen the country attain one of the millennium development goals-on improved access to health, which in February this year compelled the fund to sign a new and bigger deal, worth of $204 million to support the fight against HIV, malaria and TB.
The Global fund audit team released on July 15, 2014 an audit that was done in 43 health centers, three prisons and seven district pharmacies across the four provinces and city of Kigali in the country.
The global fund team was in Rwanda for over a month, going across the country to visiting health facilities in the sector, from referral hospitals, prisons health services, and across the border to see how Rwanda has been doing in areas of malaria, HIV and TB among other health services.
The team also accessed management of the health sector in Rwanda- such as the operations of the financial system, monitoring and evaluation, procurement, ICT infrastructure- used to manage the sector; so as to pave way for improvement before the implementation of the funds.
The audit indicates that though the funds were managed well, medical data are often still recorded on paper at health facilities, an aspect that may affect the countries monitoring and evaluation of the health system, to a greater extent.
“Internal control is sound but some of the areas; just like any other system, where we saw weakness, and needed strengthening further; relate to IT infrastructure and also data collection, monitoring and evaluation supervisory controls were some of the key issues we discussed with the ministers” said Martin O’Malley, the Inspector General of Global Fund.
Data entry in hospital, health centers and even in private clinics is widely recorded on paper documents and file; and health workers have to refer to a pile of records to get a specific case that treated or handled at certain time and date. Most of the information is stored in boxes and shelves that are usually pilled in a store area.
The global fund team looked at detailed systems that exist to ensure that Rwanda is going to produce reliable and credible outcome and impact indicators that are embedded within the GF grant- focusing on M&E controls, supply and Procurement mgt. financial management and IT infrastructure which underpins all the above.
“We started to explore root causes and trying to come up with solutions that are sustainable. So, it’s not just correcting the errors that have been identified but building something that can extend beyond the things that are not working”. O’Malley said.
Inspector General of Global Fund, Martin O’Malley, says that what Rwanda is doing is quite innovative- which is a result-based-financing system in the health sector – a Global fund pilot project that is currently being tested in Rwanda alone- to see if this works out before being duplicated elsewhere.
Adding that Rwanda was selected- because of its virtuous circle of accountability embedded within the systems of internal control and self-correct which is sound in Rwanda- which are some of the areas that Global fund audits was looking for.
Those are our largely our issues, but overall we believe that the internal control system is sound and decision by GF to pilot the result based financing in Rwanda was a right decision.
Result based financing is a pilot and GF would like to do it elsewhere but clearly Rwanda was seen as the first one where it made more sense. Our job was to work was to evaluate why Rwanda was selected and whether we agree with the decision and secondly what is critical to the ongoing success of RBF in Rwanda and hopefully what is mutually critical to the success of the health system in Rwanda”
Rwanda Minister of Health, Dr. Agnes Binagwaho- The audit is important, and instructive. It is what an audit should be- find problems and propose solutions for improvement for better services to the population.
And the State Minister for Public Health and Primary Care, Anita Asiimwe, said that the ministry is looking for ways of investing in IT infrastructure to close the digital gap, but didn’t specify when and how.
The Global Fund galvanizes support for the fight against AIDS, TB and malaria, working with partners to support the most effective prevention and treatment.
On July 17, 2014, Global Fund announced that 6.6 million people are getting antiretroviral treatment for HIV through programs supported by Global Fund grants, with particularly strong gains in Nigeria, Mozambique, India, and Uganda this year.
In mid-year results for 2014, the Global Fund also reported that programs supported by its grants have distributed a total of more than 410 million mosquito nets to protect children and families against malaria, an increase of 14 percent.
In addition, 11.9 million people have been treated for tuberculosis in programs supported by the Global Fund. In the first half of 2014, the number of people treated for multidrug resistant tuberculosis rose to nearly 140,000 from 110,000.
“These results show that we are accelerating progress against HIV, TB and malaria,” said Mark Dybul, Executive Director of the Global Fund. “We can do even more, and reach more people, when we work together and concentrate our efforts on those who are most vulnerable.”
This year, the Global Fund is in a transition in how to assess impact that better reflects the collective contribution towards goals and targets. In that process, the Global Fund is working with partners and experts to arrive at an improved methodology to measure health impact of HIV, TB and malaria programs.
The 6.6 million people on antiretroviral therapy mark an increase of 8 percent, up from 6.1 million at the end of 2013. The 410 million mosquito nets distributed is an increase from the 360 million at the end of 2013, and the 11.9 million cases of TB treated is a 6 percent increase from 11.2 million at the end of 2013.
During the same period, counselling and testing sessions for HIV increased by more than 50 million, from 306 million to 360 million, approximately 17 percent. Over the past year, the number of orphans and vulnerable children that received basic care and support for HIV in programs supported by the Global Fund increased from 6.5 million to 7.1 million, a 9 percent jump.