Follow-up Audit of Global Fund Grants to the Republic of Sierra Leone
27 March 2023
The Global Fund’s audit of Sierra Leone in 2018 highlighted the “implementation and assurance arrangements” and “in-country supply chain mechanism” as areas that needed significant improvement. Subsequently in April 2020, the OIG published an investigation report on fraudulent procurement payments and overcharging in Global Fund grants. In December 2022, the OIG published an investigation report on fraudulent and collusive procurements surrounding a training course. The Global Fund Secretariat allocated US$255 million in grants and put significant effort to address the agreed management actions from these audits during allocation 2017-2022.
Several mechanisms were introduced in NFM3 (2020-2022) to strengthen fund accountability and mitigate fraud risks. However, the capacity of the Project Management Unit (PMU) to monitor grant implementation remains limited. The Fiscal Agent role has been strengthened, but expertise gaps were noted for procurement and fraud risk management. The Secretariat’s actions in 2022 to address PMU staffing gaps include the approval of additional finance experts and salary adjustments. However, in an inherently risky environment, constant attention is needed to strengthen fiduciary controls and to mitigate the risk of opportunistic fraud. Therefore, the effectiveness of the PMU in implementing Global Fund grants and managing emerging risks and the role of the Fiscal Agent in mitigating fraud risks need significant improvement.
While the 2018 OIG audit rated “the program management and monitoring processes” as partially effective, the audit also highlighted the need for Principal Recipients to analyze the community health worker (CHW) program and to develop a plan to improve access to services for the three diseases. The follow-up audit observed significant achievements in Sierra Leone’s efforts to implement integrated CHW interventions, including establishing and implementing a CHW strategy and completing 50% of intended training activities. The OIG noted challenges during the roll-out of CHW training that resulted in delayed implementation. The absence of a transition plan also disrupted CHW services. Therefore, the design and effectiveness of key program interventions, with a particular focus on CHW, are partially effective.
Supply chain information systems have improved in Sierra Leone through the “m-supply” system and District Health Information System 2 (DHIS2). The supply chain, however, still could not ensure the availability of drugs to patients and effective use of Global Fund funded commodities. Frequent stock-outs were noted at all levels, as well as significant quantities of expired commodities. Therefore, the design and effectiveness of in-country supply chain arrangements to ensure continuous availability of commodities and accountability at all levels need significant improvement.