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Corruption &Drug Quality &Funding Bill Brieger | 31 Jan 2013

Fakes and Fraud: another threat to malaria funds

While some countries are being praised this week for their progress in controlling malaria, Uganda seems to be suffering from a double knock out punch when it comes to malaria financing. Challenges have appeared in both the private and public sectors.

In the most recent scorecard from the African Leaders Malaria Alliance (ALMA) scored poorly in terms of long lasting insecticide treated net distribution and low on the measure of government financial support for the health sector.

herbshop2a-sm.jpgThe private sector challenge has come in the form of fake medicines in local shops. This comes in the form of a threat to individuals and families who spend their hard earned cash, that is out-of-pocket expenditure (OOP) of malaria medicines that at best inappropriate and at worse are devoid of active ingredients, increasing the likelihood that the sick person will develop severe disease and maybe die.

Specifically the Washington Post reported that an indigenous medical practitioner “in Kampala, says he has seen a big increase in business as patients turned off by the prospect of dangerous fake drugs seek relief from illness.” The article explains that although “Officials and international aid agencies have long encouraged the sick to place their trust in modern medicine. But fake pharmaceuticals believed to have come from Asia have flooded” African Markets including Uganda.

The irony is that Uganda is part of the testing of the Affordable Medicines Facility malaria (AMFm) project that was supposed to drive out fake and inappropriate medicines by making low cost (subsidized) quality antimalarials available in both public and private sectors. While Uganda witnessed an increase in market share of the green-leaf branded quality assured artemisinin-based combination therapy drugs, it did not achieve other benchmarks such as supportive behavior change communication and low cost targets (mark-up averaged 133% – highest among the 8 pilots).

The second threat comes from extensive embezzlement by national malaria program staff.  Earlier this month Uganda was in the news for returning 4 million Euro of misappropriated funds to the Irish Government.

Then an ongoing investigation into embezzlement came to light a few days ago. The Observer Newspaper as shared on reported that …

“An investigation into the financial practices of officials running the ministry of Health’s Malaria Control programme (MCP) shows they forged almost everything from workshops, car hires, allowances and fuel expenses. The investigation has now shifted its focus to the extent of the forgery and theft by officials implicated in the loss of nearly Shs 78bn (US $29m). The shift in the focus of the inquiry follows a review of stacks of documents provided by three suspects involved in the MCP scandal. Police confirm that the documents show the extent of the forgery by some officials involved in the anti-malaria campaign.”

In these times when it is difficult to increase health development spending for malaria both domestically and from international donors, all efforts are needed to ensure that waste and fraud are eliminated.

Corruption &Funding Bill Brieger | 30 Nov 2012

Global Fund Observer on Uganda Malaria Funds

Issue 204 of the Global Fund Observer explains efforts to clarify funding challenges with the Ugandan malaria grant from the Global Fund. Their posting is shared below to increase access to this information. The financial problems have extended over several years, and GFO provides links to its previous articles on the problem, of which putting money into personal bank accounts was just one example.

gfo-logo.jpgNEWS: Uganda and the Global Fund to strengthen control and financial oversight of anti-malaria programmes: Global Fund insists on refund of ineligible expenses: PR told to stop transfers of malaria programme funds to personal bank accounts

The Global Fund and Uganda’s Ministry of Health are implementing a plan to safeguard Fund disbursements in the country following concerns over possible mismanagement of a $51 million grant to support antimalarial bednet distribution. The principal recipient (PR) for the grant was the Ministry of Finance, but the implementing entity was the Ministry of Health (MOH).

The Fund said in a statement that options to strengthen financial oversight and management to mitigate the risk of fraud are also being discussed.

The statement follows a review by the local fund agent, PriceWaterhouseCoopers Limited Uganda, which was commissioned by the Global Fund. The purpose of the review was to assess part of anti-malaria support programmes which involved the procurement and distribution of over seven million insecticide-treated nets to pregnant women and mothers with young children. As a result of the findings from this review, the Global Fund asked the LFA to expand its review even further.

