MAXIMIZING POSITIVE SYNERGIES - World Health Organization

International Health Partnership, the Clinton Foundation and other groups. 23 Data collection was
carried out in January and February 2009. Data were abstracted from paper registers, monthly or
annual site reports, or from the regional ministry of health office. Complete definitions of
indicators were provided to the data abstraction teams. Data were entered in Boston, after a data
dictionary was created and rules of coding were established. Data were entered into MS Access,
and analysed in R version 2.7. Analysis of this data is ongoing.
Results
Leadership and Governance
GHI impact on the role of the Ministry of Health
The MOH is committed to leading the national response to health, and informants universally
agreed that the MOH had the capacity to do so effectively, providing direction and leadership. The
role of GHIs was seen as enabling and strengthening the national response. While the Global Fund
has allowed the MOH to define its role and priorities, informants felt that PEPFAR’s model of
working through NGOs did not acknowledge the government’s leadership in health system
strengthening.
GHI impact on health care managerial and leadership capacity
While informants mentioned some investment from the GHIs in improving managerial and
leadership capacity, most felt that more support was needed in these areas. Some Global Fund
funding was used to build administrative capacity within the MOH, but generally the Global Fund
was seen as “simply a funding system.” PEPFAR provided more technical support, which has been
valuable in improving the management capacity of the Rwanda Drug, Consumables and
Equipment Central Procurement Agency (CAMERWA).
Financing
GHI funding impact on resource allocation within national or local health budgets
While Global Fund money flows directly to the MOH, and PEPFAR money is channelled to NGOs,
both the Global Fund and PEPFAR contributed greatly to the resources available for health,
particularly for HIV care. The GoR has significantly expanded its HIV programming as a result, and
has tried, when possible, to scale-up general health services as well. Several informants described
the GoR as using its national plan for health to align available funding with its priorities. It has had
to negotiate with GHIs around this strategy, but generally been able gain their support. One
informant explained:
23 A referral score was created from variables that evaluated the facility’s ability to function within a health network. One
point was assigned for each of the following: a higher level health care facility is within two hours by car from the health
centre location; the health care centre has the ability to communicate using a radio, phone, or the internet, with a higher
level health care facility; the health centre has access to an ambulance; the health centre provides the patient with a
transportation fee to facilitate referral; the health centre uses referral forms when referring patients from facility to
facility; the patient who is referred is physically accompanied to the referral site during part or all of the journey and/or
physically accompanied during the encounter at the referral site; and the health centre has referral forms for community
health workers to refer patients to the facility.
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