In Zambia, UNDP assumed the role of interim Principal Recipient of grants of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in 2010, with the aim of strengthening national capacity in key functional areas. This integrated capacity-development approach of resilient and sustainable systems for health included working closely with the Ministry of Health to strengthen programme management, health information systems and supply chain management and establish a new financial management system. It resulted in the Ministry of Health reassuming the Principal Recipient role again in 2015.
In 2016, the Ministry of Health decentralized the implementation of HIV, tuberculosis and malaria programmes by appointing all 10 provincial health offices to implement programme activities in their respective catchment areas directly. Based on the new Ministry of Health financial management system, UNDP and the Ministry of Health conducted a joint assessment and designed the decentralized roll-out to support the financial system in all provinces. The support included the installation of enterprise resource-planning software and risk management, training and development of procedures to ensure compliance with both financial and programmatic reporting. UNDP also worked with the Ministry of Health to introduce on-site mentorship to the provincial health offices, with a focus on addressing challenges experienced in finance, programmatic and operational issues. The multifaceted support helped to improve access to and sharing of health and financial data and manage risks, and ensures that the programmes continued to receive funds and were compliant with financial and programmatic reporting requirements.
In 2018, UNDP partnered with Gavi, the Vaccine Alliance (Gavi) to support the Ministry of Health to augment financial management capacities at the district level. In 2017–2018, several partners supported the Ministry of Health to roll out an automated accounting tool, Navision, in the districts, but did not provide further training on the use of the system, including donor reporting and asset management. As part of a Gavi health systems strengthening grant, UNDP therefore worked with the United Nations Children’s Fund (UNICEF) and the Ministry of Health to run a financial and programme mentorship programme for district health offices in seven districts supported by the grant. The programme resulted in improvements across all key functional areas of financial and programme management, contributing to better planned immunization programme activities and reduced delays in disbursement due to reporting gaps. UNDP is now working with the Ministry of Health and UNICEF to expand the mentorship programme to 11 district health offices.
The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has provided support to the national HIV, tuberculosis and malaria programmes in Indonesia since 2003. The Ministry of Health, through the Directorate-General of Disease Control, manages the programmes as the Principal Recipient of the grants. As a country consisting of 17,000 islands, Indonesia has unique implementation challenges, including issues of connectivity and linkages across islands. The Ministry of Health, as Principal Recipient, has oversight over 110 sub-recipients and over 200 sub-subrecipients, which includes district health officers and implementers at the grassroots level. It also must coordinate the activities of different functional units, including finance, programme, logistics and information and communications technology (ICT). Within this unique operating environment, grant management challenges arise from a number of risks associated with the highly decentralized health system, presence of many implementing partners and requirements for strict grant compliance and complex reporting. Risks pertaining to financial management in particular have wide-ranging consequences for the sustainability of the programmes and impact of investments.
Following on from its role as technical support partner of the Global Fund Country Coordinating Mechanism under the 2015–2017 Global Fund grant cycle, UNDP has continued to build its relationship with the Ministry of Health since 2017. Based on UNDP’s status as a trusted health and development partner, with expertise in strengthening financial management systems for health and managing Global Fund grants in similar country contexts, the Ministry of Health established an agreement with UNDP in July 2019 for it to provide technical assistance on financial management.
UNDP identified several key areas for support through close engagement with the Ministry of Health to jointly assess and determine good practices to address capacity gaps in financial processes. Currently, UNDP’s capacity-building support to the Ministry of Health focuses on strengthening financial reporting, establishing financial management policy implementation manuals that align government and donor requirements, and developing risk assessment tools to aid the Ministry of Health in subrecipient monitoring and oversight. UNDP is also supporting the implementation of a new financial management information system, helping to improve practices for records management and strengthening human resource capacities, including through on-the-job training.
UNDP continues to work closely with the Ministry of Health to expand the scope of support based on Ministry of Health priorities, including interventions to strengthen the internal audit and oversight functions of the Ministry of Health and institute public financial management reforms in support of the decentralized health units. Based on the effectiveness of UNDP’s support and the recognition of further capacity gaps, the Ministry of Health requested an extension of the initial three-month partnership agreement and has contributed more than $3 million for UNDP’s technical assistance.
The Government of Zimbabwe Public Financial Management System (PFMS) had been in limited use by government ministries and did not have the capability to manage donor funding. A new module for PFMS to track donor funding was critical for the resources to be channelled and tracked through the national financial system rather than parallel financial management and accounting systems.
With UNDP’s support, through funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the Ministry of Health and Child Care (MoHCC) became the first ministry to roll out a grant management module for the PFMS in 2015–2016, starting with the configuration of Global Fund grants. When fully operational, the grant management module allows for data capture in near real-time for reporting to MoHCC and donors. MoHCC coordinated closely with the Ministry of Information and Communications Technology (ICT) and the Ministry of Finance and Economic Development. UNDP supported MoHCC to contract the required support from external parties related to ICT assessments, software configuration and procurement of hardware. It also supported the Ministry of Health to undertake training of trainers, resulting in a cumulative total of 800 health workers trained in the use of the module across eight provinces, along with district-level staff responsible for financial accounting and management.
Since the roll-out in 2016, some 90 grants have been configured into the PFMS grant management module, building on the example set forth by the Global Fund grant configuration. While implementation is ongoing, the introduction of the module and accompanying capacity-building activities have already yielded some initial enhancements in the financial management of health activities. These include improved timeliness and completeness of financial data to inform decision-making, reduced workload on staff responsible for data entry and reporting, and improved security and transparency. Further investment and support to fully operationalize the PFMS grant management module within the MoHCC down to the district level will help to ensure that it meets national and international requirements. Continuous improvement, effective leadership, greater integration and prioritized investments, including bandwidth, are needed to leverage and sustain the gains.
Effective financial management is inseparable from good governance. A robust internal audit system is key to enhancing governance, accountability and transparency in the management of health programmes, including public finances for health. Over the last decade, UNDP has supported MoHCC to strengthen its internal audit systems and processes, including the:
More information on the process and lessons from UNDP’s support to public financial management and internal audit in Zimbabwe can be found in the case study Case Study: UNDP and Global Fund support to strengthen financial and risk management for the delivery of health services in Zimbabwe.