Office of the Inspector General

In-country data and data systems

03 April 2023

The availability of quality data is critical in the fight against the three diseases to support robust decision making and oversight, both for implementers and the Global Fund Secretariat. The importance of data quality is reflected in the inclusion of key objectives to strengthen data quality and systems in both the 2017-2022 and 2023-2028 Global Fund strategies.

To support these objectives, the Global Fund has invested US$1 billion in in-country programmatic data systems, tools and processes in the New Funding Model 2 (NFM2) and Grant Cycle 6 (GC6) implementation cycles. Coordinated with key domestic and international technical partners, these investments have improved programmatic data availability, disaggregation and reporting completeness at the country level. However, there has been less success in enhancing data accuracy and timeliness. While in-country programmatic data timeliness has improved by 22% between 2017 and 2021, further progress has been hindered by country-level challenges with data systems, use of manual tools and multiple fragmented systems. Data accuracy of key programmatic indicators also continues to vary significantly, both across the three diseases and across portfolios.

For procurement and supply management (PSM) data, there is limited end-to-end data visibility and quality at the country level, despite 55% of the Global Fund’s total grant allocations in NFM2 and GC6 relating to PSM activities. These country-level issues are linked to gaps in the Secretariat’s approach to data, including sub-optimal performance monitoring of the Global Fund’s strategic framework for programmatic data (Global Fund Strategic Framework for Data Use for Action and Improvement at Country Level, 2017-2022 “DUFAI”), as well as the lack of a detailed Global Fund PSM data strengthening strategy. There is also limited portfolio-wide visibility on country-level investments in data and data systems, which limits the ability to effectively address data issues. Considering the improvements in programmatic data availability and completeness alongside the issues in programmatic data accuracy and challenges with PSM related data, the adequacy and effectiveness of the strategic framework for strengthening in-country data and data systems needs significant improvement.

The Global Fund has developed detailed guidance and tools on monitoring programmatic data availability and quality at the country level. There are also health management information systems (HMIS) and monitoring and evaluation (M&E) performance indicators within performance frameworks in all sampled countries. Over 40% of the total Global Fund investment in HMIS and M&E relates to monitoring and oversight activities for programmatic data and data systems. These Global Fund investments support guidelines and provide tools for implementers to monitor health facilities. While there are well-designed guidelines and tools for monitoring and assurance, the OIG noted implementation challenges. Regarding implementer monitoring of data quality, most issues were identified at the health facility level, where processes and controls over in-country HMIS are not always formalized and followed, and there are significant M&E staff capacity gaps impacting the robustness of monitoring of data quality.

Outside health facilities, there are issues with monitoring, oversight, and supervision visits by national and regional entities. These reviews are often delayed, not performed, or do not result in improved data accuracy. There is also a lack of triangulation of patient and PSM consumption data, as well as limited monitoring of data accuracy, which affects the ability of implementers to detect material inaccuracies in reported data. At the Secretariat level, there is limited differentiation of Local Fund Agent assurance over programmatic data based on portfolio risk. Thus, the design and effectiveness of the Global Fund’s monitoring and assurance over programmatic data risks at country level need significant improvement.