Meanwhile, Uganda’s MOH carried out an internal audit to verify expenditures and address the internal control weaknesses.

The Fund said in the statement that it instructed the PR to discontinue transfers to individual personal bank accounts of funds intended for programme implementation. The Fund has also warned Uganda that it will seek a refund of all improper payments related to the $51 million grant for supply of anti-malarial bednets, and will insist on appropriate disciplinary action against anyone found to be involved.

Global Fund programmes in Uganda currently provide ARV treatment for 291,000 people and have distributed 7.7 million insecticide treated nets. According to the country’s Malaria Control Strategic Plan, malaria kills between 70,000 and 100,000 people in Uganda annually.

A detailed account of the genesis of the problems facing Global Fund grants in Uganda can be found in GFO issues 90, 103, 113 and 125. [This article was first posted on GFO Live on 21 November 2012.] To comment on this article at the GFO website, click here.

Corruption &Health Systems Bill Brieger | 18 May 2012

Will Economic Woes Prevent Countries from Sustaining Malaria Programs

Over the past few years everyone has been worried about the willingness and ability for donor nations to provide continued support for malaria control efforts – either multilaterally through Global Fund contributions, or bilaterally.  Recent changes at the Global Fund itself reinforced these financial fears.  What may have been overlooked is the financial health of recipient countries themselves.

slide6_0-public-sector-financing-of-health.gifDonor support for malaria control provides major assistance for commodities, but usually is not expected to support the running of the basic health system from which those commodities are delivered to people in need of prevention or treatment services.  Recent news from two malaria endemic countries in southern Africa call into question the basic ability of governments to provide basic human and material health infrastructure.

The BBC reports that, “Britain is calling for urgent action to prevent a Greece-style financial crisis in Malawi, one of the world’s poorest countries, where recent political turmoil, a suspension of foreign aid, and an abrupt currency devaluation have conspired to leave the new government with a gaping hole in its budget.”

The new president believes that there is less need to worry because of existing pledges for cash that suspended last year because of the increasingly autocratic behavior of her predecessor.  But it is often easier to turn off the financial tap than turn it back on.  Donors become wary and wait and see.

Likewise the behavior of political elites is causing concern in Swaziland. According to IRIN the International Monetary Fund is withdrawing support from the country where government spending currently exceeds its revenue. While there has been a revenue from the Southern African Customs Union since 2008, a more proximate cause of financial woes is “The spending habits of King Mswati III – sub-Saharan Africa’s last absolute monarch – and the royal household are routinely splashed across newspapers, from the overseas shopping trips of his 13 wives to a “birthday present” for the king this year of a multimillion-dollar private jet.”

IRIN notes that “About two-thirds of Swaziland’s 1.1 million population live in chronic poverty in a food insecure country that also has the world’s highest HIV/AIDS prevalence, with one in four people aged 15-49 infected.” This is not an environment where malaria can be eliminated, as is the goal of the South African Development Community.

Controlling and eliminating malaria in the context of a strong health system requires political will.  Some countries are making great strides. Maybe the African Leaders Malaria Alliance can be a forum for applying peer pressure for ‘good political behavior’.

Corruption &Funding Bill Brieger | 28 Jun 2011

Global Fund’s OIC Grabs Nigeria

The Daily Trust Newspaper today has a shocking front page headline: ‘N7bn malaria, HIV funds frittered’ (that’s Naira). This is equivalent to US $475 million. No principal recipient (PR) appears to be left unscathed. Specifically the article leads with the assertion that …

About N7 billion donor funds sent to Nigeria for the fight against malaria, HIV and tuberculosis were frittered away, according to an audit report by the international agency that provided the funds. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) said in a report filed with the Independent Corrupt Practices Commission that beneficiary agencies failed to account for up to $475 million meant to “save lives”.

The story is based on a report from the Global Fund’s Office of the Inspector General (OIG) who discovered “the fraud in a recent audit of 15 grants amounting to $474,519,260 disbursed between 2003 and 2009 for the purpose of saving lives in the country.” Nigeria has had three GFATM malaria grants over this period.

