15 April 2016
An Office of the Inspector General investigation (OIG) in Côte d’Ivoire found that two million RHZE pills, a critical drug used in the first-line treatment of tuberculosis, were unaccounted for. The OIG concluded that they were the likely source of illicit sales in street markets. The strong antibiotic drug was being sold as a so-called cure to a number of ailments raising concerns about the risks of increased Multi-Drug Resistant Tuberculosis taken outside of a formal medical treatment. The Global Fund has put in place a number of actions to prevent further losses of RHZE stocks and will seek potential recoveries for the unaccounted for pills.
Since 2003, the Global Fund has invested US$336 million in Côte d’Ivoire with 15 grants covering HIV/AIDS, tuberculosis and malaria. Tuberculosis investments total US$28 million and pay for the treatment of over 25,000 patients per year. The Programme National de Lutte contre la Tuberculose (PNLT), a program within the Ministry of Health, was the Principal Recipient for the country’s last two tuberculosis grants.
The two million pills were bought with Global Fund grant funds at a cost of US$148,544 but with a street value of roughly double. The two million pills were from PNLT emergency reserves representing four months’ supply of tuberculosis treatments nationwide.
The OIG’s investigation confirmed the illicit sale of RHZE in local markets throughout Côte d’Ivoire. Following a review of drug stocks and records maintained at the Nouvelle Pharmacie de la Santé Publique—responsible for stocking and distributing program medicines nationally, the OIG identified significant weaknesses in its stock management, inventory and billing systems. Based on the amounts involved and other evidence, these pills are a likely source of much of the RHZE for sale in the local markets.
The OIG also found that between January 2014 and June 2015, contrary to its own distribution rules, the Nouvelle Pharmacie delivered to PNLT close to nine percent, approximately 700,000 pills, of the total amount distributed in the country. PNLT is located next to a market in central Abidjan where some of the illicit sales were occurring.
As it did not recognize the missing stocks at the Nouvelle Pharmacie, PNLT continued to procure more pills than necessary for annual patient consumption to replace missing reserve stocks. Moreover, in 2015, PNLT raised its target of reserve stocks from 2.5 million to 4.5 million RHZE pills. Given PNLT’s and the Nouvelle Pharmacie’s inability to adequately control and account for their stocks of RHZE, the larger volume of reserve stocks of pills were at high risk of being diverted to the markets.
To help mitigate the public health risks of illicit drugs sold on the markets, Côte d’Ivoire is a pilot country for the OIG’s anti-corruption awareness campaign called ‘I Speak Out Now!’. The OIG and the Secretariat have agreed to tailor the OIG campaign to target and curb the demand for RHZE on markets by raising awareness amongst the general population of the dangers of consuming the drug without a prescription. Reusing the slogan, ‘Le médicament de la rue tue!’ (Drugs bought off the street are deadly!), to build on work already started by the Fondation Chirac, the former French President’s charitable foundation, the OIG is launching the community phase of the campaign in April through print, online media and radio announcements as well as mass distribution of flyers.
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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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