XIX International AIDS Conference

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MOPE701 - Poster Exhibition


Transitionning PEPFAR-supported HIV clinical services to the Rwanda Ministry of Health: assessing health facility management capacity

I. Kankindi1, S. Kamonyo2, R.M. Kadende-Kaiser3, E. Wheeler4, E. Kayirangwa3, S. Sabimbona1, J.P. Nyemazi1, J.P. Mfizi1, K. Bitamara1, F. Kayitesi1, C. Biedron4, Z. Ahmed5, B. Chitou3, F. Morales5, J.R. Morales6, V. Mugisha7, C. Baribwira8, L. Isanhart-Balima8, R. Sahabo7, A. Asiimwe1, A. Binagwaho1, P. Raghunathan3

1Rwanda Ministry of Health, Kigali, Rwanda, 2Rwanda Ministry of Health, Decentralization and Integration, Kigali, Rwanda, 3Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Rwanda, Kigali, Rwanda, 4Allan Rosenfeld American Society for Public Health Fellow assigned to Centers for Diseace Control and Prevention (CDC), Rwanda, Kigali, Rwanda, 5CTS Global assigned to CDC-Rwanda, Kigali, Rwanda, 6Health Resources Services Agency (HRSA), Bethesda, United States, 7ICAP, Columbia University, Mailman School of Public Health, Kigali, Rwanda, 8AIDSRelief Rwanda, Kigali, Rwanda

Background: From 2004-2009, Rwanda expanded HIV clinical services to 395 health facilities with US President's Emergency Plan for AIDS Relief (PEPFAR), Global Fund, and Rwandan government support, and achieved 77% coverage of people in need of antiretroviral treatment (ART). PEPFAR-funded international nongovernmental organizations (NGOs) directly managed HIV services. From 2009-2012, PEPFAR NGOs under the mandate of US Department of Health and Human Services (HHS) gradually transitioned management of HIV services to MOH. We analyzed the impact of transition on PEPFAR/HHS budgets and health facility management capacity.
Methods: MOH, NGOs, and CDC jointly visited facilities biannually and administered a questionnaire assessing financial, human resources, supply chain, quality improvement, strategic information, and laboratory capacity. We compared baseline, 6- and 12-month management scores using nonparametric Kruskal-Wallis testing and generalized estimation equations for longitudinal data. We computed budgets per output during 2009-2011 (excluding commodities) for patients on ART, receiving >1 clinical service, and voluntary counseling and testing (VCT) clients.
Results: In 2009 PEPFAR/HHS NGOs supported 21,830 antiretroviral treatment (ART) patients; in 2011 MOH supported 27,490 ART patients. From 2009-2011 budgets per output decreased from $318 to $214/ART patient, $51 to $38/HIV+ patient receiving clinical care, and $0.57 to 0.50/VCT client. Mean health facility management scores remained consistent post-transition (n=24; baseline 73%, 6 months 79%, 12-months 76%, p=0.28). Since 2011, MOH directly receives PEPFAR funding, manages 76 health facilities and conducts mentorship and supervision visits previously undertaken by NGOs. MOH oversees feedback to health facilities and action planning following biannual performance monitoring.
Conclusions: For the first time, Rwanda MOH delivered HIV services as direct PEPFAR funding recipient. NGOs successfully transferred HIV program management responsibilities to Rwanda MOH. Costing analysis is warranted to investigate apparent budget efficiencies. Sustaining and improving HIV program management capacity will require continued monitoring of health facility performance.

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