Office of the Inspector General

Audit of Global Fund Grants to Ghana

27 October 2015

An Office of the Inspector General (OIG) audit of Global Fund grants to Ghana found financial and fiduciary risk management was generally effective. Financial management processes were strong and there has been considerable progress since the last OIG audit in 2010. However, the auditors found significant unaddressed weaknesses in the supply chain that delivers health products to patients and inventory problems concerning drug storage, accounting, quantification, forecasting and quality assurance. The Global Fund is working closely with in-country partners to put in place corrective actions.

The OIG covered active grants implemented by the Ministry of Health for each of the three diseases and an HIV grant implemented by the Ghana AIDS Commission. The audit team visited 27 health facilities including district and regional hospitals and health centers in seven out of ten regions in Ghana.

The audit focused on identifying strategic risks and the program's long-term effectiveness and impact in the country. It specifically aimed to answer three key questions:

  • Do health products reach patients in time and in good quality and quantity?
  • Are programmatic data on the three diseases sufficiently reliable for decision-making?
  • Are assurance mechanisms adequate and effective to mitigate the significant risks?

The supply chain weaknesses have been further compounded by a recent fire at the Central Medical Store, which led to the loss of a major portion of drugs stored inside. The cause of the fire is under investigation by local authorities. The store and its commodities, including the Global Fund's investments, were not externally insured.

The auditors also detected more than 10% deviations in most of the malaria and HIV data indicators. Tuberculosis data indicators and the Ghana AIDS Commission data indicators had minor discrepancies. Fragmented data systems and weak monitoring mechanisms also caused issues in the calculation of the number of adult patients receiving antiretroviral therapy.

The Global Fund has recently stepped up its efforts to finding a long-term solution for a more effective supply chain by coordinating with all partners and the Government of Ghana. It has also prioritized improving data quality and more accurate accounting of patients receiving antiretroviral therapy. It will further enhance the management of financial risks by helping to build up the Ministry of Health's internal audit function and implementing new external audit measures.

Ghana has an estimated 12th highest malaria burden in the world, the 23rd highest HIV burden, and the 53rd highest tuberculosis burden. Between 2003 and 2017, the Global Fund has allocated US$ 911 million to fight the three diseases in the country.

Audit of Global Fund Grants to the Republic of Ghana (GF-OIG-15-018 - 27 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.

The Global Fund 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 speak out to report fraud, abuse and human rights violations that prevent Global Fund resources from reaching those who need them.