10 March 2017
An Office of the Inspector General (OIG) audit found that the country has made significant progress in its fight against AIDS, TB and malaria. However, significant grant implementation weaknesses prevent Global Fund financed programs from having more impact. The OIG also concluded that controls and assurance mechanisms within the supply chain need major improvements. The Secretariat, with in-country partners, is putting in place corrective actions including strengthening oversight, coordination and accountability of Global Fund grants.
As of September 2016, the Global Fund had disbursed US$664 million to Mozambique with the following results: AIDS mortality has decreased by 9%; the number of people on antiretroviral treatment has risen from 646,312 in 2013 to 922,054 in 2016; malaria-related deaths dropped by 74% and TB-related deaths by 25% between 2000 and 2014. However, human resources for health are severely constrained with only 1.74 health workers per 1,000 people compared to a minimum of 2.5 per 1,000 as recommended by the World Health Organization (WHO). Furthermore, Mozambique's health infrastructure has also been devastated by decades of war.
The auditors found that increases in patient coverage are not always followed by commensurate and consistent quality of diagnosis and treatment. Many of the service providers who diagnose patients failed quality control testing. For example, 17% of HIV tests at community level are not in line with WHO standards. This means that there is the risk that HIV positive people may not get treatment and HIV negative people may be put on treatment unnecessarily. Mozambique continues to have low retention rates of patients on HIV treatment and multi-drug resistant TB treatments. Currently, only 66% of HIV patients remain on antiretroviral treatment 12 months after initiation.
In terms of oversight, the Country Coordinating Mechanism does not effectively oversee implementation of the grants. Furthermore, infrequent and inconsistent coordination of ten implementing agencies within the Ministry of Health has resulted in delays or duplication of activities. The Project Management Unit responsible for the coordination of the Global Fund grant at the Ministry of Health lacks resources to ensure the effective implementation of the grants. As a result, only 25% of funds disbursed to the Ministry of Health have been used.
Approximately 84% of Global Fund grants to Mozambique are spent on the procurement of medicines and health products through the Secretariat's central pooled procurement mechanism. This not only reduces the risk of disbursing grants directly to the country, it also ensures the country receives the necessary products. However, the OIG found gaps and inefficiencies in storage, distribution and logistics systems managed by the Central de Medicamentos e Artigos Médicos, the department of the Ministry of Health responsible for storage and distribution. For example, all the warehouses visited were overfilled with products and could not adequately monitor and control storage temperatures. The auditors also found stock-outs of varying magnitudes at all levels, with the situation worsening at the lower level of health facilities. Accountability and ownership of the supply chain network are split across the administrative levels of the country resulting in a lack of overall oversight of the supply chain network.
The Secretariat is working with the Ministry of Health to put in place a series of improvements including a study to track people who are lost to follow-up for HIV treatment; a plan for decentralized and integrated supervision for the three diseases; and restructuring the Ministry of Health's Project Management Unit.
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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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