Message from the Executive Director: Global Fund Grants in the Republic of Angola
09 April 2024
While Angola has made some gains against HIV, tuberculosis (TB) and malaria in the last few years, that progress has been limited. In 2022, the country still has one of the highest rates of mother-to-child transmission of HIV in the world (15%), and the lowest early infant diagnosis rates for HIV (3%), and women in Angola are disproportionally affected by HIV, representing 61% of people living with HIV. In the fight against TB, Angola remains on the list of 30 high-burden countries for TB and drug-resistant TB. High rates of patients lost to follow-up in both TB and HIV programs have also limited the effectiveness of treatment. As for malaria, the disease remains the principal cause of illness and one of the most common causes of death in the country, with the entire population at risk. We continue to invest together with Angola to strengthen the country’s ability to respond to the three diseases and create resilient and sustainable health systems to confront these diseases of today and those of the future. We also remain engaged on working with Angola to fulfill their co-financing commitments.
A 2024 audit of the Global Fund’s investments in Angola conducted by the Global Fund’s Office of the Inspector General (OIG) found that some of the challenges identified in an earlier OIG audit from 2019 have persisted. The 2024 audit found significant weaknesses in key procurement and supply chain management in the country. It found that grant monitoring and oversight was ineffective. The audit also found that the implementation of key programmatic activities remained suboptimal, especially at community level, and needed significant improvement. While there has been strong progress in ensuring timely reporting on the status of co-financing, the audit noted that there were gaps in effective oversight and action on co-financing by the relevant governance bodies. We will continue to work with the government of Angola on co-financing as we strive to see that the country meets its co-financing requirements as a critical element toward accelerating progress in the fight against HIV, TB and malaria while addressing critical sustainability and transition challenges.
That the challenges in Angola persist despite the efforts our partnership has made in the last four years to accelerate course correction is indicative of the serious work that needs to be done in Angola, to find innovative ways to address the country’s unique and complex operating environment. To achieve lasting impact here, our partnership will need to be more patient and resilient: The reforms we began to institute in 2019 are still taking root.
The Global Fund Secretariat responded quickly to the results of the 2019 OIG audit. It invoked the Global Fund’s Additional Safeguards Policy, closing the two grants managed by the Ministry of Health early, withholding access to the 2023-2025 allocation until certain conditions were met, and engaging with the Head of State to discuss the future of our partnership with the country.
The Agreed Management Action from the 2019 audit required a revised strategy for the Angola portfolio and was timely met by the Secretariat. A decision was made to shift the portfolio from funding ad hoc commodities at the national level to a unique subnational investment model based on a “saturation” principle to achieve impact by focusing our investments on provinces with a high disease burden. This approach was grounded in analytics and programmatic data and was reviewed by senior management at the Global Fund, including the Chief Risk Officer and the Head of the Grant Management Division. The Technical Review Panel and Grant Approvals Committee were briefed and consulted for guidance prior to the rollout of the revised strategy.
However, the transition to the subnational approach coincided with the initial phase of the COVID-19 pandemic (January to June 2020), which significantly impacted all aspects of program implementation. Travel to and within Angola was limited, complicating the recruitment of national and international staff and the necessary stakeholder engagement, including with new provincial actors. Supply chain disruptions at the global and national level impacted commodity availability.
More generally, many of the underlying political and health systems-related issues described in the 2019 audit report have persisted. These challenges also apply to the target provinces selected for the initial rollout of the subnational approach, as they are characterized by low baseline HIV, TB and malaria service coverage, high programmatic needs and insufficient human resources for health.
Despite the evolution in the portfolio over the last four years, Angola remains a complex and expensive operating environment. Nevertheless, our partnership with Angola matters for three reasons: first, there is a need to demonstrate value for money and impact in the target provinces with Global Fund resources; second, our funding creates leverage to unlock more and better government co-financing for the three diseases; and, finally, Angola’s disease burden has public health consequences for its neighbors and the larger southern Africa region.
The issues flagged in the 2024 audit report have been well-known to the Secretariat, and actions are being taken to address each of the findings in the report. We are making a course correction, notably in monitoring and evaluation (M&E) and procurement and supply management of health products. We continue to learn from the two focus provinces, whose grant ends in June 2024. These lessons are already informing implementation readiness as the program prepares to scale up to the third province to be included in the upcoming three-year grant cycle, GC7. For example, efforts are already underway by the Principal Recipient and the government to develop a commodity transition plan to support overall implementation readiness prior to GC7 rollout and ensure an adequate supply of commodities to health facilities during the expansion to Bié province. With respect to M&E, implementing partners in Angola are drafting an acceleration action plan based on lessons learned from GC6 implementation and several data-related evaluations with a view to identify and address the underlying causes of poor data quality.
The execution challenges highlighted in this report are an urgent imperative. Nonetheless, it is important that we allow time for the unique subnational investment model devised for Angola to reach full maturity. In complex and fragile contexts like Angola, confronting deep-seated systemic challenges means that sustainable changes will take time. We are confident that these audit findings will help to strengthen Angola’s positive trajectory in the coming years.
The OIG is an integral and important part of risk management, conducting independent audits and investigations to complement the active risk management and controls put in place by the Secretariat with oversight by the Global Fund Board. We thank the OIG for this audit report, which upholds our proactive approach to detecting and being fully transparent about problems in the implementation of our grants. The Global Fund is committed to constantly strengthening measures to increase value for money and improve the effectiveness of health investments so they can reach the people most in need, in communities all over the world.
- Global Fund Grants to the Republic of Angola (GF-OIG-24-006 - 9 April 2024)
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