Global Fund Grants to the Republic of Namibia
Article Number: 6
Significant progress has been made in the fight against the three diseases but improvement is needed in community interventions
The Office of the Inspector General’s audit report on the Global Fund grants to Namibia conveys good news about the progress in fighting HIV/AIDS, TB and malaria and the effective role of community interventions. Concern is expressed about the unreliability of reported information – an issue relevant to what we have to say about the study report on Global Health Initiatives – and OIG notes that gains from the Country Coordinating Mechanism (CCM) Strategic Initiative have not been sustained – an issue relevant to our article on the OIG audit of CCMs.
On 2 August 2023 the Office of the Inspector General (OIG) published its report on the Global Fund grants to Namibia during the period January 2021 to December 2022.
Approximately 54% of the active grant of $53.15 million for the 2021-2023 implementation period, which covers all three diseases, had been disbursed as of December 2022.
The Ministry of Health and Social Services (MOHSS) is the Principal Recipient (PR) of the HIV/TB and malaria combined grant. Grants are implemented by sub-recipients, including the National Tuberculosis and Leprosy Programme (NTLP), National Vector-Borne Diseases Control Programme (NVDCP), National HIV Programme, Advanced Community Health Care Services Namibia (CoHeNa), Intrahealth Namibia, Ministry of Education, Arts and Culture, Positive Vibes, Development Aid from People to People (DAPP), One Economy Foundation and Society for Family Health.
Progress in fighting HIV, TB and malaria is summarised in the following table from the report:
Audit objectives and scope
The objectives of the audit were to assess the adequacy and effectiveness of:
- Implementation and oversight arrangements of Global Fund supported programs to ensure achievement of grant objectives, with a particular focus on the Project Management Unit (PMU) and the Country Coordinating Mechanism (CCM);
- Community-based interventions to ensure access to quality services by beneficiaries with a focus on: vulnerable and key populations (including adolescent girls and young women (AGYW), female sex workers (FSW), and men who have sex with men (MSM)), multi-drug resistant TB (MDR-TB) and malaria vector control intervention (indoor residual spraying (IRS)) ; and
- Adequacy and effectiveness of financial controls and in-country assurance mechanisms in safeguarding Global Fund resources.
The first finding is that gaps in financial and procurement management have resulted in weak accountability for Global Fund grants. Inadequate design and non-compliance of some of the existing guidelines are impacting both the transparency and competitiveness of procurement processes, as well as the achievement of value for money. There is therefore a need to enhance the design and compliance of financial and procurement processes to safeguard grant funds.
The second finding is that the PR’s reporting structure and capacity are hindering effective delivery of its roles and responsibilities. This has impacted efficient and effective grant implementation. Delayed implementation of the CCM Evolution Strategic Initiative has impacted CCM’s governance and oversight. Improvement is therefore needed in implementation and oversight mechanisms to ensure achievement of grant objectives. See our article in GFO 438 on the OIG audit of the CCM Evolution Strategic Initiative.
The third finding is that the gains made in the HIV, TB and malaria programmatic outcomes could be hindered by limited availability of community health workers, insufficient planning and execution of malaria IRs, and challenges in HIV prevention interventions for AGYW, FSWs and MSM. Therefore, while significant progress has been made in the fight against the three diseases, improvement is needed in community interventions.
In terms of the audit objectives, OIG’s overall assessment was that:
- The adequacy and effectiveness of implementation and oversight arrangements of the Global Fund supported programs is partially effective.
- The adequacy and effectiveness of community-based interventions to ensure access to quality services by beneficiaries is effective.
- The adequacy and effectiveness of financial controls and in-country assurance mechanisms in safeguarding Global Fund resources needs significant improvement.
Agreed Management Actions
The agreed management actions (AMAs) to address each of the three findings are as follows:
1. The Global Fund Secretariat will work with the PR to:
a). assess, by 31 March 2024, the financial management and reporting systems to address weaknesses identified during the audit; and
b). operationalize the outcomes of the assessment in (a) by 31 December 2024.
2. To address the second finding, the Global Fund Secretariat will:
a). work with the MOHSS and relevant in-country stakeholders to: (i) by 30 June 2024, conduct a functional review of the PMU to strengthen operational management which supports the effective and timely implementation of grant activities. Building on the PR’s recent progress to address procurement processes, this review will also include the PMU procurement arrangement to define roles and responsibilities that support procurement oversight and quality assurance measures; and (ii) by 31 March 2025, provide evidence of the operationalization as stipulated in part (i); and
b). work with the CCM in Namibia to: (i) by 30 November 2023, facilitate inclusive representation including active involvement of government stakeholders, and via the CCM Evolution, improve the CCM functionality in oversight and clarifying roles and responsibilities for the CCM and sub-committees; and (ii) by 30 June 2024, provide evidence of the operationalization as stipulated in (i).
3. To address the third finding, the Global Fund Secretariat will work with the PR to leverage data to routinely assess, by 30 June 2024, the referrals and linkages for HIV counselling and testing, sexual and reproductive health and other support services for KPs (AGYW, FWS and MSM), in order to improve the effectiveness of services.
This report conveys good news about the progress in fighting the diseases but, given the increase in malaria cases in 2021, it may be optimistic to assume that malaria will be eliminated by 2030.
Against the background of well performing disease programs, it is disappointing to note the concern about the reliability of reported financial information. This is an example of the issue of data reliability that is something that the authors of the study report on GHIs should look into; and review their findings and conclusions accordingly. See our article here.
It is interesting to note that the OIG reports that “early gains from the evaluation project (that is the CCM Evolution Strategic Initiative) have not been achieved due to implementation delays”. This supports a general concern about CCMs – see our article on the OIG audit of CCMs.