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Promoting accountability and collaboration in global health: insights from an Aidspan roundtable
GFO issue 438

Promoting accountability and collaboration in global health: insights from an Aidspan roundtable


Samuel Muniu

Article Type:

Article Number: 5

The evolving partnership between donor organizations and Supreme Audit Institutions

In a recent roundtable discussion featuring prominent voices in global health, participants from Gavi, the Global Fund, and Supreme Audit Institutions and their umbrella organizations in Africa delved into the important issues of accountability, transparency, and collaboration. These entities hold key positions in the battle against infectious diseases and strengthening healthcare systems. The roundtable discussions in Kigali highlighted the evolving partnership between donor organizations and Supreme Audit Institutions and its significance in achieving global health goals.


In collaboration with the Office of the Auditor General of Rwanda and BACKUP Health, Aidspan organized a roundtable on 5–7 September 2023 in Kigali, Rwanda. The event is part of a project supported by the German Federal Ministry for Economic Cooperation and Development (BMZ) and the UK’s Foreign, Commonwealth & Development Office (FCDO) that focuses on strengthening the capacity of Supreme Audit Institutions (SAIs) in sub-Saharan Africa to ensure accountability of Global Health Initiative (GHI)-supported programs.


The participants included influential figures working in global health from Gavi, as well as the Global Fund. Additionally, there were representatives from SAIs, the African Organization of English-speaking Supreme Audit Institutions (AFROSAI-E), and the African Sub-Saharan Organization of French-speaking Supreme Audit Institutions (CREFIAF). The discussions primarily focused on strategies to enhance accountability measures for health programs supported by donors in sub-Saharan Africa, highlighting the evolving partnership between donor organizations and SAIs and its importance in achieving global health goals.


Figure 1. A group photo of the roundtable participants


Source: Aidspan


This article summarizes the key highlights from the roundtable discussions featuring these prominent speakers.


Gavi’s commitment to strengthening accountability and collaboration in global health 


Charles Ohene-Nyako, a Senior Manager at Gavi, highlighted the significance of collaboration, accountability, and prevention of misuse of funds in Gavi’s efforts to support vaccination and strengthen healthcare systems in partner countries. He outlined the six key principles of Gavi’s accountability framework:


    1. Respect for aid effectiveness: Gavi respects aid effectiveness principles and relies on existing country systems.
    2. Prevention: Gavi places a strong emphasis on preventing the misuse of its support through regular monitoring and collaboration with SAIs to address issues.
    3. Promotion of flexibility and country ownership: Gavi prioritizes flexibility and underscores the importance of partner countries taking ownership of healthcare programs.
    4. Knowledge transfer: Gavi highlights knowledge transfer as a means to ensure that implementers fully understand and meet their expectations.
    5. Mutual accountability: Gavi enters into agreements with governments to foster mutual accountability for program outcomes.
    6. Sustainable systems: Gavi invests in strengthening country systems to prevent any lapses in progress.


Charles discussed Gavi’s investments, such as working with assurance providers, direct disbursements to countries, collaboration with SAIs, and support for internal audits. He concluded by emphasizing the goal of strengthening accountability and improving systems in collaboration with partners.


Gavi is currently implementing initiatives in this regard. It is launching a comprehensive initiative with assurance providers to enhance knowledge transfer and accountability. Together they have initiated a Request for Quotation (RFQ) and Request for Proposal (RFP) process to ensure that every eligible country receives support from assurance providers. Additionally, Gavi invested around $30 million in 2021 and 2022 to facilitate the transition to using country systems, enabling 50 countries to receive direct disbursements and reinforcing their accountability.


Furthermore, Gavi has signed an MOU with the Global Fund and AFROSAI-E to enhance the capacity of SAIs, with Aidspan playing a significant role in implementing this agreement. Gavi is also working on an addendum to the existing MOU between CREFIEF and the Global Fund, developing a comprehensive work plan to translate these agreements into tangible changes and measurable results. Gavi is committed to engaging with SAIs through AFROSAI-E, emphasizing its dedication to mutual understanding and collaboration.


The Global Fund’s commitment to enhancing global accountability and fostering collaboration


Adda Faye, the Chief Financial Officer at the Global Fund, addressed the roundtable participants on accountability, transparency, and collaboration in the context of the Global Fund’s efforts against AIDS, TB and malaria. She thanked Aidspan for its watchdog role in holding the Global Fund accountable. Adda highlighted the Global Fund’s commitment to principles like transparency, accountability, and country ownership. She emphasized the significance of implementing countries taking ownership of their responses and being accountable for the allocated funding. She cited Rwanda as a positive example of a country that has established self-accountability and self-auditing mechanisms.


