Office of the Inspector General

Global Fund Grants in the Republic of Niger

28 March 2023

According to the United Nations Development Program, Niger is ranked among the top three lowest human development scorers in the world. The Global Fund has classified Niger as a Challenging Operating Environment (COE) since 2016 because of its volatile political and security situation. Malaria is endemic and its burden is among the highest 11 in the world while tuberculosis (TB) and HIV have a high burden. In addition to the three diseases, acute malnutrition is a major threat to children in Niger. Despite this challenging context and the recent impact of COVID-19, Niger has made good progress in the fight against the three diseases. In particular, the incidence and mortality rate of malaria and tuberculosis reduced significantly between 2012 and 2021.

The malaria interventions cost, accounting for 59% of the overall New Funding Model Three (NFM3) investment, shows good performance regarding case management, vector control and drug preventive therapy for targeted children, even if assigned targets are not fully met. Of the confirmed malaria cases between 2021 and 2022, 85% were treated according to national malaria treatment guidelines. Other key interventions such as drug preventive therapy for pregnant women still need to be improved. Investigations into the rising number of malaria cases and deaths since 2017 were completed in December 2022. Most planned grant activities for HIV, TB and COVID-19 were only partially or not implemented during the period under review. In response, greater accountability for implementers is needed alongside strengthening of the grant management unit (UGS) within the Ministry of Health. The OIG noted limited progress in improving the quality of HIV services and data reporting since the last audit in 2018. While mitigation measures were identified, implementation has been slow. Implementation arrangements at the Ministry of Health, as well as the design and implementation of key program interventions need significant improvement.

Most key health products were available at central and peripheral levels in 2021 and 2022 thanks to improved quantification processes, timely execution of the procurement plan and increased distribution capacity of the central medical store. The level of expiries remains disproportionately higher for HIV commodities compared to the cost of actual ARV needs. Despite investments to improve storage conditions, drug quality could still be compromised because of sub-optimal storage conditions in the main warehouses. Furthermore, inventory management processes are inadequate to ensure visibility on drugs throughout the supply chain. Design and implementation of measures to ensure availability of quality-assured health commodities, efficiency, and accountability across the supply chain is partially effective.

Internal controls and assurance mechanisms for Principal Recipients have proved effective in preventing and detecting non-compliant transactions. However, financial absorption by the government Principal Recipient remains low (29%) after 18 months of implementation due to various factors including slow disbursement to implementers, insufficient planning and coordination capacity of the UGS and the long turnaround time for expenditure validation. The Country Team did not leverage enough the financial flexibilities to maximize the use of Global Fund grants. Implementers’ financial management system and the assurance mechanism to mitigate financial and fiduciary risks is partially effective.