MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Information
GHI influence on reporting mechanisms
GHI funded improved M&E systems, although some informants were concerned that HIV systems
were more sophisticated than other systems and not integrated. The MOH developed and put in
place the Global Fund M&E plan. An M&E group ensures the plan’s execution, reviewing strategic
plans, making field visits to collect data, and revising the plans when appropriate. In addition to
this group, the Global Fund funded the installation of electronic information systems to facilitate
reporting, and other measures to improve the quality of data collected, including hiring additional
district-level staff. The challenges in meeting Global Fund M&E requirements did not necessarily
stem from a lack of funding, but from a lack of capacity. One informant said, “I remember even in
my office we used to fail to finish [Global Fund] money allocated for monitoring and evaluation
[M&E] because you had to find the right people to do that monitoring and evaluation [M&E] from
the national level up to the community level.”
PEPFAR has worked with the government on its M&E system and requirements as well. The
PEPFAR requirements are quite extensive and require sophisticated systems to be in place, which
has at times been a burden on implementers. Some informants criticized PEPFAR’s requirements
because PEPFAR did not want the national indicators included in the same system as the PEPFAR
indicators. Currently, PEPFAR is working to harmonize multiple information systems.
Many informants suggested that all GHIs synchronize their indicators and M&E plan, including
their reporting calendar. As one person expressed:
… my personal impression is that the information systems, and data collection
and monitoring and evaluation [M&E] in Rwanda have been very vertical – very
separate for the malaria programme, for the HIV programme, and probably. . . as
a result of, or definitely supported by the vertical programmes that we’ve
implemented.
While presenting some challenges, the GHI monitoring and evaluation systems did facilitate the
transition to performance-based financing by making data to evaluate performance more reliable
and available.
Service Delivery
Integration of GHI-funded programmes and the health system
As mentioned, the GoR developed an integrated approach to health delivery and built system
strengthening components into GHI grants as much as possible. As one respondent reported:
It [the health system] was integrated; there are no HIV health facilities. We have a
microscope, and we have the capacity to test HIV. With this capacity, we also test
other diseases, like syphilis or other. The material is there. The people are trained,
so they are not just doing HIV. But we have through the opportunity of HIV
money to buy the microscope or for the machine, etc.
Other examples of health system strengthening efforts include the integration of PMTCT
programmes in maternal health programmes and the purchase of ambulances for all those
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