Audit of Global Fund Grants to South Sudan
05 October 2015
An audit of the Global Fund’s grant portfolio in South Sudan found US$ 935,138 worth of transactions and bed nets worth US$ 431,223 that could not be accounted for. Office of the Inspector General (OIG) auditors also identified that a lack of funding and oversight resulted in low coverage of affected populations and that 56% of buildings funded by the Global Fund had defects and/or were not in use. The Global Fund is taking measures to address the issues including steps to recover the sums identified.
The Republic of South Sudan is considered a “challenging operating environment” by the Global Fund. This means that it is difficult to deliver health services to the population because of security problems, poor infrastructure and a general lack of resources after decades of conflict. Malaria is endemic in the country with 100% of the population at risk. Tuberculosis is also a leading cause of mortality. Approximately 2.6% of the population are living with HIV.
Despite these challenges, the Global Fund and its partners have made notable headway in the fight against the three diseases. Bed net ownership increased from 53% in 2009 to 66% in 2013. The coverage of pregnant women receiving intermittent malaria preventive treatment also increased from 13% in 2009 to 26% in 2013. A total of 21,000 new smear-positive tuberculosis cases have been detected and treated. The Global Fund’s investment of US$ 16 million in construction, health equipment and health worker training has also contributed to improved service delivery.
In its audit, the OIG assessed the effectiveness of the implementation arrangements of Global Fund grants in the country, focusing on their impact and on identifying and mitigating the risks of operating in such a difficult environment. The audit covered four active grants managed by two Principal Recipients, the United Nations Development Program and Populations Services International. The OIG found the following problems:
- The number of patients on anti-retroviral treatment (8,500 clients as at June 2014) represents only 12% of the 72,000 people eligible for treatment.
- Financial and fiduciary risks at sub-recipient level are not always properly mitigated. The OIG identified transactions amounting to US$ 935,138 incurred by one sub-recipient with inadequate supporting documents.
- Twenty-six of the forty six buildings constructed (56%) under Phase I of the Health Systems Strengthening grant either have defects and/or are not in use. This is largely because the buildings are located in insecure areas or far from townships, have design flaws, and/or lack basic utilities.
The OIG also concluded that there is limited differentiation in the application of Global Fund policies to countries at different stages of the development continuum. The audit raises questions about the suitability of applying the standard grant operational processes to challenging operating environments like South Sudan.
The Global Fund is taking a number of corrective actions to address the OIG’s findings including new grants to increase coverage of people affected by the three diseases. As part of its new strategy currently under development, the Global Fund is also considering how to introduce a more flexible approach to operating in challenging environments such as South Sudan.
- Audit of Global Fund Grants to the Republic of South Sudan (GF-OIG-15-016 - 5 October 2015)
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The Office of the Inspector General safeguards the assets, investments, reputation and sustainability of the Global Fund by ensuring that it takes the right action to defeat AIDS, tuberculosis and malaria. Through audits, investigations and consultancy work, it promotes good practice, reduces risk and reports fully and transparently on 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.
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