IPNEWS: Twelve persons have been indicted by the Grand Jury of Margibi County to answer to the Crimes of Economic Sabotage, Theft of Property, Tempering with Public Records, Criminal Felicitation and Criminal Conspiracy after an LACC investigation into the Global Fund Grants under the ministry of health.
LACC Chairperson Cllr. Alexandra Zoe said, the LACC lifted to investigate the April 14th, 2022, edition of FrontPage Africa Online publication Captioned “US$1.1million of donor funds wasted/mismanaged by the Ministry of Health, the Liberia Anti-Corruption Commission following an extensive investigation and diligent legal proceedings.
Those indicted were jointly and severally charged to answer to the above crimes which grows out of Financial Improprieties and Kickbacks by Officials of the Margibi County Health Team, in the tone of
US$188,978.00 from the USAID funded project intended to improve the Health Care Delivery service of citizens of Margibi County.
It may be recalled, an audit in the Global Fund conducted in 2022, stated that Sub-optimal financial management and oversight over sub-recipients and grant assets has significant issues of improprieties.
The significant issues according to the Audit were noted in relation to the contracting and oversight of sub-recipients (SRs) under the MoH grant.
No SRs were contracted to provide TB services at the community level in 2016 and short-term contracts were awarded for the last eight months of both 2017 and 2018, negatively impacting programmatic activities and financial absorption. Gaps in financial management and oversight of HIV and TB SRs by MoH were also noted.
Limitations in the oversight of the Fiscal Agent as well as a lack of SR management policy in MoH contributed to these deficiencies. Gaps in the recording, tracking and utilization of grant assets were also noted. For example, grant assets worth US$1.1m were not recorded in the fixed assets register and assets amounting to US$0.8m (36% of sampled assets) could not be physically verified by the OIG.
Fifty-eight microscopes, funded by the Global Fund, were not used for 15 months after delivery in-country, impacting TB programmatic performance.
The audit further reveals among other things, ineffective linkages to care impacting provision of quality HIV & TB services to intended beneficiaries.
It states that while positive trends in scaling up HIV and TB services have been noted, gaps in linkages to care for HIV and MDR-TB testing and treatment have resulted in low antiretroviral treatment and MDR-TB coverage, as well as high loss to follow up: antiretroviral treatment coverage is at 31%, and MDR-TB case notification and treatment at 39% and 27% respectively.
At the 25 health facilities visited by OIG, 49% of HIV patients were classified as lost to follow up in 2018.5 Delays in the roll out of HIV and TB joint supervision and monitoring as well as gaps in the national community health worker strategy contributed to the ineffective linkage to care. National TB guidelines were last updated in 2012 and do not include current WHO guidelines, including GeneXpert diagnosis. Limited engagement of the private sector to achieve malaria grant objectives: Despite the importance of the private sector to the health sector in Liberia, MoH has not effectively engaged private sector facilities to improve access to malaria services.
The Memorandum of Understanding (MOU) between MoH and private sector facilities ceased in April 2017, despite Global Fund funded commodities still being provided to these facilities. Although private sector facilities (profit and not for profit) represent over 84% of all health facilities supported by the National Malaria Program in Montserrado county, 6 which accounts for one-third of the population, they account for only 7% of reported malaria tests.
In addition, 30% of the private sector facilities visited by the OIG were selling Global Fund funded commodities in contravention of the Global Fund gratuity policy, impacting access to medicines. The lack of a comprehensive strategy on the engagement of private sector facilities and of a defined approach to the monitoring and supervision of private sector facilities limits the Global Fund grants’ effectiveness.
Improvements needed in the design and implementation of interventions for Key Affected Populations: Significant delays in the completion of key programmatic studies and surveys have impacted the design and effective monitoring of performance of the PSI grant, which implements interventions for key affected populations. Consequently, the grant has low programmatic targets. Based on the latest Key Population Size Estimation Study, the key affected population program covers 20% of the population of men who have sex with men and of female sex workers.
Implementation of prevention services to key affected populations is suboptimal due to shortages in key commodities, including condoms and sexually transmitted infection medicines. Inadequate donor coordination has resulted in a significant proportion of peer educators working under the Global Fund program joining the US Government key affected population program. This has contributed to lower results for the key populations grant in the first semester of 2019. Lack of leadership and coordination of the key affected population program by the MoH and the Country Coordinating Mechanism have contributed to these gaps.
Weak supply chain governance and leadership is affecting the timely availability of quality assured commodities was also identified.
The audit report further noted that significant gaps in inventory management at the central level as well as deficiencies in laboratory supply chain were identified; these have resulted in stock-outs and expiries at the service delivery level as well as increased risk of loss and diversion of Global Fund funded commodities. For example, OIG’s reconciliation of stock movements between August 2018 and April 2019 noted an unsupported net difference of US$1.4m.
Weak management and recording of stocks increase the risk of loss or diversion. Deficiencies in the laboratory supply chain are contributing to poor utilization of diagnostic equipment, leading to low early infant diagnosis coverage (9%) and low viral load coverage (20%).
The underlying cause of these challenges is the lack of effective leadership and oversight across the supply chain by key stakeholders such as the MoH and technical committees, including the Supply Chain Technical Working Group. The lack of defined roles and responsibilities between government stakeholders and development partners as well as fragmentation in these roles are also impacting supply chain effectiveness in Liberia
