Audit of Grants in Mali
20 November 2017
An OIG audit found that financial management of Global Fund grants in Mali is generally functioning effectively. Despite being one of the poorest and most fragile countries in the world, Mali has made significant progress in reducing its AIDS, tuberculosis and malaria disease burdens. However, improvements are still needed in the supply chain as well as in the accuracy of program data and patient service quality.
Total Global Fund investments of over US$314 million since 2003 have helped reduce malaria deaths from 20 per 100,000 in 2010 to less than 10 per 100,000 in 2015; distribute approximately 10.5 million mosquito nets between 2013 and 2015; and increase antiretroviral treatment of people living with HIV from 40% in 2014 to 58% in 2016.
In 2010, following the discovery of extensive financial irregularities, the Secretariat made substantial changes to grant implementation arrangements including replacing the Principal Recipients and instituting a zero cash policy at the sub-recipient levels. These measures have significantly reduced the financial risks and irregularities in the programs.
The OIG found that the Mali supply chain has improved. The country has put in place inventory, logistics and health information systems which have led to better quality information from health facilities, compliance with treatment as well as fewer drug expiries.
However, stock-outs, distribution delays and data inaccuracies continue to exist which can lead to emergency orders and testing/treatment disruptions. Country stakeholders need to coordinate more systematically to quantify product needs for the HIV and malaria programs. A lack of coordination, for example, resulted in an emergency order of antiretroviral medication in 2017. The country also needs to use aggregated national stock data for malaria and HIV commodities to pre-empt stock-outs.
Although the quality of program data and patient services has also progressed, there are still weaknesses. The auditors noted material data inconsistencies throughout the reporting chain; non-adherence to treatment guidelines; and delays or gaps in testing or treatment. The testing and treatment gaps in the disease programs include some cases of malaria treatment without proper testing, HIV treatment without CD4 or viral load testing, or failure to provide treatment because testing could not be carried out.
To address the above issues, the Secretariat will work with the national programs and development partners to continue automating inventory management and data migration as well as implementing better tools to strengthen data quality, among other corrective measures.
- Global Fund Grants in the Republic of Mali (GF-OIG-17-023 - 20 November 2017)
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For more information:
Thomas Fitzsimons
Email:
Mobile: + 41 (0)79 412 1461
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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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