21 September 2016
In this audit of the Global Fund's third most important portfolio, representing over a billion dollars of funding, the OIG found that controls over procurement and supply chain management were ineffective, and that financial controls, access to care and program data needed significant improvements. Nonetheless, recent data show an encouraging upward trend in the fight against AIDS, tuberculosis and malaria.
Implementing health in DRC is a serious challenge. The country has come out of two decades of intermittent civil war which severely degraded infrastructure and produced significant political instability. Despite this, the Global Fund and its partners have made progress. From 2000 to 2014, the tuberculosis (TB) death rate was reduced by 14%, and HIV co-infection has steadily decreased from 60 to 45 cases per 100,000 inhabitants. The number of households possessing at least one mosquito net rose from 9% in 2007 to 70% in 2014.
In a portfolio which has as its main objective to make sure drugs reach patients, the supply chain controls were found to be ineffective. The OIG can provide reasonable assurance on drug accountability up to the health zone level with 97% of drugs sampled traced from regional warehouses to health zones. However, 31% of drugs sampled could not be traced from health zone to local health facility level. Moreover, in the absence of effective supervision, adequate oversight over the consumption of drugs, and last mile delivery, stock-outs were pervasive along the supply chain.
Although the HIV program has substantially increased the number of people on antiretroviral treatment, the current 32% coverage rate remains low compared to other countries in the region. Moreover 30% of people on antiretroviral treatment are lost to follow up and viral load monitoring is only performed for 25% of people on antiretroviral treatment. In addition, in spite of recent efforts to improve HIV-TB collaboration, there are multiple signs of weaknesses in program quality. For example, 65% of facilities audited did not provide treatment to prevent people on antiretroviral treatment from getting tuberculosis.
In its efforts to achieve impact in such a challenging country, the Global Fund Secretariat finances more than 700 staff positions across the country at a cost of about US$64 million, or 12% of the 2015-2017 grant budgets under review. There has been no detailed analysis by the Global Fund Secretariat on staff distribution across implementers to ensure that these resources are used effectively. The OIG also found significant variations across different implementers for mosquito net unit price, drug transportation and storage cost and in-country allowances.
Regarding programmatic data, the auditors found multiple gaps in the controls over the collection and transmission of strategic data. This leads to the Global Fund reporting inaccurate data on its performance in a mission critical portfolio, affecting the decision-making process. The OIG also noted that certain recent changes to enhance financial management have not yet produced the results the Global Fund is aiming for, particularly regarding the Ministry of Health's program management unit which oversees the implementation of 9% of the portfolio.
The Global Fund is putting in place several corrective measures considering the size of the portfolio including pilot initiatives to strengthen supply chain arrangements, a supervision plan with its country partners across the three diseases, and assessing the reasonableness of Principal Recipient costs.
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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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