IPNEWS: President Joseph N. Boakai has officially launched the Global Fund Grant Cycle 7 for Strengthening Health Systems in the fight against HIV, Tuberculosis, Malaria and other diseases in Liberia.
Earlier in May 2023, Mark Eldon-Edington, Division Head, Grant Management, Global Fund, informed Liberia through its Chair, Liberia Coordinating Country Mechanism, Ms. Joyce Kilikpo, that it will increase investments from one grant implementation period to the next after it spent over 300 million since 2010.
The communication dated May 4, 2024, detailed that for the Grant Cycle 7 implementation period, the Global Fund has renewed its commitment to support Liberia in the fight against HIV, tuberculosis, malaria and for strengthening its health system through an allocation of US$ 87.3 million, as well as two catalytic “Matching Funds” for a total of US$ 5.9 million. An Executive Mansion release, however, puts the grant figure in the sum of US$117,546,670, which it states represents a renewed dedication to improving health care outcomes for Liberia.
As part of this renewed Global Fund Grant, Liberia will also benefit from two catalytic Strategic Initiatives for integrated laboratory systems strengthening, and for effective Community Systems and Responses.
It may be recalled President Boakai held sideline meetings with both the leadership of the Global Fund and Millennium Challenge Corporation (MCC), pledging Liberia’s commitment to ensuring straight adherence and scale up performance to meeting the MCC score card and all benchmark of the Global Fund.
Over the past two years, serious compliance issues were raised at the Ministry of Health, both by the Office of the Inspector General (OIG) investigation and grant oversight mechanisms.
The compliance issues are related to recurrent challenges of accountability at the Ministry of Health resulting in US$ 6.7 million of non-compliant expenditures (US$1.9 million confirmed + US$ 4.8 million potential), persistent systemic risks within the Ministry of Health, despite the ongoing implementation of the OIG related Agreed Management Actions and Risk Management Measures. While acknowledging the Country Team’s and Fiscal Agent’s role in effectively mitigating the identified risks, the outcome of the OIG investigation (April 2022), the Grant Cycle 6 expenditures review (November 2022), and the Fraud Risk Assessment (December 2022) raised additional concerns due to the persistent systemic weaknesses leading to suboptimal culture on accountability, and insufficient management capacities and grant oversight demonstrated by the Ministry of Health as Principal Recipient resulting in ineffective program delivery.
Almost no HIV or tuberculosis activities were implemented in 2022 under the LBR-C-MOH grant, meaning less access to quality services and leading to a low in-country absorption rate of grant funds (47% as of December 2022).
These issues put the entire portfolio, especially the beneficiaries, at risk since the Ministry of Health manages 48% of grant funds.
As part of the support to improve the grant management and governance framework, the Global Fund stated that it conducted a high-level mission to Liberia from 5 to 7 September 2022. Following various engagements with the Office of the President and governmental entities, a decision was made to establish a Memorandum of Understanding to increase the oversight and support from the Ministry of Finance and Development Planning.
The Global Fund also decided to sign a Memorandum of Understanding with the General Auditing Commission for the purposes of providing external assurance services to the Global Fund Liberia grants. As at the date of this letter, both Memorandums of Understanding remain pending for signature by the Ministry of Finance and Development Planning and the General Auditing Commission respectively.
In order to safeguard the Global Fund’s investments in Liberia, the Global Fund leadership decided to invoke its Additional Safeguard Policy1 on the entire Liberia portfolio with immediate effect.
This decision was taken after an extensive internal consultation process. It is expected to trigger a sustained improvement of accountability in the management of grants, which will enable better program results and a greater impact for the benefit of the people of Liberia, according to the Global Fund Investigation.
In line with the invocation of the Additional Safeguards Policy, the Global Fund Secretariat led the selection of implementers, for any future funding to Liberia, including Principal Recipients and Sub-Recipients. For Grant Cycle 7, the following changes will be reflected in the grant implementation arrangements:
- Closure of the LBR-C-MOH grant managed by the Ministry of Health as Principal Recipient by the end of its implementation period (31 December 2023). C19RM funds currently approved for the LBR-C-MOH grant will be transferred to the Principal Recipients selected for Grant Cycle 7.
- Reduction of the number of grants in the portfolio from four to two for increased efficiencies i.e.: (i) one combined grant for HIV and tuberculosis; and (ii)one malaria grant, with components of Resilient and Sustainable Systems for Health embedded in both grants.
- Selection of two Principal Recipients with the aim of an improved risk oversight while maintaining the Ministry of Health as a key implementer, in the role of Sub-recipient. The Secretariat will steer this selection process, in close collaboration with the Country Coordinating Mechanism.
Additionally, as part of the improvements, the Country is requested to enforce the below risk mitigation measures:
- With respect to Global Fund grant funds, maintain a Zero Cash Policy at the Ministry of Health and all local implementers associated with the Ministry of Health; any exceptions should require the Country Team’s no-objection;
- Implement a whistleblower program by the Ministry of Health and all implementers associated with the Ministry of Health as part of the wider reform of the Ministry of Health’s fraud prevention and management framework under the leadership of the Government of Liberia; and
- Safeguard Global Fund funded commodities throughout the supply chain system.
The further Safeguard Policy is invoked as a temporary measure for the current grant implementation period (Grant Cycle 6) and the upcoming grant implementation period (Grant Cycle 7), includes To revoke this status, the Global Fund has included a draft and indicative list of “Exit Criteria”
The policy also directs that Liberia will need to demonstrate including the recovery of confirmed non-compliant expenditures, evidence of strengthened internal controls at the Ministry of Health, and an increased government support for effective implementation. The “Exit Criteria” will be negotiated in consultation with the Country Coordination Mechanism to formalize the Additional Safeguards Policy’s Exit Roadmap.
The Global Fund Secretariat acknowledges Liberia’s achievements despite all the challenges and remains committed to continuing to support the Country in combating HIV, tuberculosis, and malaria and building resilient and sustainable health systems. The Global Fund counts on the Liberia Country Coordination Mechanism to continue its vital role in overseeing program implementation, and acting as a forum for discussing strategies, opportunities and progress of the Global Fund funded programs.
