Malawi stands to lose $25 million (about K10 billion), this year, in approved grants for tuberculosis (TB) and malaria programmes due to alleged mismanagement of funds and failure to submit audit reports on time.
This would create possible drug stock outs for TB and malaria treatment thereby putting at risk lives of about 21 000 TB patients and other millions, especially children, infected by malaria, Malawi Health Equity Network (Mhen) has feared.
According to the latest Global Fund briefing paper to governmentWeekend Nation has seen, Ministry of Health is alleged to have mismanaged around $84 309 (about K34 million) malaria grants for Rounds 7 and 9 of the programme in unjustified expenditure between January and June 2012.
It says at first the ministry failed to account for malaria grants spent during the period, which led to Global Fund not disbursing further funds in 2012 for the two rounds.
“To date the outstanding amount unjustified over the period January 2012 to June 2012 is $44 089 [about K18 million] for Round 7 and $40 220 [about K16 million] for Round 9.
“The total amount of $84 309 [about K34 million] on both Round 7 and Round 9 malaria grants should be immediately refunded by Ministry of Health in absence of supporting documents,” reads Global Fund communication dated March 1 this year.
If the ministry fails to address several highlighted audit queries, Global Fund will not disburse $25 million (about K10 billion) malaria and TB grants for Round 7 whose deadline is December this year, according to the communication.
“Round 7 malaria will close on 31 December 2013 with undisbursed to date of US$ 20 million. Round 7 TB will close on 31 December 2013 with undisbursed to date of US$ 5 million. No disbursement has been made to PRs [principal recipients] for in-country activities since one year.
“Malawi has a history of closing grants with huge undisbursed balances due to various reasons, including delay in fulfilling CPs [Conditions Precedent] in good time, delay in justification of programme expenditures and delay in submitting audit reports,” read the briefing notes in part.
The revelation comes at a time Malawi is refunding abused grants worth $3.9 million (about K1.5 billion) to the Global Fund and also recently lost another $17.1 million (about K6.8 billion) for Round 5 HIV and health systems strengthening (HSS) programmes due to delayed disbursement.
It also comes at a time the country’s hospitals are facing acute shortages of TB drugs while the Central Medical Stores Trust (CMST) has been struggling to procure several medicines, including malaria drugs, to address increased malaria cases during the current peak season.
“We have serious concerns relating to the following areas: weak controls relating to the management of fuel, weak controls over advance payment of per diems and inadequate reporting of per diems. There is need to improve the cash management policy at all levels, especially at districts,” says the Global Fund.
The National Malaria Control Programme (NMCP) and National TB Control Programme under Ministry of Health are some principal recipients of Global Fund grants which the donor wants to be more aggressive on usage of the aid.
Mhen executive director Martha Kwataine on Wednesday said while the country’s drug availability situation has slightly improved in some health facilities, the country needs the undisbursed grants to stock adequate amounts of drugs and avoid further drug crisis.
“It means the drugs shortages we have in hospitals are artificial. It’s like penalising innocent patients when the problem is not Global Fund. This reflects lack of seriousness…this would lead to loss of lives,” said Kwataine.
Malawi registered about five million malaria cases in its health facilities in 2012 alone and lost about 5 500 people to the disease which is preventable and curable, according to a 2012 Malaria Indicator Survey.
Ministry of Health spokesperson Henry Chimbali on Thursday said the ministry is working on the audit queries for the Global Fund, admitting that the withheld K10 billion is affecting implementation of targeted activities.
“The issue of the audit report is just within one of the many conditionalities that Ministry of Health has to submit for us to start accessing the GF funds for TB and malaria. It is being dealt with [together with] other issues that Global Fund would want us to work out,” said Chimbali.
He said government will ask for extension of the grants’ utilisation deadline because it is impossible to spend all the K10 billion in the remaining nine months even if it were all released today.
Lilongwe District Health Office (DHO) spokesperson Alvin Chidothi Phiri said they have not had paediatric TB drugs for the past three months because they were not available at CMST a shortage he said affected over 40 government health centres in the district.
“We have had only TB drugs for adults and not paediatrics, but I am told that the drugs for children have just arrived at Central Medical Stores,” said Phiri.
National TB Control Programme director Dr. James Mpunga said the withheld Global Fund TB grants are meant to buy drugs, refurbish hospital laboratories with microscopic equipment for testing TB and conduct TB training for medical workers in hospitals, among others.
He said last year they pleaded with Global Fund to at least release money for drugs out of the withheld amount to avoid putting at risk lives of about 21 000 patients currently on TB treatment across the country.
“The delays to get Global Fund grants have affected us in the sense that we planned to carry out some activities and we are unable to do that,” said Mpunga.
He said they have so far refurbished only 40 laboratories with TB microscopic equipment out of the targeted 80, adding the remaining laboratories are awaiting release of the withheld funds, a situation which further limits the capacity of the country’s hospitals to detect TB in new patients.
“Global Fund has been able to understand us, that’s why they agreed to give us the money for drugs. They also allowed us to borrow from government to implement some activities so that when we get the undisbursed amount after sorting out the outstanding issues, the money can be paid back to government,” said Mpunga.
He said apart from government and Global Fund, Health Sector Wide Approach (SWAp) donors, including United States support the country’s malaria and TB programmes.