Government only used 30 percent of the $125 million (K88 billion) Global Funds (GF) allocation to the fight against Aids, malaria and TB between 2009 and 2015.
A GF report released in July says only $36 million (K25 billion) was used, prompting the Fund to claim back the remaining 70 percent, which translates to K53 million.
The report says failure to absorb the funds resulted in the doubling of TB and malaria prevalence, which in turn increased the number of people requiring treatment and causing drug stock outs.
It also resulted in inconsistent compliance with national HIV guidelines on testing and effective monitoring of people under treatment.
But government has blamed the low absorption rate on red tape in disbursing the funds by the GF and its principal recipients (PR)—World Vision and Action Aid.
Until last year, the National Aids Commission (NAC) was the PR of the Fund in Malawi.
Although the report praises Malawi for registering some significant progress in the fight against the three diseases, it says government did not implement important components of GF interventions such as making available quality as well as key services to beneficiaries.
GF says “national disease programmes have limited capacity to implement activities that are critical to the overall success of the programmes, even when funding is available.”
Minister of Health Peter Kumpalume, in an interview last week, acknowledged the problem, saying the ministry would strive to maximise the use of funds at its disposal.
Said Kumpalume: “This report talks about historical trends and there have been a number of contributing factors. It is a fact that we have never been able to consume all the money made available to us, but there are justifications for that.
“However, what is most important is how in future we will ensure that we use all the resources on the agreed programmes and are able to account for them.
“We now have a Programme Implementation Unit (PIU), which keeps an eye on the funds, the deliverables and reports. I am confident that from this year, we are going to use the majority of the funds available.”
Ministry of Health (MoH) spokesperson Adrian Chikumbe, in an e-mailed reponse on Wednesday, said it is not as if the funds were readily available over the six-year period.
“For the larger part of the audit period, GF funds were not disbursed and the country implemented activities using money from the Government of Malawi and other partners,
“The GF funds which never came have been carried over to the current new funding model which started in January 2016. As such, causes for low absorption were both at Global Fund and principal recipient (PR) levels. The causes have been identified and are being addressed,” Chikumbe said.
Treasury spokesperson Nations Msowoya, whose ministry has oversight powers over the GF funds, said low absorption of GF funds is a challenge to many developing countries.
“The main contributing factor is logistical and procurement delays,” he said.
Some organisations that disburse funds to local community-based organisations (CBOs) for capacity building in HIV/Aids programmes complained about delays in processing of funds, saying they cripple efforts to reach targets for the national HIV/Aids programmes.
Robert Phiri, who runs a sub-recipient organisation for GF resources, noted: “Unfortunately, the problems of lack of funds, especially for organisations that handle activities at community level continues. As we speak, the first tranche was supposed to start by January 1 2016, but funds were only disbursed in May. We lost four months in between.
“The second tranche was expected to roll out on July 1, but there are no signs of doing that so far. As a result we are struggling to finance operations in areas of transport, equipment and personnel in programmes that we are running. These include HIV Testing and Counselling (HTC) referral programmes for the sick and sputum collection points, among others.”
But a GF report for June 2016, identifies ineffective programme management by implementers and inefficiencies in managing the HIV/Aids portfolio by the local management team as factors resulting into low absorption of funds dedicated to in-country activities and delays in the implementation of those activities.
The report also says inefficiencies in its country team—comprising representatives from various organisations represented in Malawi working on HIV/Aids, TB and malaria projects—in managing the portfolio and in the fiscal agent processes also contributed to delays and ineffective implementation of key local activities.
A year ago, GF removed goverrnment-owned NAC as its principal recipient for the country and gave the role to World Vision International (WVI) and ActionAid.
When we sought a comment from the NAC, its spokesperson Francis Thawani declined to comment on the issues covered in the draft report.
“NAC reserves its right to comment,” he said. n