Capacity Development Results - Evidence From Country Experiences

The UNDP – Global Fund partnerships with national entities supporting capacity development is generating a growing body of evidence and lessons learned to inform the next round of capacity development plans. The following country examples where UNDP has acted as interim Principal Recipient (PR) for Global Fund grants, provides an overview of how the approach has been adapted to strengthen national systems for health taking into account the country context;

Belarus – With support from UNDP, the Global Fund and technical input from WHO, Belarus has successfully rolled out a national electronic register that collects TB and MDR-TB patient information, laboratory results and drug inventory and distribution. The register is used by all TB hospitals and dispensaries and currently tracks 29,836 patients across Belarus. Facilitating real-time use of patient data, the register has made important contributions to improving treatment outcomes and continuity. In 2015 a joint transition plan was developed and implemented by the government, the Global Fund and UNDP to strengthen the national systems for health and enable a national entity to become PR in 2016.

Cuba – The national HIV response has benefited from a strong, functional health system and human capacity in health and social welfare domains. HIV-related programmes were built on strong foundations and for the most part, did not require the creation of new systems or parallel mechanisms. In addition to biomedical aspects, Cuba did not struggle to build and maintain health systems as much as many other countries did. Cuba more rapidly began to act on social and cultural aspects of the HIV pandemic, and built a more sustainable response.  In addition the effective integration the health care of mothers and children with the health management of HIV, contributed to The World Health Organization declaring Cuba the first country to have eliminated the transmission of HIV from mother-to-child.

El Salvador - UNDP acted as interim PR of Global Fund grants from 2003. In preparation for a successful transition to national entities, UNDP worked with the Government of El Salvador and national stakeholders to develop their capacities to implement HIV and TB programmes and to address capacity gaps. The transition has been successful and since January 2015, El Salvador is managing and implementing Global Fund resources for the first time. 

Iran – As a middle income country (MIC) Iran became no longer eligible for Global Fund support for the National TB Programme. In preparation for this the MOH and UNDP facilitated a consultation of national and provincial stakeholders to identify priority actions to ensure a sustainable transition of the Global Fund supported activities TB programme to national entities. The TB transition plan prioritized the resources available to ensure a continuation of services going forward.

Tajikistan – UNDP has invested resources over a 10 year period to compliment and lever the significant investment by the Global Fund, through the incremental strengthening of national processes and systems ranging from policy development to financial management systems for the main national entities. This culminated in facilitating the Government of Tajikistan adopting a Capacity Development and Transition Plan for the Ministry of Health, which lays out the activities, milestones and results required for transition to a national PR.

Zambia – A flexible partnership including the Ministry of Health, Medical Stores Limited, the Global Fund and UNDP designed and implemented a comprehensive Capacity Development Plan to strengthen national systems. This included developing an automated financial management system supported by the development and operationalization of a financial manual and SOPs and rolling this out with supporting hardware at a national level. Together with the strengthening and operationalization of supply chain management SOPs and Logistics Management Information Systems (LMIS) this has enabled over half a million people to receive ART treatment. Following a comprehensive approach to capacity development there was a smooth transition of the PR role from UNDP to the Ministry of Health. The new national PR was awarded new grants by the Global Fund worth US$234 million in 2015 to fight HIV, TB and malaria in Zambia. The Ministry of Health (MOH), the Global Fund and UNDP continue to work in partnership to further strengthen MOH Sub-recipients, in particular at a provincial level to improve performance and service delivery.

Zimbabwe - Central to the Ministry of Health and Child Care (MOHCC) strengthening systems for health is the national Public Financial Management System (PFMS) having the capability to manage and report on government and donor funds including the Global Fund. UNDP facilitated the preparation and implementation of a comprehensive Capacity Development Plan in 2015. The critical success factor is the roll out of the PFMS at a provincial and district level. UNDP has supported MOHCC and the Ministry of Finance to develop a grant management module for the PFMS to track and report on donor funds in the health sector. The PFMS system has been rolled out at a provincial level and a road map is being implemented to reach every district, taking into account the constraints faced at a local level. This reform when complete will be the first time a sector in Zimbabwe will have a fully functional PFMS able to carry out financial management and reporting on a real time basis.