In Côte d’Ivoire, the Nouvelle Pharmacie de la Santé Publique (NPSP), the facility responsible for receiving, warehousing and distributing medicines, and the Programme National de Lutte contre la Tuberculose (PNLT), a principal recipient, were responsible for a massive diversion of TB drugs financed by The Global Fund.
This is the conclusion of a report of the Office of the Inspector General (OIG) that has just been published. According to the OIG, this diversion did not lead to any treatment disruption.
Since 2004, The Global Fund has invested $336 million in Côte d’Ivoire.
Last year, routine spot checks by the Secretariat revealed that RHZE, a first line TB drug, was being sold illegally in local markets. Touted as a cure for many diseases, RHZE had a street value that was double its original price.
The OIG investigation also identified through market surveys a cross-border inflow of RHZE. Boxes of the TB drug financed by The Global Fund and other development partners from neighboring countries in West Africa were found in the local markets in Côte d’Ivoire.
Two million pills diverted
According to the OIG, the Nouvelle Pharmacie could not account for two million doses worth $148,544. These pills were from the program’s emergency reserves representing four months of supply for the whole country.
Between January 2014 and June 2015, the PR received 9% of all the doses distributed in the country, said the OIG. The PNLT claimed that having its own stock of pills was a way to prevent temporary stock-outs in treatment centers that had experienced unavoidable delays when ordering from the Nouvelle Pharmacie.
However, during its field visits, the OIG team found that RHZE drugs were stored “haphazardly” in small quantities in a “untidy and poorly maintained room.” It also found that the program was located near one of the local markets where the illegal sales occurred.
According to the OIG, the program continued to procure more RHZE pills than necessary. In 2015, it raised its target of reserve stocks from 2.5 million to 4.5 million pills.
The OIG report identified $155,605 in non-compliant expenditures.
“I Speak Out Now” campaign
Among the root causes of the diversion, the OIG cited weak stock and supply management by the Nouvelle Pharmacie and PNLT.
Côte d’Ivoire is one of the three pilot countries in a campaign called “I Speak Out Now,” launched by the OIG in March 2016. The goal is to increase awareness among, and provide information to, potential whistleblowers about fraud and abuses committed within Global Fund-supported programs (see GFO article).
One aspect of this campaign involves using public announcement on national radio and in the media to inform about the dangers of taking RHZE without prescription.
When informed about the problem in August 2015, the Ministry of Health immediately instructed PNLT to stop receiving and distributing RHZE in treatment centers.
It also required that PNLT provide a new operational plan for procurement, stock management and TB drugs for 2016-2017. A multi-sectorial committee was created to oversee the stocks. Finally, the PNLT and the Nouvelle Pharmacie were required to conduct regular inventory counts, with CCM members present as observers.
Among the measures taken by the Secretariat, a stock and logistic module is being integrated into the country’s district health information software tool. This is being done with the participation of stakeholders and development partners.
The Global Fund Secretariat will also determine and “aggressively” pursue appropriate amounts for recovery.
See also separate GFO article on OIG investigations in India, Bangladesh and Guyana.