As is usual though the OIG paints both ‘minor’ accounting problems as well as gross misconduct with the same brush. The most egregious offender appears to be the Yakubu Gowon Centre (YGC). YGC has been a malaria PR since Nigeria received its first GFATM grant and almost lost that grant due to poor performance about five years ago.

Currently YGC is one of three GFATM Round 8 malaria grant PRs.  In terms of the most current performance ratings, The Society for Family Health was rated B1, The National Malaria Control Program was rated B2, while the YGC received a ‘C’ – the lowest or a failing grade by Global Fund accounting.

The Daily Trust quotes the OIG report The report thus: “The value for money audit report indicates that the Yakubu Gowon Centre for International Cooperation illegally transferred funds outside the country amounting to $15.5million, incurred extra budgetary expenditures of $5.2m, and had undocumented expenditures amounting to $3m. The unretired expenditures of the centre for the period under review amounted to $1.2m, while the management fee not accounted for was $659,000.”

ygc-performance-report-sm.jpgThe GFATM progress report says of the YGC performance on the Round 8 malaria grant that the average programmatic performance is 34.7% among all the program targets.  In fact some states served by the YGC are reporting stock out of malaria drugs much needed for saving lives.

It is certainly good that the IOG identified major misconduct that threatens progress to control malaria. The question is who will pick up the slack in malaria commodity supplies while all this is being sorted out?

Corruption &Funding Bill Brieger | 29 Jan 2011

10 years and $27 billion for a new business model

The Global Fund to fight AIDS, TB and Malaria (GFATM) represents a different business model in international health and development aid. Unlike traditional aid agencies, the GFATM does not maintain a direct in-country presence of technical and administrative staff who work directly with counterpart local agencies to develop plans for funding.  The GFATM’s business model basically raises funds and turns these over to local recipients (government ministries, national NGOs, international partners etc.) who have submitted technically and financially feasible proposals during annual funding rounds.

These local recipients set their own targets and basically are given enough rope to succeed or to hang themselves.  The latter appears to have garnered the attention of the international media after several grants have been suspended and words of caution have been directed at others who not only have not achieved their self-set targets but appear to have misappropriated, misused or otherwise ‘lost’ some of their funds. One recent account shows that such loss may be in theft of product, not just straight-forward embezzlement of funds.

Local recipients receive some oversite in terms of both expenditure and achievement of program targets. In theory the local recipients – both Principle Recipients (PRs) who are money managers and Sub-Recipients (SRs) who are program implementers – are screened and approved by a national Country Coordinating Mechanism (CCM). The set of projects in a country are also overseen by a Funds Manager based in Geneva who reviews reports and makes occasional site visits.

There are quarterly progress reports submitted through CCMs to independently contracted Local Fund Agents (LFAs), who in the past were more of accounting firms, but apparently now can also ‘audit’ technical aspects, and ultimately to GFATM itself. After two years (or functionally 18 months) each project is reviewed both finacially and technically and given a ‘Go’, ‘Conditional Go’ or a ‘No Go’ to enter ‘Phase 2.   This exemplifies another basic tenet of of the business model, performance based funding.

The GFATM is a consciously evolving organization and has conducted and contracted various evaluations in order to make decisions about program and organizational directions. Such have included the specific, a CCM assessment that identified the need to ensure these bodies were independent of government (or any other group) as well the general, a series of 5-year evaluations. As a result the GFATM has reconsidered funding processes and is evolving toward more alignment with national disease control strategic plans and less on focused annual funding rounds.

Another example of GFATM decision making based on evidence was the change in PR requirements for proposals. After an evaluation showed that NGO PRs performed generally better than government of international agency PRs, and also after it was found that NGOs better represent the interests of the recipient communities (e.g. people living with AIDS), the GFATM Board decided that all grant proposals should have at least one NGO PR.

