OIG DIAGNOSTIC REVIEW SAYS CUBA CAN BE A MODEL FOR OTHER COUNTRIES

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Download PDF People living with HIV represented in all key decision forums Cuba has broad spectrum of activities focusing on the promotion of human rights and the respect of sexual diversity At the end of April this year, the Office of the Inspector General (OIG) released a diagnostic review of the Global Fund grants to the Republic of Cuba. The…

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ABSTRACT In its diagnostic review of Global Fund grants in Cuba, the Office of the Inspector General found strong evidence of successful national responses to HIV and of the effectiveness of TB control in Cuba. The OIG also identified many good practices.

People living with HIV represented in all key decision forums

Cuba has broad spectrum of activities focusing on the promotion of human rights and the respect of sexual diversity

At the end of April this year, the Office of the Inspector General (OIG) released a diagnostic review of the Global Fund grants to the Republic of Cuba. The purpose of the review was to identify and share good practices; and to identify key risks to grant programmes and make recommendations on how these risks can be reduced.

The fieldwork for the diagnostic review was conducted from 31 October to 16 November 2011. The review covered all three grants to Cuba totalling $76 million, of which $68 million had been disbursed. The United Nations Development Programme (UNDP) was the principal recipient (PR) for all three grants.

As reported in an article in GFO 182, the OIG found strong evidence of successful national responses to HIV and effective TB control in Cuba. The OIG identified many good practices during the course of the diagnostic review. Cuba is a low disease burden country and has been classified as a middle income country, which makes it ineligible to submit further proposals to the Global Fund under current eligibility rules. Despite this, however, the OIG said the good practices it spotted may serve as lessons for other countries receiving Global Fund support.

Some of the good practices the OIG identified in Cuba are as follows:

• All Global Fund-supported programmes rely on existing government staff and volunteers; so the only additional salary costs that were included in the programme funded by the grants was salaries for the PR (UNDP).
• Among the volunteers associated with the HIV and TB programmes, people living with HIV play an important role at the national, provincial and municipal level. They are represented in all important decision forums related to the country’s response to the diseases.
• The national programme for HIV testing and counselling is carefully designed to maximise reliability and quality. It also has wide coverage, with over two million people tested in the first 10 months of 2011.

Cuba has an HIV prevention programme supported by the Global Fund which focuses on sexual rights, gender equality, respect of sexual diversity and prevention of sexual violence. It is a programme of the National Centre for Sexual Education (CENESEX) and the Ministry of Education, targeting youth aged 12-19. The programme addresses the main social drivers of HIV vulnerability. The OIG said that this focus on social vulnerability is highly appropriate.

The country also has Global Fund-supported programmes for men who have sex with men (MSM). They include a broad spectrum of activities focusing on the promotion of human rights and the respect of sexual diversity. “The programme has significantly decreased the stigmatisation of homosexuality in Cuban society and has stimulated a social and political dialogue on sexual rights that is unprecedented in Latin America,” the OIG report says.

The OIG cited as a best practice the fact that Cuba has national information systems for HIV and TB that provide comprehensive and reliable data almost in real-time. The information systems for TB and for HIV case detection are integrated into the national health information system and provide reliable weekly data that allows for any type of analysis.

The OIG identified the following additional best practices:

• In Cuba, decisions for the use of antiretroviral (ARV) medications are made by treatment committees which meet weekly at the provincial and central level to decide on the treatment plan of each patient based on clinical and laboratory evidence.
• The National Statistics and Information Office conducts biennial surveys on issues relevant to HIV prevention and social support among the general population and among specific groups such as MSM and people living with HIV. These surveys provide reliable data which is used to guide prevention and social support programmes.
• There is regular communication between all layers of the Cuban health system. Meetings are held regularly where various people working in programmes and logistics share ideas with clinicians and warehouse management staff regarding matters such as supply of condoms, laboratory reagents and medicines. The OIG says that missing data or inaccuracies in condom distribution monitoring reports were quickly identified and corrected because of these meetings.

Another good practice identified by the OIG is that Cuba has many online information portals that are widely used. These include a database of all people living with HIV in Cuba and a database which contains detailed medical records of more than 90 percent of people on ARVs. There is also a database that has stock and consumption data of all pharmacies country-wide.

The OIG found that Cuba has a good supply management and distribution system of ARVs and other medicines. The system works on the basis of weekly orders and provides for buffer stocks of 30-60 days. There are minimum and maximum stock levels. The online system provides real-time stock and consumption information by health facility, product and province.

The OIG noted that the government has an agreement with the national passenger bus service to provide emergency delivery service of small packages within 24 hours countrywide. This eases deliveries of ARVs and avoids stock-outs. Laboratory samples, such as for CD4 determination, are transported daily to the nearest laboratory using the same buses. This ensures that results are received within three days.

The OIG said that the national drug regulatory authority provides quality control and certification of the warehouses and trucks used for medicines based on good pharmaceutical distribution and warehousing practices.

 

All of the OIG reports released in April 2012 are available on the Global Fund website here.