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Addressing Fiduciary Risk in Zambia’s Health Systems


  • Zambia was unable to reliably receive direct donor funding for healthcare.
  • Abt is working with the Ministries of Finance and Health to track funds for HIV.
  • The Copperbelt Provincial Health Office is using electronic accounting to post transactions in real-time.
The Challenge

As a sub-contractor on USAID’s Supporting an AIDS-Free Era (SAFE) project, Abt is providing technical assistance to Zambia’s health system. A fiduciary risk assessment of the Zambian Ministry of Health and district-level health services identified a number of issues that would make it risky for the Government of Zambia to receive direct donor funding for healthcare. Among those issues is the possibility that donor funds are not properly accounted for, are not used for their intended purposes and/or do not provide value for money.

The Approach

Working in Copperbelt and Central Provinces, we’re addressing issues identified in public financial management risk mitigation plans from the Ministries of Health and Finance. That includes enhancing health systems and strengthening the Ministries’ capacity to track government-to-government (G2G) funds for HIV. This work includes:

  • Supporting improved procurement processes.
  • Helping agencies adhere to procurement plans.
  • Tracking equipment purchases with G2G funds.

We’re also working at the provincial level to improve human resource management, particularly through the use of an annual appraisal performance for employees.

The Results

During the first year of the project, Abt provided technical assistance to ensure Copperbelt and Central Provincial Health Offices (PHO) could use an electronic accounting system to post transactions in real-time. (Online accounting increases the transparent and ethical use of donor funds.) By the end of September 2018, the Copperbelt PHO went live, creating and generating purchase requests, purchase orders and payment vouchers using Microsoft Dynamics NAV accounting software. Abt continues to develop sustainable solutions to address all of the risks identified in the risk mitigation plans.