21 July 2015
Auditors from the Office of the Inspector General (OIG) rated the management of financial, health services and product risks as ‘generally effective’ in Kenya. However, the OIG called for the Global Fund to develop a longer term strategy to tackle the three diseases beyond 2016, including a more coordinated approach with other donors and health service providers in the country. The Global Fund Secretariat, working with country partners, has agreed to a number of corrective actions.
Kenya, with approximately 5% of the global HIV/AIDS disease burden as well as substantial shares of the malaria and tuberculosis (TB) epidemics, has made good progress in reducing disease rates over the past few years. For example, HIV prevalence in people aged 15-49 has decreased from 10.5% in 1996 to around 6.0%.
The Global Fund is one of the main donors in the country having disbursed of US$ 698 million of funds to date. Thanks to these funds, there are currently 340,000 people on antiretroviral therapy, 11 million mosquito nets have been distributed and 167,000 people have been tested and treated for TB according to the latest published results.
The OIG auditors found that financial and fiduciary risks were well-managed including the Local Fund Agent reviews and grant recipient audits themselves, most of which were carried out by the Kenya National Audit Office. The Global Fund Kenya Country Team, in conjunction with the national programs, has developed its own portfolio-level strategy, including an increased focus on disease hot spots and key populations, resulting in tangible impact on the three epidemics.
However, the OIG found that the strategy only covers the current implementation period (2014-2016) and has not addressed some key issues that are critical to ending the three diseases in Kenya in the long term. These issues include the need for better coordination between partners on common targets and assurance activities, and better management of the risks caused by the devolution of health care to the county level which led to TB drug stock outs in some regional health centers in 2014. The OIG noted that the last TB prevalence survey dated back to the 1950s. Delayed since 2011, a new survey is expected to start mid-2015 which should help to better measure the impact and limitations of current interventions to inform future strategies.
The OIG also noted that grant performance is measured using health targets at the national level, rather than grant specific indicators and targets. While this is in line with the Global Fund’s policy and encourages sustainability, it means that measuring grant performance is more difficult. As the Global Fund’s investments account for between 25-45% of the total program expenditure in Kenya, using national targets alone does not offer a sufficiently rigorous way to assess the grant recipient performance or to link targets with expenditures.
Global Fund management has agreed to put in place corrective actions to address the issues raised by the OIG, including an updated donor mapping framework, following up on the TB prevalence survey and ensuring that strategic risks, including those linked to the devolution of health care to the counties, are mitigated.
The Office of the Inspector General works to ensure that the Global Fund invests the world's money in the most effective way possible in the fight against AIDS, tuberculosis and malaria. Through audits, investigations, oversight and consultancy work, it makes objective and transparent recommendations to promote good practice, reduce risk and condemn abuse.
Established in 2005, the Office of the Inspector General is an independent yet integral part of the Global Fund. It is accountable to the Board through its Audit and Ethics Committee and serves the interests of all Global Fund stakeholders. Its work conforms to the International Standards for the Professional Practice of Internal Auditing and the Uniform Guidelines for Investigations of the Conference of International Investigators.
The Office of the Inspector General believes that every dollar counts and has zero tolerance for fraud, corruption and waste. Through its whistle-blowing channels, the Office of the Inspector General encourages all to come forward to point out any irregularities that prevent Global Fund resources from reaching those who need them.