Recent allegations of the misuse of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria could jeopardize Uganda’s malaria funding and hurt efforts to fight the disease, which is a leading cause of mortality and morbidity.
Evidence of the mismanagement of a US$51 million malaria grant to Uganda from the Global Fund resulted in the July arrest of three Ministry of Health employees and prompted a police investigation into the matter. In September, the organization called for the refund of any ineligible expenses under the grant and the strengthening of safeguards to prevent future misappropriation of funds.
Global Fund-supported programmes provide life-prolonging treatment for some 291,000 HIV-positive Ugandans - more than 80 percent of the total number receiving treatment - and have distributed 7.7 million insecticide-treated nets to protect families from malaria.
In November 2011, the Global Fund commissioned PricewaterhouseCoopers - the local fund agent - to review transactions relating to a Round 7 malaria grant, inaugurated in 2009, to procure and distribute 7.4 million long-lasting, insecticide-treated mosquito nets. Following the review, the Fund recommended "strengthening accounting records, reinforcing internal controls and oversight of programmes".
Marcela Rojo, a Global Fund spokesperson, said the Round 7 malaria grant had not been suspended, but told IRIN/PlusNews in an email that “any country where the Global Fund identifies irregularities in the use of funding is subject to [a] freeze or suspension of funds”.
In its mid-September announcement, the Fund called for an immediate end to transfers of programme funds to individuals' bank accounts. Rojo said the transfer of Fund money to personal accounts was against the law in Uganda and should not have been allowed to happen under current guidelines.
A suspension would be devastating to the country’s efforts to fight malaria, said Nathan Kenya-Mugisha, a technical advisor for health programmes in the Ministry of Health; the country’s most recent Malaria Control Strategic Plan reported that between 70,000 and 100,000 people die each year from the disease.
“Malaria was not attracting development partners until the Global Fund arrived,” he said, adding that a suspension could see the country face a shortage of drugs and supplies for the treatment and prevention of the disease.
History of misuse
These are just the latest episodes in Uganda’s rocky history with the Global Fund; a 2005 audit revealed massive graft, leading the Fund to suspend five grants to the country. The grants were reinstated several months later, and several people have since been jailed in connection with the scandal.
Uganda also lost out on a $16 million grant in 2007 because of the country's "unsatisfactory performance", according to Aidspan, an NGO that serves as an independent watchdog of the Fund.
Asuman Lukwago, the permanent secretary for Uganda's Ministry of Health, said the country was committed to returning any misallocated funds and to holding any culprits accountable.
"Our final beneficiaries should not be made to suffer because of the motives of some public servants," he said. "Everything that disturbed the Fund will be answerable by the public servants."
Lukwago said the possible corruption surrounding the malaria grant was uncovered by his department, which, working with Global Fund officers, discovered that "there could be fraud in the management of the money".
Improved financial tracking
Ministry officials are now looking at methods to better track and monitor funds and the supplies they purchase. Lukwago said ministry officials were in talks with the Swedish government about a programme to regularize accounting.
|HEALTH: A timeline of Global Fund reforms|
|HEALTH: The Global Fund adopts new funding model|
|GLOBAL: Falling foul of the Fund|
|HEALTH: From malaria research results to policy|
The ministry is also considering implementing an 'e-health' initiative that would provide for better online resource tracking as supplies are procured and distributed. Lukwago said it would be a way to take stronger preventive action rather than waiting for reports of corruption and then "discover there is something wrong".
Peter Wandera, the executive director of the Ugandan chapter of Transparency International, said the recent events showed the ministry's oversight system had improved significantly since the last major scandal.
"The issue was taken up and people were arrested," he said. "At least we have seen the process working."
Raymond Byaruhanga, the executive director of Uganda's AIDS Information Centre, sits on the Country Coordinating Mechanism (CCM) that oversees Global Fund money and says the system has become more transparent but “loopholes” still exist.
He pointed to the funding distribution system in which the Ministry of Health picked local partners to help implement grant projects; some of the money went to "organizations that are not existing on the ground". Additionally, a lack of clarity in accountability rules had led some NGOs to become fearful of utilizing the funds, leaving gaps in the implementation of programmes.
"As the CCM and civil society, we can continue to push for better systems and improvement," Byaruhanga said.