Zimbabwe

Audit Report: Global Fund Grants in Zimbabwe

Attachments

1. Executive Summary

1.1 Opinion

Zimbabwe has made significant progress in the fight against the three diseases, despite a prolonged economic crisis that has led to a deterioration of health infrastructure, loss of experienced health staff and a decline in the quality of health services. National malaria incidence almost halved in 20171 , while many countries globally were experiencing malaria resurgence. TB incidence declined by almost 60% between 2010 and 20172 , with treatment coverage and treatment success rate both exceeding 80% by 2018. HIV prevalence has decreased significantly among adults as well as children3 . AIDS-related deaths fell by 60% and annual infections fell by 38% from 2010 to 20184 .
Zimbabwe ranks among the top 18 countries achieving an incidence-to-prevalence ratio of 3%5 .

However, some challenges remain. There are HIV data anomalies, with significantly higher cases detected annually than estimates, and efforts are required to understand the underlying root causes and inform an appropriate programmatic response. Further improvements are needed in outreach among hard-to-reach populations, and in putting all identified patients on treatment. Part-time health facility staff means a risk of deteriorating access and quality of care, as well as other grant management areas, over the long term. The program is currently partially effective in patient tracking and counseling, key population coverage, early infant diagnosis, and overall viral load suppression; further improvements will be needed to reach the ambitious program objectives.

Regarding the supply chain, no material stockouts or expiries of ARVs were detected at any level for the three diseases during 2018-19. Monthly stock counts and warning mechanisms for near-to-expiry products are in place. Global Fund commodities are generally traceable. The country is expanding the drug storage capacity of central and regional warehouses and has rehabilitated 169health facility stores to address warehousing challenges. However, overall capacity needs are almost twice the current warehousing capacity, and an updated assessment of warehousing needs is required. Space issues prevent good inventory management; the audit noted cases of slow stock rotation, forced ‘transfer’ of drugs to health facilities which stretches their capacity and increases risks of expiries, and simultaneous expiries and stock-outs of commodities at different facilities. Gaps were also noted around timely and accurate data entry into inventory systems, reconciliation of inventory records, triangulation of drugs consumption and patient data, and oversight and supervision. The Secretariat has made efforts with the national programs to optimally utilize existing warehouses, and register supply chain improvements; however, further improvements are needed. Overall, supply chain management is assessed as partially effective.