26 July 2016
The Office of the Inspector General (OIG) found supply chain controls and assurance mechanisms were ineffective after an audit of grants to Cameroon. The auditors found that health products were stored in poor conditions leading to risks of spoilage or theft. The Global Fund, in co-operation with technical partners and the Ministry of Public Health, is currently examining long-term systematic improvements of the supply chain.
The OIG found that storage space was inadequate and temperatures were too high in CENAME, the country's central medical store, as well as in four of the five regional medical stores. Despite a number of internal reviews to improve and strengthen inventory management, the records systems and associated controls remain ineffective in CENAME, leading to the loss or theft of health products. For example, products worth US$261,602 could not be located during or after the audit. This amount constitutes non-compliant expenditure and is proposed for recovery by the OIG.
Cameroon's malaria and tuberculosis control programs have implemented tools to monitor stock availability of health products at the national and regional levels. However, none of the three disease programs regularly monitor stock levels, which can lead to stock-outs or overstocking. For example, out of the five regional stores visited by the OIG, four had material stock-outs of HIV or malaria drugs lasting between a few days and two months, during which deliveries could not be made to health districts and facilities. Six health facilities had major stock-outs of malaria drugs lasting between several weeks and six months, resulting in treatment interruptions to patients.
None of the disease programs monitor consumption patterns. Malaria product consumption data in 2015 showed discrepancies with patient numbers. A drug to treat severe malaria and a simple malaria drug were consumed at respectively 70% higher and double the rates expected for the number of patients served.
In contrast, the auditors found that the Global Fund Secretariat has significantly mitigated procurement risks in the Cameroon portfolio through the use of centralized agents and quarterly reports, which should simplify product tracking. As a result, the OIG rated procurement controls and assurance mechanisms as "partially effective". However, the principal recipients do not have controls in place to check deliveries against payments. Due to the large number of deliveries, their complexity and significant value (worth US$45.2 million in 2015) there is a risk of unjustified payments being made to procurement agents or health products being lost.
Cameroon is one of the Global Fund's core countries, currently with the 15th largest funding allocation worldwide (US$288 million from 2014-2017). It is also one of the 20 countries that are part of the Global Fund's "Implementation through Partnership" project, an initiative launched in late 2015 to assist countries who have difficulties in absorbing funds for greater impact. The Government of Cameroon has also continuously increased its contributions to fight the three diseases. There are currently 160,000 people on antiretroviral therapy, 111,000 tuberculosis cases have been detected and treated and 10,500,000 insecticide-treated nets have been distributed.
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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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