In short, the GFATM has shown an ability to learn by actively seeking knowledge of its operations and make changes and monitor those.  Of course the recent reports from the Office of the Inspector General show that this is not an easy process to manage from afar given such a large portfolio.

The calls by some for the US Congress to do its own study of the stituation will hopefully not result in throwing the babies sick and dying from AIDS, TB and malaria, out with the bathwater. The GFATM has shown itself willing and able to change without such dire threats. We can still question whether the Global Fund would change its basic business model and become more than a funding agency.

Other aid partners are often left holding the bill for technical assistance to address needs and gaps in country programs. In theory country recipients can use their GFATM funds to pay for TA, but most prefer to go the guaranteed route of buying the commodities (that have gotten some in trouble). Agencies like WHO, USAID, DfID, Unicef, and the Clinton Foundation, to name a few, have always been willing in the end to cough up their own funds to support the TA that is not paid by the GFATM. This creates an uncomfortable marriage among aid agencies.

So maybe the Global Fund will preserve its business model, but if the Fund cannot or will not have a more active presence on the ground, maybe it should pay its aid partners to do this work, for which they have generously been using their own funds in desparation.

Corruption &Learning/Training Bill Brieger | 26 Dec 2010

Global Fund – timely oversight or trigger happy

In the past year the Global Fund to fight AIDS, TB and Malaria (GFATM) has suspended grants in Mauritania, The Philippines, Zambia, and Mali. In fact one grant to Mali was terminated. Efforts to identify high risk grants are underway.
Some are saying that the Office of the Inspector General (OIG) of GFATM is finally showing some teeth, while others worry that actions to suspend and terminate will harm the very persons that the Global Fund was set up to help. At the recent 22nd GFATM Board Meeting the Executive Director provided the following comments based on OIG work:

  • Based on recent OIG findings in a number of countries, activities involving cash transfers for training events and associated costs, including per diems, travel, meal and expense payments, are in many cases posing a high risk of misuse
  • The OIG has identified five countries where measures to protect Global Fund-financed drug shipments from theft need to be implemented
  • The Secretariat and OIG agree that LFAs have not been sufficiently focused on the identification of fraud risks and actual fraud in Global Fund-financed programs, and may not currently have the capacity to address these risks

Prior to the recent Board meeting, one wonders whether the communication between the Secretariat, the Executive Director and the Office of the Inspector General were clear and efficient. A 6th December 2010 memo entitled “Joint communication on Inspector General matters” mentioned that, “The Inspector General and the Executive Director of the Global Fund have initiated sincere effort towards collaboration to follow up on recent findings by the Inspector General as well as to take steps to permanently strengthen grant oversight.”

The memo concluded that, “The Global Fund, by nature of its mandate, sometimes has to work with entities with weak programmatic and financial capacity, and to operate in environments where there may be a paucity of financial controls and lack of oversight systems. The Global Fund’s risk management systems are constantly improving. Recently discovered fraud has made the Secretariat determined to redouble its efforts to improve these systems.”

In some cases of suspended grants the Global Fund is looking for alternative Principal Recipients to manage the funds or find alternatives to ensure services to those in need do not cease to be served.  The concern about the Local Fund Agents is valid since the Global Fund, unlike other international agencies, does not have country offices or provide technical assistance.

Several years ago I worked with a team in Nigeria to design and deliver adolescent and youth peer education on reproductive health through community based organizations (CBOs). The initial effort focused on how to organize and train peer educators and the technical aspects of reproductive health. Eventually it became obvious when one CBO leader was using her personal bank account to keep project funds that the local CBOs needed as much technical assistance in establishing and maintaining proper financial and accounting procedures as they did in organizing peer based reproductive health education.

The Global Fund operates in a scale thousands of times larger that our small peer education projects, but the basic principle remains. Don’t condemn local organizations for poor financial performance if you did not try to help them develop better financial and accountability procedures in the first place.

Currently 22% of grants are considered to be poor performers. Too much is at stake in reaching 2015 and beyond to simply say to poor performers, “sorry, your funds are suspended.”

