How to leverage partners’ money in strengthening a country’s health system

Dr Yvan Butera

The Global Fund to fight AIDS, Tuberculosis, and Malaria, based in Geneva, Switzerland, is a financing institution created in 2002 by governments, private sector, civil society, and people affected by the diseases.

The Global Fund mandate is to provide support to countries in the response to the three diseases. Since disbursing its first grant to Rwanda in 2003, The Global Fund has, to date, invested in Rwanda US$ 1,182,222,269 (Global Fund, 2017) in programs dedicated to combat the three diseases. Rwanda, however, has made a deliberate effort to use that money in strengthening its health system overall.

Rwanda’s visionary approach to the use of Global Fund money for strengthening its health system has been effective in meeting health-related development targets and allows the government to look ahead toward strategies for maintaining a resilient health system independently. We should, now, usher in the era of a progressive shift en route to locally-funded health programs.

The Global Fund approach in Rwanda, and everywhere else, was to fund vertical (disease-specific) programs, in this case, HIV/AIDS, Tuberculosis, and Malaria. Unlike most countries, Rwanda also used the money to strengthen its entire health system. For example, laboratories and clinics built for HIV diagnosis and treatment were used in scaling up access for other medical conditions as well. Emergency and critical care rooms built for the care of patients with severe malaria requiring aggressive monitoring were also used to accommodate other patients in critical conditions secondary to other diseases. Labor wards and operating rooms built to harbor HIV positive women who have labor complications were also used to deliver maternal and obstetric care to the remainder of the population. It is worth mentioning that modern day medicine has no problem decontaminating such facilities such that transmission of HIV/AIDS is not a problem.

In addition, Rwanda developed a task shifting policy for HIV care, with appropriate training of nurses and community health workers to fulfill responsibilities previously reserved for physicians, allowing for better coverage of patients receiving anti-retro viral therapy. This task-shifting model is now being used for non-communicable disease management as well. Similarly, the supply chain model of antimalarials, HIV, and TB drugs developed with The Global Fund money was conjointly used for other drugs and commodities.

With this approach, Rwanda was able to achieve the health-related Millennium Development Goals through financial inputs of the Global Fund. The Global Fund contribution, for example, to the 2014-2015 budget was US $ 123 million, which is 53% of o the HIV operational plan for the 2015 fiscal year. This level of investment plus the Rwandan government’s effective leadership, commitment to universal health care, political will, accountability, and corruption-intolerant models at all levels (central government, local government, community leaders) have permitted the efficient implementation of the Millennium Development projects. As a result, all health-related MDGs have been met. (Rwanda Demographic and Health Survey, 2014-2015).

Looking forward, these gains should be kept, improved, and sustained with decreasing reliance on the Global Fund. It is through a resilient health system owned by the country, public-private partnership, and local inter-sectorial partnerships that the health system can be sufficiently strong.