HIV & AIDS
Tuberculosis
Malaria
Audit of Grants in Burkina Faso
22 November 2017
OIG auditors found that Global Fund grant arrangements in Burkina Faso are well-structured and supported by a well-designed system of community health organizations. This has contributed to reducing significantly the AIDS, tuberculosis and malaria burden in the country. However, although the main grant recipient has functioning governance and control processes in place, it needs to improve its transparency, oversight capacity, program and financial management.
Burkina Faso, with a population of just over 18 million, has the eighth highest malaria disease burden in the world. Since the Global Fund started investing in the country in 2003, the malaria mortality rate has more than halved and the HIV prevalence rate has also decreased significantly.
The OIG found financial risk mitigation processes established by the Global Fund Secretariat are mainly effective. Following an OIG investigation in 2015, the Secretariat put in place measures such as a Fiduciary Agent, a restricted cash policy and strong controls for both health and non-health high value procurements. These measures have contributed to ensuring that program funds are used according to grant objectives.
The Programme d'Appui au Développement Sanitaire du Burkina Faso (PADS), a project management unit established by the Ministry of Health, is one of three Global Fund Principal Recipients. It manages three out of five grants and almost 70% of total Global Fund grant funds. As a result, the effectiveness of PADS has a significant impact on the overall quality of program implementation. The OIG noted some gaps in PADS grant arrangements including:
- The Monitoring and Evaluation team of three is also responsible for program management in the absence of a dedicated unit. Most of the team’s time is taken up reporting to donors rather than monitoring progress on grant objectives.
- PADS does not have adequate project management capacity. No sub-recipient has been selected to implement a health systems strengthening grant financed by the Global Fund. This has contributed to the underperformance of this grant.
- An ineffective treasury system has also resulted in delays in implementing grant activities. The audit found weak controls over regional expenditures, which represent 42% of total in-country expenditures. Nor does PADS have an adequate fraud identification, mitigation and reporting mechanism.
- PADS could be more transparent towards donors regarding governance mechanisms and budgeting. For example, there is no cost sharing mechanism across donors to minimize the risk of double billing of salaries and expenses.
The involvement of community health organizations and health workers is key to achieving grant objectives in Burkina Faso. The government contributes 75% of health worker salaries, thus ensuring sustainability for the system. However, the OIG found there were significant delays in recruiting the organizations. As a result, the country is still struggling with low rates in retaining people on antiretroviral therapy, HIV testing for infants and detecting tuberculosis cases.
The Secretariat has a comprehensive capacity building plan for PADS to address the weaknesses noted by the audit. The plan will include program management; monitoring and evaluation; financial management; budgeting and governance mechanisms.
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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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