Office of the Inspector General

Message from the Interim Executive Director – Nigeria

16 February 2018

Nigeria is a mission-critical country in efforts to end epidemics. It has the largest malaria burden of any country in the world, with 30 percent of global malaria deaths. Nigeria is number two for HIV globally and seventh for TB burden. We cannot succeed in ending epidemics without delivering significant results in Nigeria. Yet Nigeria is also a complex and challenging operating environment.

Despite challenges, Nigeria has made progress against HIV, TB and malaria. Programs supported by the Global Fund have saved the lives of 1.7 million people in Nigeria, as of end 2016. Between 2000 and 2016, deaths from malaria dropped by 43 percent. Incidence of HIV declined by 37 percent from 2000 to 2016. With the support of the Global Fund, Nigeria passed the 1 million mark for people on ART in 2017. In addition, in 2017, the Global Fund financed the distribution of 14 million mosquito nets in six states over a five-month period, covering an estimated 28 million beneficiaries.

This follow-up audit report clearly demonstrates that the Global Fund together with its country partners have achieved rapid and significant progress since 2015, when a previous audit was conducted. The portfolio is now managed under a strengthened risk management and assurance framework and is on a better trajectory for enabling the country deliver improved programmatic results. The audit takes a sharp view of progress in the areas where deficiencies were previously identified and highlights some specific gaps and key areas requiring further improvement. The Secretariat is already taking responsive action that will further improve grant implementation.

Equally important, the Government of Nigeria has now fully repaid to the Global Fund all amounts deemed recoverable, as identified in the May 2016 OIG Audit and Investigation reports, which we hope will allow us to accelerate the positive trajectory in our partnership to end the epidemics in Nigeria.

I want to highlight some important improvements since the last audit:

  • We have significantly expanded the Secretariat’s country team for the Nigeria portfolio, and it has improved our ability to collaborate more proactively with health leaders and partners to resolve issues early and seize opportunities for delivering results.
  • The new HIV implementation arrangements are performing well, as this report notes. In response to challenges described with the malaria grants, the Secretariat and Principal Recipients have revised the implementation arrangements for 2018-2020, including the engagement of experienced sub-recipient organizations that enable the PRs to re-focus on management, oversight and coordination, with increased technical support for the national malaria program, and monitored through structured quarterly reviews of progress.
  • We now have significantly greater assurance that Global Fund financed medicines and other health products available to patients when and where they need. Part of this was through the establishment of 37 Logistics Coordination Management Units, one in each state, which focus on improving timeliness and accuracy of supply chain data. We also repositioned short-dated TB and malaria medicines and other health commodities, resulting in the use of life saving commodities that would otherwise been at risk of expiry.
  • We are working with key partners, and especially the Government of Nigeria, on the first national population-based AIDS impact and incidence survey (NPHIIA) in Nigeria. Preliminary results of the survey are expected by second quarter of 2019.
  • In addition to continuing our work with the State Government of Lagos, we are in dialogue with state governments in Oyo, Imo and Kaduna, with the aim of developing specific, measurable and time-bound ways in which we can support these high disease burden states build resilient and sustainable systems for health.
  • We have reinforced the roles of assurance providers to better manage financial management risks and the risk of fraud. The Secretariat has put in place formal collaboration protocols between the Fiscal Agent, Local Fund Agent and the External Auditors to ensure regular information sharing and a coordinated approach to risk management. In direct response to the latest OIG findings, the Secretariat is now actively working with assurance providers to further strengthen the performance management of the fiscal agent and quality assurance of the finance support provided to implementers.

The Global Fund Secretariat continues to invest significant time, resources and initiatives to ensure an effective and sustainable response to HIV, TB, and malaria in Nigeria. Not all of these yielded measurable results during the period covered by the follow-up audit, but they will represent important advances as we look forward to our medium-term goals.

In summary, I am pleased this report provides evidence of the significant progress made during the 16 months between the release of the 2016 Audit and the end of the current audit’s review period.

Marijke Wijnroks