Corruption Bill Brieger | 11 Dec 2010

Bribery and Health Care

Transparency International’s latest poll on corruption across the world was reported by the BBC with the concern that people perceive their countries as more corrupt over time. One of the key institutions responsible for demanding bribes is the police.

BBC’s own poll on the topic found people talking about bribery as a problem more often that poverty, unemployment and other national problems. Although health care was not featured when the issue of to whom bribes were paid was raised, public institutions generally came under scrutiny.

A 2006 press release by Transparency International addressed health care bribes directly. Concerns ranged from direct loss of life when people were denied services to the problem of corruption that allows counterfiet drugs into a country, thus jeopardizing more lives.

Specifically Transparency International stated that, “Corruption is undermining progress towards the United Nations’ Millennium Development Goals, in particular the three related directly to health: reduced child mortality; improved maternal health; and the fight against HIV/AIDS, malaria and other diseases.”

The issue of bribery does not feature prominently in the health literature although it is a major problem threatening quality of care.  A multi-country research project on health worker and client relationships found that health workers were willing to talk about the problem:

… participants in many sites spoke openly about various forms of informal income generation engaged in by health workers. This took the form, for example, of insisting on ‘tips’ before people received treatment and alternative prescribing methods or alternative charging structures for treatment and prescriptions. This open discussion continued despite people saying that talking about it made them feel ‘ashamed’.

Jennifer Hunt in a study of bribery in health care in Uganda found examples in both public and private sectors. Interestingly bribery may be associated with worse quality health care, and bribes may be an attempt to improve this, but to little effect.

When researching a story on health insurance in Nigeria a reporter from the Daily Independent found that, “… off record (some respondents) were soon to confide that a few workers demand inducements before attending to patients. (One) also remarked that while some personnel at the PHCs (Primary Health Centers) do not ask for bribes, most patients are compelled to give them packages when they notice that those who did before them were better taken care of.”

While we have recently reported on large scale corruption involving major donor funds, it is the small scale bribes at the front line level that immediately affect life and death access to malaria and other health services. Can we expect the front line health worker to behave any better than the big national program manager or policy maker? What can we do to end the culture of corruption and achieve our malaria elimination goals?

Corruption Bill Brieger | 08 Dec 2010

Suspense at Suspending – the Global Fund and Mali

A few years ago, the Global Fund to Fight AIDS, TB and Malaria (GFATM) issued as evaluation report that among other things documented that among three types of agencies who had served as Principal Recipients (PR) of funds – government entities, international organizations (e.g. UNDP) and Non-governmental organizations – the latter had the best performance record on average.  Not long after, GFATM issued a directive that with all grant applications there must be at least one NGO nominated as PR.

dscn1973-sm.JPGNo organization is perfect, but NGOs are known for being flexible and able to innovate and involve the grassroots, particularly the people who are living with the three diseases. In contrast, we outlined the challenges of big government bureaucracies and corruption a few days ago. Now it seems that the ‘disease’ of corruption is more widespread than expected.

Unfortunately it appears to be Mali’s turn in the spotlight now. A press release from GFATM yesterday announced that it had “suspended funding of two malaria grants in Mali with immediate effect and has terminated a third grant for tuberculosis (TB) after it found evidence of misappropriation and unjustified expenditure.” Ironically, one of the suspended PRs is an NGO.

An Associated Press story explained that, “The announcement came two days after Malian Health Minister Oumar Ibrahima Toure resigned without explanation on Sunday.” The story went on to announce that, “The fund said the $4 million appeared to have been skimmed through false invoices, fake bid documents and overcharging for goods and services,” and that 15 unnamed government officials had been arrested. The GFATM Executive Director was quoted as saying …

The Global Fund tolerates no fraud, and we take public action to stop it, recover lost money and establish new and trustworthy channels for resources so they can reach those in need.

The Associated Press story also explained that, “The poor, landlocked West African nation relies on international donors to fund its health system. In August another international body, the GAVI Alliance, which helps get vaccines to developing countries, also froze the funds it gives to Mali because of corruption fears.”

