Follow-Up Audit in Tanzania
21 March 2018
The Secretariat and stakeholders in Tanzania have made significant efforts to mitigate the risks that the OIG identified when it audited the country last in 2015. This includes improvements in supply chain management leading to fewer medicine stock-outs, and stronger grant implementation arrangements. Nevertheless, the auditors found expired HIV drugs worth approximately US$9 million; significant proportions of people living with HIV lost to follow up within one year of starting treatment; and gaps in governance and oversight.
Tanzania has made major progress against the three diseases. The malaria mortality rate went down by 76% between 2004 and 2016. Since 2015, antiretroviral treatment coverage has increased from 47% to 63% of people living with HIV, while tuberculosis treatment success rates have reached 90%.
The OIG auditors found that overall procurement and distribution arrangements have improved since 2015. Commodities are now directly delivered from the warehouses of the central Medical Stores Department, the central agency responsible for procurement and distribution of drugs in Tanzania, to health facilities. For example, in 2017, almost 90% of orders for malaria commodities were delivered directly to health facilities when, in the past, they were only delivered to the regional and district levels. As a result, stock-outs and expiries of malaria drugs at the health facilities have been low.
However, health commodity management by the national disease programs remains a challenge. Although the US$9 million worth of expired HIV antiretroviral drugs represent only 4% of Global Fund-financed HIV drug procurements during the same period (January 2016 and September 2017), the absolute values are high. The auditors also found material discrepancies, worth more than US$1.2 million, between the malaria drugs consumed as reported in supply chain records and those based on patient treatment data.
The OIG found that oversight and governance mechanisms are partially effective and need further improvements. Despite multiple layers of oversight, gaps still exist in grant implementation. There are also delays in key portfolio decisions, low in-country absorption, and continued heavy reliance on donor financing. Existing governance mechanisms have not been able to effectively tackle these broad portfolio-level issues due in large part to an unclear definition of roles, responsibilities and accountability for various decisions, the lack of structured mechanisms for following up on corrective actions, and delays in submitting information needed for oversight and monitoring.
The Secretariat is taking measures to address the above issues including working with the government ministries and Principal Recipients to map out grant implementation structures, roles and accountabilities in the country; identify and address critical human resource gaps while also seeking long-term, sustainable solutions.