MAXIMIZING POSITIVE SYNERGIES - World Health Organization

needing medical transport. Both GHIs provided funding for Mutuelles de Santé. To achieve
integration between the GHI-funded programmes and the health system, the CCM funded
organizations that would invest in health system strengthening. System strengthening was seen
as a necessary part of developing targeted responses, and the Global Fund approved funding
being used in this way.
Overall, the Global Fund and PEPFAR investments supported the national response to HIV, TB, and
malaria. Both GHIs supported the national decentralization of HIV services and the MOH’s national
HIV treatment guidelines so that all patients accessing HIV treatment would receive the same
medications, regardless of the site’s funding source. One respondent talked about a similar means
of integration for the TB programme:
The [Global Fund] project has allowed us to integrate the money in the national
plan for response to the disease; it has been a success. Also what is good is that
all the funds for tuberculosis have been aligned to the same plan and the same
programme. So, in one word, we have applied what we call the three one’s. That
means one action plan, one monitoring and evaluation [M&E] plan, and one
unique authority to lead people around that plan and that monitoring and
evaluation [M&E] plan. That’s how we managed. It has help also to, to provide
the same level of services with geographic equity.
Treatment programmes for HIV and TB have also been integrated with one another at the facility
level.
The MOH dictates where its partners (NGOs providing HIV services) - who are also required to
provide a minimum package of primary care services - implement programmes and therefore
where GHI-funded programmes work.
Several coordination bodies exist between GHI and the government. These include the GHIspecific
groups, such as the CCM and the PEPFAR steering committee, but also entities like the
coordinated procurement and distribution system, which organizes the ARV supply chain for the
country (see the supply chain section below for more information).
Respondents perceived PEPFAR’s funding model as resulting in less integrated programmes than
the Global Fund’s model. The number of NGOs in the health sector can result in lack of
coordination or duplication of activities. As one informant noted:
Again this [impact on non-target diseases and access] depended entirely on the
NGOs involved. It depended on the goodwill of the country representative or the
ladies and gentlemen who were managing them. We could get some good
impact only when they accepted to integrate their actions with ours. Otherwise
our systems run parallel. The Government’s interest was to integrate them into
the system but theirs was to stay isolated.
Impact of delivery models on access and coverage
GHI investment in Rwanda had a significant impact on geographic equity of health delivery,
increasing the availability of ART and other services, particularly in rural areas. The Global Fund
enabled the government to implement community-based delivery models, including malaria
management and DOTS, which increased the accessibility of care and treatment for many. In
addition, investments in Mutuelles de Santé - covering the fees for those who met the criteria for
poverty (regardless of HIV status) - helped reduce financial barriers to care for those without target
diseases as well.
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