Apparently GFATM officials are in Bamako to rescue the funds and ensure that disease control services are not disrupted, especially in this year when countries are trying to achieve universal coverage. The GFATM press release also indicated that, “Management of the two suspended grants will be transferred to a new Principal Recipient.” A watchlist has been formed of grants requiring closer financial scrutiny including Cote d’Ivoire, Djibouti, Mali, Mauritania and Papua New Guinea.

GFATM is about to disburse its 10th Round of Funding. It is encouraging that over the past 10 rounds relatively few cases of outright embezzlement of GFATM monies and corruption have been documented, because the temptation is certainly large. Sometimes threatened suspension of grants arises simply from poor management and performance.  The fact that GFATM is setting up mechanisms for more accountability among grantees is a timely step.

We have come too far along the pathway toward malaria elimination to be derailed by corruption.

Corruption Bill Brieger | 05 Dec 2010

Corruption Threatens Health

A major agenda item for the upcoming Global Fund Board Meeting is a report by Office of the Inspector General (OIG) “on investigations on ‘fraud and abuse’ (investigations of potential fraud, misappropriation, corruption or mismanagement), audits on internal control processes, functional reviews and assurance validation.” A current article at the BBC provides a broader context in which these concerns arise:

The Kenyan government has said it could be losing nearly one-third of the national budget to corruption. Finance ministry officials told a parliamentary committee the losses could be nearly $4bn (£2.5bn) a year. They said individuals were taking huge sums meant for development projects.

In a 2006 article The Economist wrote cynically that, “scandals are as regular as Africa’s tropical rains,” when reporting on Kenyan scandals at that time. Often the same leader who vowed to fight corruption are later “exposed for theft and rotten dealings of his own.”

BBC noted last month after four Kenyan government officials were accused of several million dollars of fraud that, “Kenya, generally seen as one of Africa’s more stable and prosperous countries, is also one of its most corrupt.” and explained that the most recent corruption perception index from watchdog Transparency International (TI) shows Kenya placed a joint 154th, along with war-torn nations or those recovering from conflict such as Congo, Cambodia and Guinea Bissau.”

Then earlier this year the BBC reported that, “Kenyans are becoming increasingly angry with their politicians as corruption and deepening rifts in the coalition government threaten the country’s peace. International donors have suspended some funding because money is being siphoned off before it reaches the projects it is intended for.”

But back to the OIG … The OIG, which was set up in 2005, submitted a report dated September 2009 outlining a variety of problems with Global Fund operations that may not be actual acts of corruption, but leave the door wide open to the possibility of fraud. Such problems include conflict of interest among members of the Central Coordinating Mechanisms (CCMs), lack of auditing, monitoring and oversight capacity and procedures by CCMs for Principal Recipients (PRs) and of Sub-Recipients (SRs) by PRs, procurement and logistics management irregularities, and excessive top-up salaries for PR and SR officials (who often are also government employees). Some of the OIG report findings on Kenya include …

  • inefficiencies with in-country financial management systems resulted in significant delays in program implementation
  • monitoring and evaluation systems were ineffective
  • the CCM was not performing oversight functions properly
  • non-transparent selection and funding of civil society organization recipients
  • late and inaccurate reports

The Standard News was a bit more blunt about Kenya’s predicament earlier this year. Dann Okoth reported that, “Kenya stares a major health crisis in the face amid donor uncertainty, poor management, corruption and apathy. Possible grant freeze and shifting donor priorities could critically affect HIV and Aids, tuberculosis (TB) and malaria programmes and compromise millions of lives, it has emerged. But it is Kenyans’ own inefficiency, corruption and impunity that would be the final nail on the coffin of a well thought out health plan gone terribly awry.”

