Global Fund programmes providing HIV and TB treatment to the uninsured population in Thailand (about 6–7% of the total population) are not sustainable because they are not integrated with the national health system. This was one of the observations the Office of the Inspector General (OIG) made in a report on its diagnostic review of six grants to Thailand.
The diagnostic review, which was carried out in the last quarter of 2012, covered all six active single-stream-of-funding grants to Thailand. The six grants had a value of $116 million, of which $64 million had been disbursed at the time of the review. The government principal recipient (PR), the Department of Disease Control (DDC) in the Ministry of Public Health, managed three of the grants, one for each disease. Each of three civil society PRs – Raks Thai Foundation, Populations Services International and the AIDS Access Foundation – managed an HIV grant.
The diagnostic review identified many good practices. For instance, the OIG said, there were numerous examples of innovative and creative community-led HIV prevention programmes among key affected populations that were implemented despite limitations created by the general political context in Thailand. The OIG also observed that the approach to social support of vulnerable children in programmes funded by the grants was aligned with the national child protection policy.
However, the OIG also identified a number of risks that it said could impede the achievement of programme objectives if they are not mitigated. The OIG said that some of the extensive information collected for M&E purposes in Global Fund grants to Thailand was not used or not needed, or could more easily have been obtained from other sources.
The OIG said that organisations implementing programmes targeting children spent more than 50% of their time completing forms, particularly documents designed to provide proof of their activities. In addition, the OIG noted, a migrant HIV prevention programme managed by one PR had 32 different data collection instruments for nine output indicators in the performance framework.
The diagnostic review identified problems with the use of the Global Fund’s Voluntary Pooled Procurement (VPP) mechanism. According to the OIG, the average lead time for procurement through the VPP was 10.4 months (versus the 6–8 months recommended in the VPP guidelines). The OIG identified two factors that contributed to the increased lead-times: (1) purchase orders were being issued only after the receipt of grant funds; and (2) the PR had to obtain approval from the Global Fund Secretariat each time unit price quotations obtained through the VPP exceeded reference prices in the grants’ approved procurement and supply management plans.
The OIG said that, one year, the long procurement cycle led to the receipt of bednets after the peak malaria season had passed; and to a stock-out of some malaria tablets, which required an emergency order.
Other weaknesses observed by the OIG included the following:
- Certain programmes were not well-designed, were based on invalid assumptions or were out of date.
- There were inadequate financial controls and poor financial management practices.
- The financial oversight of grant programmes by PRs and sub-recipients (SRs) was not effective.
The OIG mentioned an additional risk: the emergence of Artemisinin-resistant malaria in the western (Myanmar) and eastern (Cambodia) border areas of Thailand. The OIG said that almost two-thirds of malaria cases recorded in 2010 were among refugees and short-term migrants.
The country coordinating mechanism, the PRs and the Global Fund Secretariat agreed with all of the findings and recommendations in the report. They agreed to strengthen financial controls and seek additional resources for the oversight of SRs. The Secretariat agreed to review its VPP processes in order to shorten the lead times for procurement.
The OIG’s report on its diagnostic review of grants to Thailand is available on the Global Fund website here.