Adda underscored the substantial funding allocated by the Global Fund, especially in Africa, emphasizing the need for effective and efficient fund utilization. She stressed the direct impact of fund allocation decisions on vulnerable populations’ lives and well-being. Furthermore, Adda advocated for the use of country systems and public financial management to ensure trust and proper accountability. She recognized the role of national accountability institutions like SAIs in ensuring accountability of those delivering healthcare services. Adda outlined three key points for SAIs, including improving value for money through programmatic audits, optimizing fund usage, and maintaining a zero-tolerance policy for fraud.


Adda shared a poignant anecdote about Rwanda’s commitment to utilizing funds effectively and contrasted it with the significant sums lost due to underutilization in other countries. She noted that, “The funds allocated to Africa that are not used on a three-year basis were $1.4 billion in the 2017-2022 period and $900 million in the last three years.” Adda encouraged the audience to use the roundtable as a call to action, not just for themselves but for the people in their communities who rely on these funds for their health and well-being.


Enhancing collaborative relationships between donor organizations and SAIs


A panel discussion featuring representatives from AFROSAI-E, Gavi and the Global Fund stressed the importance of collaboration and partnership in the context of donor-funded health programs. The conversation revolved around the role of SAIs in conducting risk assurance for these programs and the value they bring to the table. Representatives from Gavi and the Global Fund shared their insights, highlighting the significance of SAIs in ensuring transparency, accountability, and the effective use of donor funds.


Figure 2. Panel discussion members


Source: Aidspan. From left, Eric Boa from the Global Fund, Edmond Shoko from AFROSAI-E, Charles Ohene-Nyako from Gavi, and Maryline Mireku from Aidspan.


We summarize below the key takeaways from the discussion, highlighting the evolving partnership between donor organizations and SAIs.


Understanding the role of SAIs


SAIs, often overlooked players in the world of donor-funded programs, play an important role in holding government entities accountable. They possess the unique ability to access a wide range of information and provide comprehensive audits that go beyond the capabilities of private audit firms. SAIs have the expertise to dig into government systems, policies, and procedures, making them invaluable partners for donor organizations.


The evolution of partnership


The conversation revealed a shift in mindset among donor organizations, particularly Gavi and the Global Fund, towards greater collaboration with SAIs. Traditionally, these organizations have relied on private audit firms due to their perceived efficiency and speed. However, they’ve come to realize that while private firms offer quick solutions, they may not provide the comprehensive overview needed to ensure donor funds are used effectively. Nor do they build national public capacity.


Investing in capacity building


To bridge this gap, donor organizations are investing in capacity building for SAIs. Training programs have been initiated to equip SAIs with the necessary skills and knowledge to effectively audit donor-funded programs. These training initiatives aim to create a pool of auditors who not only understand the technicalities but also the specific needs and challenges of donor organizations.


Enhancing visibility and engagement


Engagement between donor organizations and SAIs is key to building trust and ensuring that audits are conducted effectively. Donor organization representatives emphasized the importance of interaction, with plans to meet SAIs during their country visits. Additionally, they encourage SAIs to be proactive in reaching out, even if it means setting up an initial meeting just to establish a connection.


Creating understandable audit reports


Another critical aspect of collaboration is ensuring that audit reports are clear, concise, and understandable to programmatic personnel within donor organizations. SAIs have been encouraged to simplify their reports to facilitate better comprehension. A shared language and clarity in reporting are essential for aligning efforts towards program improvement.


Balancing demands


While donor organizations acknowledge that their demands can be onerous, they emphasize that it’s a journey towards building trust and enhancing the partnership. The more SAIs engage and provide value, the more investments and support will flow naturally. By starting slowly, with a comprehensive action plan, and demonstrating tangible benefits, collaboration between donor organizations and SAIs can flourish.


Coordination and alignment


Donor organizations also emphasized the importance of coordination and alignment among various actors in the health sector. Partnerships with regional bodies and initiatives like Global Health Initiatives aim to streamline demands and ensure a more coordinated approach when engaging with SAIs. This alignment benefits both donors and SAIs, fostering a more efficient and impactful partnership.


In conclusion, the evolving partnership between donor organizations and SAIs in the context of donor-funded health programs is a testament to the commitment to transparency, accountability, and effective resource utilization. While challenges exist, both sides recognize the value they bring to the table and are determined to build stronger, more collaborative relationships. As SAIs continue to grow in capacity and donor organizations become more supportive, the result is a win-win situation for all stakeholders, ultimately benefiting the communities and populations these programs aim to serve.


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