The Standard’s reporter also bemoaned the lack of transparency from either the Kenyan Government or the Global Fund about where the country should be in terms of funding and implementation of grants. He also observed that, “of 144 countries receiving the grants, Kenya is ranked 110th in terms of average grant rating as at November 2008.” This, he implied may not be unconnected to the rejection of Round 8 and 9 Global Fund applications.

The Human Rights Advocacy Forum highlighted the plight of TB patients who depend on Global Grants for their regular drug supply. They reported that, “The procurement by the ministry is fraught with irregularities, including not adhering to procurement regulations, procuring of goods not required and substandard goods at inflated prices,” and observed that “Kenya Medical Supplies Agency (KEMSA), responsible for the procurement, storage and distribution of drugs on behalf of the government, was investigated for corruption and its CEO was sacked in October 2008.”

Obviously Kenya is not the only challenge to the OIG and the Global Fund. Other countries have had grants suspended including Uganda and Zambia. What is surprising is that such practices have been going on for so long with so little obvious response. Corruption kills just as easily as the viruses, bacteria and parasites that the Global Fund was created to fight.

Corruption &Performance Bill Brieger | 19 Jun 2010

Freezing in Zambia

zambia-malaria-indicators-2008.jpgZambia was one of the first recipients of Global Fund support and since Round 1, it has received 3 HIV grants, 2 TB grants and 3 Malaria grants. The chart here shows that Zambia has performed fairly well on achieving Roll Back Malaria coverage indicators. In fact, though not yet reaching the 2010 targets of 80%, Zambia has been seen as one of the top performers in its efforts to control malaria as highlighted in a panel presentation at the recent Women Deliver Conference.

Therefore it comes as a surprise to read the press release from the Global Fund stating that, “Global Fund confirms freeze on cash disbursements to Zambia’s ministry of health, grants to be transferred to UNDP.” This decision was made in August 2009, though not announced until June 2010. The press release stated …

The freeze in disbursement came after Zambian authorities last year uncovered fraud within its own Ministry of Health. Further investigations by the Global Fund showed that the Ministry of Health was not able to safely manage grants. The organization has demanded the return of US$8 million in unspent funds from the Ministry of Health. The Global Fund has also demanded that Zambia takes action against individuals found to be involved in the unaccounted expenditures that led to the freezing of grant disbursements.

A news source reported that, “Money is still being paid to civil society organisations (CSOs).” As noted above the government component of the grant will be managed by UNDP for the meantime. Sarah Boseley of the Guardian points out threats to continued funding translates to more deaths from the three diseases. Furthermore, “The Global Fund is Zambia’s main donor to the health sector, and the suspension of aid will likely hinder the nation’s efforts to fight Aids, tuberculosis and malaria.”

It is interesting to reflect on the Global Fund 2007 Progress Report which showed that 83% of CSOs as principle recipients of grants scored ‘A’ or ‘B1’ on their grant performance progress reports compared to 75% of grants managed by UNDP and 72% by government agencies. There has been overall improvement in performance in recent years, but the 2009 results reported this year still place CSOs ahead at 84% performing at ‘A’ or ‘B1’ level compared to 75% for governments and 79% for UNDP. Transferring Zambia’s support from government to UNDP is certainly not a long term solution to its problems.

There seemed to be some confusion about the suspension in Zambia. “Zambia’s Health Minister Kapembwa Simbao denied the suspension of funds and said there had been no indication from the organisation to halt donations,” even though the GFATM Board apparently made the decision official at an April 2010 Board meeting. Zambia’s efforts to fight corruption have been undermined when a former president was charged, though acquitted of corruption charges and the Netherlands suspended aid also because of alleged corruption.

Radio France International explained that, “The freeze became public when Aidspan, a group which works with the Global Fund, posted the decision on its website on Monday. The fund issued a statement two days later.” The GFATM is usually known for its transparency, and so the delay of the announcement about the Zambian funding freeze is almost as perplexing as the problem in Zambia itself.

Since GFATM money comes from taxpayers around the world, public accountability is expected. Shining a light on corruption can preserve disease control funding and save lives.


PS – see relevant article in Global Fund Observer:

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