06 September 2017
An OIG audit concluded that significant improvements have been made in the financial management of Global Fund grants in Cambodia since a 2013 OIG investigation found misappropriation of funds. The subsequent safeguards put in place have improved financial controls and therefore greatly mitigated the risk of fraud. On the other hand, slow implementation of the safeguards has delayed critical malaria activities that could affect grant objectives. The auditors also noted opportunities to improve grant implementation arrangements by, for example, reducing duplicate support and supervision functions.
Cambodia is a key portfolio for the Global Fund in its mission to end the epidemics of AIDS, tuberculosis and malaria. Investments by the government itself, partners, and the Global Fund, are yielding positive results. For example, the country has made significant progress in eliminating mother-to-child HIV transmission; the tuberculosis success rate is above 90%; and 23 out of 25 districts have reached a malaria pre-elimination status.
In response to the 2013 investigation, the Global Fund implemented a series of fiduciary measures including the appointment of a Fiscal Agent for government implementers and the introduction of pre-approved travel plans to control per diems. These additional safeguards have significantly protected Global Fund investments in the country. However, slow implementation of the measures has also delayed critical malaria activities. For example, village malaria workers have not been able to provide vital community services since June 2015. This led to a decline in diagnosis and treatment of confirmed malaria cases reported by village malaria workers from 53% in 2014 to less than 9% at the end of 2016.
The OIG also noted a 14-month delay in the roll-out of new treatment regimen to fight malaria drug resistance. As the epicenter of artemisinin drug resistance, Cambodia is expected to change malaria regimen often to manage resistance to first line anti-malarial medicine.
In light of a future reduction of 30% of Global Fund investments in 2018-2020, a specific health system-strengthening grant of US$12.1 million was approved for implementation in 2015-2017. However, there have also been significant set-up delays with only 25% of the funds spent at the end of 2016.
To sustain the significant progress in the fight against the three diseases, the OIG identified a number of opportunities to improve implementation arrangements. For example, duplicative functions between four Ministry of Health implementers result in cost inefficiencies. Each implementer has parallel functions for finance, procurement, data gathering and reporting totaling 72 personnel with a budget of US$3.57 million.
The OIG also noted areas in programmatic and supply chain data that could improved. For example, key population interventions are being implemented based on mapping and size estimates that are five years old, when the World Health Organization recommends biannual estimations. Similarly, the inventory management database used by the disease programs in stores and hospitals to account for health commodities is fragmented and built on old technology.
The Global Fund Secretariat has plans to address the above challenges including the following actions: updating the risk and assurance plan for the Cambodia grants to minimize implementation delays, improve efficiency and develop capacity of implementers; and developing data quality assurance plan(s) for the three disease components supported by Global Fund grants.
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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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