The Ministry of Health (MoH) says it is in possession of the investigation report issued by the Global Fund’s Office of Inspector General (OIG) on April 8, 2022 pertaining to examination of the TB/HIV and Malaria/Health System Strengthening Grants implemented by the MoH as Principal Recipient (PR).
The Ministry appreciates the efforts of the Global Fund and its desire to safeguard and ensure transparent implementation of all Global Fund grants generally and added, “We are advised that proper management of the grant fund is very important for the attainment of the overall goal of the Global Fund—which is to invest the world’s money to end HIV/AIDS, Tuberculosis and Malaria.”
The Ministry of Health said its goal is “to improve the health status of the population of Liberia on an equitable basis” and amongst other things, it is guided by principles such as efficiency, accountability, and transparency in the discharge of its duties like the Global Fund.
Consistent with Ministry’s desire to discharge its duties in line with established guiding principles, the Ministry which is analyzing the report to inform action (s) to be instituted stated, “It is important to note the that the OIG investigation was triggered by the Ministry when discovered irregularities at one of its programs, the National AIDS Control Program (NACP) by internal audit unit of the Ministry in 2020 after which the Ministry’s alerted the Global Fund in keeping with the Grant Agreement. We also like to inform the Public that for the period under review in keeping with the Global Fund grant management and procedure, the fiduciary responsibilities such as procurement, Financial Management (including co-singing of checks, Local Purchase Orders and Vouchers), Internal Audit and External Audit functions were all being jointly executed by many international firms with the following responsibilities:
- Cardno International Development, An American base financial management firm was contracted by Global fund as its Fiscal Agent (FA) and was stationed at the MOH with the fiduciary responsibility of reviewing all procurement and financial transactions as well as providing pre-audit and post-audit functions on global fund transactions. If the LFA dissatisfied with a particular transaction or transactions, it doesn’t get processed until its corrected and signed on by the FA. The FA has the right to also declare a transaction as illegible even after it has occurred. Cardno served the Ministry in this capacity from 2015-2021 and has now been replaced by GFA Consulting Group another Internal Financial and Procurement management firm as of January 2022.
- Swiss Centre for International Health has also been under contract by the Global Fund as the Local Fund Agent (LFA). The LFA oversees quarterly reviewing and certification of all quarterly transactions submitted to the Global Fund along with their supporting documents. They also provide assurances of all quarterly report submitted to the Global Fund on a periodic basis. The LFA performed post audit of all transactions on a quarterly basis and report to the Global any irregularities. The LFA has the right to also declare expenditures stated in the quarterly report as illegible after it has reviewed the transactions. In which case, the MOH will have to reimburse the Global Fund for such expenditure deemed illegible. Since 2015 the Swiss Center for International Health has played the roles Local Fund Agent.
3.The Moore Stevens International Auditing Firm based in the UK was hired by the Global for the period of the OIG report, as is expected, the International Auditors provided assurances of all transactions carried out by the Ministry during the period 2015-2020. These very transactions which were reviewed by the FA, and LFA were also authenticated by the external auditors through the provision of an unqualified Opinion (Clean Opinion). The Moore Stevens five years contract has ended and has been replaced by Ernst & Young, another international Auditing firm who is currently conducting Audit of the Global transactions for the fiscal year ended December 31, 2021.
The Ministry said it believes that the vigorous system of check and balance the Global Fund Grant management system has in place at the Ministry of Health along with our robust Financial Management System and many years of managing grants we can safely say it’s impossible to engage in massive corruptions without being detected over a long period of time as it has been portrayed by the OIG report. OIG findings declared an aggregate expenditure summing up to US$990,000 noncompliant and recommended restitution.
Though the Ministry said it does not agree with everything in the report, it wishes to assure the public that it is giving significant attention to the allegations of fraud and misappropriation as the report implies, significant measures have already been taken to mitigate some of the risks identified.
The Ministry said significant progress has been made toward the fight against HIV, TB, and Malaria in Liberia. For example, the Ministry has been able to reduce morbidity and mortality occasioned by malaria by over 50% (Malaria Mid-Term Review Evaluation report 2018); distributed close to ten million mosquito nets, protecting the entire population with sustained vector control interventions; treated over fifteen million cases of uncomplicated malaria; tested over twenty-five million of suspected malaria cases over the period under consideration and beyond.
Further, significant progress has been made toward HIV interventions over the years. HIV prevalence among the sexually active population (age 15-49) has been declining yearly—from the peak of 2.8 in 1996 to 1.2 in 2018 and 1.1 in 2020 (Prevalence of HIV, total (% of population ages 15-49) – Liberia Data (worldbank.org)). Among other things Liberia has accelerated HIV test coverage to reach 68% of persons living with HIV knowing their status; the number of persons living with HIV receiving treatment increased from 5,916 in June 2015 to 19,328 by June 2021 (an increase by 13, 412 in 6 yrs.); in September 2019, Liberia introduced Tenofovir/Lamivudine/Dolutegravir (TLD) and accelerated the transition from TLE to TLD with about 92% of all clients on the more potent regimen; viral load testing coverage went up from 20% in 2018 to 32.5% among those on treatment in 2020 whilst HIV suppression rate also rose from 52.5% to 73.9%; progress towards the 95-95-95 global target is on an upward trajectory and currently stands at 68-89-65. Despite the challenges with Early Infant Diagnosis (EID), testing coverage among infants born to HIV-positive mothers increased by over 50%, from 163 in 2018 to 256 and 367 in 2019 and 2020 respectively.
To achieve these feats, the National Program has been swift in adapting new guidelines and partnering with the local communities and civil society organizations to implement diversified service delivery to simplify HIV services to efficiently address the expectations and needs of people living with HIV, or vulnerable to HIV as well as reducing unnecessary burdens on the already challenged health system.
Despite such momentous progress, no assurance that services were delivered as outlined in the OIG’s Report, cast general aspersion on those achievements, the Ministry submits that it has so many dedicated employees who are committed to providing required HIV/AIDS, TB, and Malaria services and without some of those staff, Liberia could not achieve the feats mentioned above.
However, like in all societies, few bad actors tend to derail the effort of the many good ones. This seems to be the case here where a few unacceptable behaviors are casting doubt on the progress of our dedicated staff, some of whom have committed most of their productive lives to the fight against HIV, TB, and Malaria.
Personnel accused of fraud and misappropriation are being investigated further, and plans are underway to ensure the termination of employment in some cases, restitution of funds in others, and the involvement of the LACC as needed.
The Ministry said it will keep the public informed of the progress towards administrative actions taken to reduce the recurrence of prohibited practices identified and remains committed to full transparency adherence to our Public Financial Management and Procurement Laws.
As a principal recipient, the Ministry of Health remains committed to the fight against AIDS, TB, and Malaria and shall not compromise the health and security of those within and without the borders of Liberia, for the contrary will not only violate the Grant Agreements with the Global Fund, but it will also be a dereliction of the statutory duties of the Ministry of Health.
“Thanks for your continuous support and we hope that, together, we can fight to secure continued funding for AIDS, TB, and Malaria to Liberia,” the Ministry stated.