Ten years of Global Fund in Rwanda

ON February 11, the Government of Rwanda through the Ministry of Health signed an agreement with Global Fund, an international financing organisation that aims to attract and disburse resources to prevent and treat HIV, Malaria and Tuberculosis. Under this partnership, Rwanda received a grant of $204m for the National strategic plan for HIV/Aids. The same day marked a 10-year successful partnership between the Rwandan government and Global Fund, a partnership that has seen Rwanda achieve major milestones in improving health care and reducing lives lost through Malaria, TB and HIV. Over the 10-year period, various funding models have been employed, but at the beginning of 2009, Global Fund shifted to funding strategic plan budgets and aligning grants to Rwanda’s annual fiscal year budget. The signature inked last week on Monday will see Rwanda access funds through a unique model, the result based financing where grants will be proportional to achievements and outcomes sustained. Dr Daniel Ngamije the Coordinator of the Project Management Unit (PMU) of the Global Fund said that HIV/ Aids prevention and management, Malaria prevention and treatment and Tuberculosis had been mitigated during the 10 year partnership. “At the inception of the partnership in 2003, there were only 44 Voluntary Counselling and Testing sites in the country but as of last year, we had 493 sites across the country all adequately equipped. This is a 1,020 per cent increase. Centres for prevention of mother to child transmission at the time stood at 53 but they have since gone up by 821 per cent to 488 centres. There has also been a great improvement in the number of people tested from 2633 to 3,810,015 people. The percentage of infants born to HIV-positive mothers who were infected went down to 0.9 per cent from 9.7 per cent.” Dr. Ngamije went on to break down other ways how HIV/Aids had been mitigated and managed through the partnership like the increase of Antiretroviral Therapy sites to 465 from 16 which caused a 95.5 per cent increase in the number of patients under the therapy. 44-year-old Beatrice Kagoyire, the chairperson of persons living with HIV/Aids learnt of her status just around the time Rwanda began its partnership with Global Fund. She said there has been a lot of improvement in recent years which has seen lives saved and stigmatisation of people living with HIV/Aids go down. “I have been able to deliver two children who are HIV negative thanks to the Prevention of Mother to Child Transmission (PMCT) programme. I can on behalf of persons living with HIV in the country say that there is access to free ARVs across the country. Children born to HIV positive mothers are able to live an HIV free life and go through school because of the various support programmes offered,” Kagoyire revealed. She went on to say that HIV-related deaths were on the decline as well as the mother to child transmission cases. Tuberculosis treatment and prevention has been stepped up in recent years through the grants obtained from Global Fund. In 2004, a year into the partnership, the percentage of successful treatment stood at 77 but it has since gone up to 89.6 per cent. “We have been able to make renovations and improved the capacity of District health facilities to handle TB cases. We have equipped health centres with solar panels, as well as procured a CT scan Machine, 8 digital X-ray machines, 8 analogue X ray machines, vehicles and computers to support the management of Information among other steps,” Dr. Ngamije explained. He went on to say that the impact has been felt from the referral facilities down to the health centres across the country. In 2003, only 24 per cent of the households had at least one insecticide treated mosquito net. As of last year, the percentage stood at 84. The positive change was also noticed in the number of pregnant women and children under five who slept under treated nets. The percentage of children under five years treated within 24 hours after detection has gone up to 96 per cent. The intervention has seen 12, 151, 989 nets distributed accross the country. “Thanks to the training of health workers and other interventions, the incidences of malaria between 2005 and 2012 declined by 74 per cent, malaria related deaths have gone down by 68 per cent and the test positivity rate went down by 64 per cent in the period between 2005 and 2012,” Dr Ngamije said. Other interventions that had mitigated the impact of Malaria were provision of ambulances and renovation of 24 hour services, emergency wards and maternity services. Late last month during the official opening of the African Union Summit of Heads of State in Addis Ababa, Ethiopia, Rwanda was feted for exceptional progress in scaling up malaria control interventions; this was partly due to the role played by the partnership. The award by African Leaders Malaria Alliance (ALMA) was the third in a row as Rwanda had maintained at least 95 per cent coverage of Long-Lasting Insecticidal Nets (LLIN) and Indoor Residual Spraying (IRS) interventions. When Rwanda was feted and considered a model for other countries, Dr. Corine Karema, the head of Malaria and other Parasitic Diseases department at Rwanda Biomedical Centre commended Global Fund as one of the partners that had helped achieve the milestone. She said the disease had dropped as a number one killer of children under the age of five and Rwanda was closer to zero malaria deaths by 2017. “Rwanda has achieved significant reductions in malaria cases over the past decade. In 2005, malaria was the number one killer of children under the age of five. In 2008, it dropped to the 3rd position and by 2012, it had dropped to 8th. We are still focused and closer to our goal of zero malaria related deaths by 2017,” Dr Karema said. Health minister Agnes Binagwaho is confident that the achievements sustained from the partnership with Global Fund and successfully managing the grant will enable the country to sustain universal access to treatment and care as well as reduce new HIV infections by two thirds to 2000 and halve HIV related deaths by 2018. “We are confident that we will sustain the universal access to treatment and care as well as reduce new infections,” Binagwaho said. Global Fund executive director, Mark Dybul commended Rwanda for the achievements it has been able to make saying it was Global Fund’s pleasure to work with an ambitious nation like Rwanda. He said that the impact of various projects had been seen and felt by citizens from all corners of the country and described Rwanda as the country at the top of a hill that other nations could draw lessons from.

Insight

Ten years of Global Fund in Rwanda