Office of the Inspector General

Message from the Executive Director: Global Fund Grants in Mozambique

11 March 2022

Mozambique has faced severe environmental disasters and instability in recent years. These challenges have created hurdles in the fight against HIV, tuberculosis (TB) and malaria in the country. The impact of COVID-19 on the three diseases has compounded the situation. The Global Fund continues to support the country through adaptations and targeted funding, as we seek to protect hard-won gains on AIDS, TB and malaria and accelerate progress toward ending the diseases as public health threats.

Our response to the three diseases in Mozambique continues to gain ground. Despite challenges in the delivery of HIV prevention and treatment interventions, we commend the country’s progress against the virus. The estimated number of people living with HIV who know their HIV status increased from 62% in 2015 to 81% in 2020, while the proportion that initiated antiretroviral therapy (ART) increased from 42% in 2015 to 68% in 2020. Viral load suppression for those on ART increased from 50% in 2019 to 55% in 2020. Mozambique has also made significant progress in their response to TB. Deaths from the disease have reduced drastically – by 54% – between 2015 and 2020. The treatment success rate for drug-sensitive TB and drug-resistant TB increased from 88% and 48% in 2015 to 94% and 66% in 2020, respectively. TB notification rates have steadily increased, from 119 per 100,000 population in 2010 to 308 per 100,000 population in 2020. As for malaria, deaths from the disease have dropped from 6 per 100,000 population in 2016 to 2.5 per 100,000 population in 2019. Through the support of the Global Fund partnership, a total of 11.9 million mosquito nets were successfully distributed in 2020. The proportion of the population using mosquito nets, among those with access, increased from 54% in 2015 to 82% in 2018.

Despite this significant progress, the 2021 OIG audit on Mozambique found that improvements are needed in the efficiency and effectiveness of the procurement and supply chain processes and systems, which continue to affect the availability of health commodities at health facilities. The audit also noted that more efforts were needed to retain and monitor people on HIV treatment, on increasing TB testing services and in malaria case management. The OIG audit noted that HIV, TB and malaria programs were relatively unaffected by the COVID-19 pandemic, but urged for more efforts to increase utilization of funds invested in the COVID-19 Response Mechanism (C19RM) in the country. We are working with the government and implementer partners to accelerate the effective deployment of the C19RM funds to mitigate the direct and knock-on impact of COVID-19 on HIV, TB and malaria programs.

The Global Fund is committed to working with Mozambique and partners to address all the key issues and risks identified under the audit.

The Global Fund is supporting the government of Mozambique and implementing partners to deliver institutional and operational reform to address the supply chain challenges and improve the traceability, warehousing, and distribution of health commodities.

Our partnership is working to produce standardized HIV prevention service delivery packages for key populations. Over the next five years, the national HIV response aims to reduce the estimated percentage of child HIV infections from HIV-positive women to less than 5% and to reduce new HIV infections and AIDS-related mortality by 25% and 30% respectively against the 2020 baseline. These targets aim to transform the vision of zero new HIV infections, zero discrimination, and zero AIDS-related deaths into concrete milestones. The Global Fund is engaged with the Ministry of Health to address the factors that lead to poor ART retention. Following extensive multistakeholder engagement and in-depth analysis, work is already well underway to finalize a roadmap that will drive improvements in ART retention rates.

The Global Fund will support implementers in the development of a National Strategic Plan for private sector engagement in TB. We will also support initiatives that provide greater insight into factors that lead to low treatment outcomes amongst patients with multidrug-resistant TB. Work is underway to align the Global End TB strategy with the National TB Programme to focus efforts on accelerating early case finding and treatment. By maximizing efforts through the Global Fund strategic initiative, we will also support Mozambique to create suitable strategies and approaches to addressing delays in TB diagnosis.

Through support from the Global Fund and other partners, Mozambique has started to conduct mass drug distributions and mosquito net campaigns among displaced populations to mitigate the increased risk of malaria infection. The Global Fund is providing strategic support to our partners in the country to ensure Mozambique has the evidence needed to inform program innovations and scale-up.

We thank the OIG for this audit report. The work of the OIG continues to complement the active risk management and controls put in place by the Secretariat and upholds our proactive approach of full transparency both on disclosing the issues in the implementation of our grants and in highlighting the successes we can build on in the future. We are committed to continuing our investments in Mozambique as we seek to accelerate progress toward ending AIDS, TB and malaria as public health threats, defeat COVID-19 and build better defenses against future pandemics in the country and beyond.