An audit report on Global Fund grants to Ghana released on 27 October by the Office of the Inspector general rated financial and fiduciary controls as effective but identified weaknesses in the management of programs and health services, and in data and risk management.
The audit covered four active grants for HIV, TB and malaria, all implemented by the Ministry of Health (except for one HIV grant jointly implemented with the AIDS Commission). For this report, the team visited 27 health facilities in seven out of the 10 regions of the country to assess access to treatment, programmatic data, and assurance mechanisms to mitigate risks.
The OIG found “significant weaknesses” in the supply chain and in inventory management methods (e.g. poor storage conditions; lack of use of stock cards and stock ledgers; lack of a functioning computerized information system; and no in-country drug testing for HIV and TB drugs). In January 2015, a fire at the Central Medical Store resulted in important losses of drugs which were not covered by external insurance. According to the report, quantifying those losses has been a challenge in the absence of a strong inventory management system.
Although a supply chain master plan had been in place since 2012, it was never fully implemented. Thus, the OIG recommended the integration of all supply chain initiatives from partners and the government and the revision of the master plan.
For the majority of the facilities visited, the OIG team found a greater than 10% error rate in HIV and malaria data. According to the report, the poor data collection is due to the lack of staff capacity, to the fragmented data systems and limited use of automated systems, and to the lack of a differentiated approach to assess the data.
These factors contributed to a weakening in the ability to detect data errors – despite an investment of $8 million in 2014 for monitoring and evaluation. The OIG said that the challenges in reporting have an impact on decision-making.
Following the report, the Secretariat agreed to take several remedial actions, including supporting the PRs to develop a plan to solve the main problems in the supply chain and to deliver an accurate accounting of ART patients in the HIV information system. It also agreed to support the Ministry of Health to produce an action plan for quality data collection in the malaria program.