Global Fund’s New Grants – Vigilance and Accountability are Needed

by Sierraeye

Last Friday, in a ceremony presided over by President Julius Maada Bio, Sierra Leone celebrated the launch of two new grants from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, totalling US$136 million. These grants promise to accelerate our fight against these deadly diseases while strengthening health and community systems nationwide. This aligns with Sierra Leone’s vision of achieving universal health coverage and meeting the 2030 targets for Sustainable Development Goal 3 on health and well-being for all.

However, while we rejoice in this new infusion of resources and hope, it is crucial to confront the elephant in the room – Sierra Leone’s troubling history of corruption, procurement fraud, and mismanagement of funds. Even the most generous grants may fail to achieve their intended impact without addressing these systemic issues.

Sierra Leone’s relationship with the Global Fund has not been without its challenges. The 2018 audit by the Global Fund’s Office of the Inspector General (OIG) uncovered significant deficiencies in the implementation and assurance arrangements, as well as the in-country supply chain mechanism. These findings were followed by investigations in 2020 and 2022, which revealed fraudulent procurement payments and collusive practices involving overcharging and the misallocation of training funds. The resultant non-compliant expenditures amounted to hundreds of thousands of dollars that should have been used to save lives.

Despite these setbacks, the Global Fund and the Sierra Leonean government have taken steps to improve oversight and accountability. Several mechanisms were introduced in the 2020-2022 grant cycle to strengthen fund management and mitigate fraud risks. However, challenges remain. The capacity of the Project Management Unit (PMU) to monitor grant implementation is still limited, and expertise gaps persist in procurement and fraud risk management. Sierra Leone has made significant strides in its fight against HIV, TB, and malaria. The country is moving closer to the 95-95-95 targets for HIV, with substantial increases in the number of people aware of their status and on treatment. TB case finding has improved, and malaria incidence rates have dropped markedly over the past decade.

The new grants aim to build on these achievements by scaling up antiretroviral therapy and HIV care, expanding access to TB diagnosis and treatment, and supporting universal long-lasting insecticidal net (LLIN) campaigns and malaria case management. Additionally, these grants will enhance systemic health improvements, including disease surveillance, laboratory diagnostics, and health product and waste management. These efforts are complemented by a US$34 million COVID-19 Response Mechanism grant, supporting pandemic preparedness and response.

The launch of these grants underscores the urgent need for vigilant oversight and robust management practices. Transparent and accountable management is not just a best practice; it is necessary to ensure that these funds translate into tangible health improvements for the people of Sierra Leone.

Key measures to ensure the effective utilization of these grants include continuous training and capacity building for the PMU and Fiscal Agent to enhance their ability to monitor grant implementation and prevent fraud, implementing transparent and competitive procurement processes to prevent fraud and collusion and ensure that every dollar is spent effectively, strengthening community engagement and participation in health initiatives to ensure that the needs and voices of those most affected by HIV, TB, and malaria are heard and addressed, and establishing robust monitoring and evaluation mechanisms to track the progress and impact of funded activities, making adjustments as needed to achieve desired outcomes.

Launching these new grants represents a significant opportunity for Sierra Leone to further its progress in the fight against HIV, TB, and malaria. However, seizing this opportunity requires a steadfast commitment to overcoming past challenges and building a transparent, accountable, and effective health system.

As we move forward, let us remember that the true measure of success lies not in the amount of money received but, in the lives, saved and the health improvements achieved. With vigilant oversight, robust management, and a collective commitment to accountability, we can ensure these grants fulfil their promise and secure a healthier future for all Sierra Leoneans.

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