19 January 2016
Auditors from the Office of the Inspector General found financial controls to be satisfactory in the management of Global Fund grants in Uzbekistan. However, they identified issues in the implementation of the HIV and tuberculosis (TB) grants as well as with the Country Coordinating Mechanism. For example, there is a lack of coordination over TB treatments and understanding better the high incidence of multi-drug resistant TB (MDR-TB) in the country. The Global Fund, working with in-country partners, is putting in place actions to strengthen the Country Coordinating Mechanism and to improve grant implementation including better aligned treatments for TB patients.
According to the World Health Organization, Uzbekistan has 7.6% of the TB burden and 1.7% of the HIV burden in Europe. MDR-TB is a particularly major issue with 23% of new TB cases (5th highest rank in the world) and 62% of retreated cases (2nd highest rank in the world) estimated to be MDR-TB. 80% of the population was affected by malaria before World War II but there has been significant progress since with no reports of malaria since 2011. The Global Fund has supported Uzbekistan with seven grants totaling USD 143 million, mainly for TB and HIV. National funds cover approximately 53% of HIV, 83% of TB and 82% of malaria interventions.
The OIG found that the Country Coordinating Mechanism has played a limited role in resolving various key portfolio issues in the country. For example, there is limited coordination between its members over the treatment of TB. The two principal coordinating bodies for TB in the country follow different treatment protocols. The Republican DOTS Center follows directly observed treatment, short course (DOTS) methodology, as recommended by the World Health Organization. However, the National Institute of Phtysiatry and Pulmonology, which supervises the overall network of TB hospitals in the country, prescribes older non-DOTS approaches to treatment. Around 85% of TB cases are treated in hospitals for prolonged periods, leading to the risk of patient infection with other strains of TB. At the time of the audit, the Republican DOTS Center and the National Institute had plans to establish a memorandum of cooperation to clarify their roles and responsibilities, and move towards universal DOTS treatment in 2017.
The OIG also calls for improved planning and coordination for HIV grant recipients including the Ministry of Health and the United Nations Development Program. There have been multiple revisions to concept notes, and consequently several short-term grant extensions, periodic service interruptions, ambiguity and duplication in implementation arrangements. The Global Fund is putting in place actions to facilitate HIV prevention and treatment activities including better assessment of new implementers and contracting additional sub-recipients to provide essential services to female sex workers and men who have sex with men.
The OIG audit identified stock-outs of significant anti-retro viral and TB drugs, which lasted between one to two months in five out of the ten treatment facilities visited. Stock-outs lead to treatment disruptions leading to advanced stages of disease or drug resistance in patients. OIG auditors established that one of the key causes for the stock-outs was the use of manual tools for drug quantification and distribution. The Global Fund is encouraging its in-country partners to introduce automatic supply chain management systems and to streamline distribution in order to provide an uninterrupted supply of drugs to HIV and TB patients.
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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.
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