It's hard to imagine that it's been five years since the scandal that compromised Mauritania's HIV program and its relationship with the Global Fund, watching mobile teams canvass neighborhoods to promote HIV diagnostics testing and develop an accurate accounting of the number of cases of AIDS. Door to door, house to house, these teams are working to turn the page on what Dr Mohamed Idoumou Ould Mohammed Vall, the executive secretary of the national AIDS commission SENLS, called a "humiliation for all Mauritanians".
The national AIDS commission was implicated in the 2009 investigation by the Office of the Inspector General for the loss of $6.7 million -- including $4.2 million taken in kickbacks by senior members of the commission's leadership team. Another $2.5 million was lost to fraud carried out by sub-recipients of the UN Development Program (UNDP).
The timing of the revelations was also damaging for the Fund, which uncovered fraud in Mali, Djibouti and Zambia at around the same time. The successive discoveries were like an electroshock for the Global Fund, exposing the weakness of its risk management system and leading to the temporary suspension of hundreds of millions of dollars in contributions by donor countries and forcing a top-to-bottom reform of the organization.
A lot has changed in Mauritania in the last five years; the country now is seen as an example by the Global Fund and its technical partners for how it is recovering from this crisis. Now Mauritania is putting the finishing touches on its concept note to access the nearly $32million allocated under the NFM, in order to revive its Global Fund-supported HIV, TB and malaria programs.
"We saw NGOs coming and going, and funds that were flying around going everywhere. There was only one thing that was clear: those who were ill were not benefitting from much," recalled Fatimata Ball, one of the two representatives of people living with HIV serving on the newly reconstituted country coordinating mechanism.
After the Fund portfolio manager triggered the alarm, what the investigators of the Office of the Inspector General discovered, between 2009-2011, was a textbook example of corruption and bad management.
"Thousands of fake, fictitious or fabricated documents that were used to support alleged program activities in order to trigger expenditures of grant funds to which they were not entitled to, and for activities that did not occur and goods that were not in fact delivered," helped fuel the bribes, and payoffs that paid for lavish homes, a fleet of vehicles and luxurious overseas holidays, the OIG report concluded.
"One witness alleged that the SENLS senior official had been throwing money instead of confetti at his/her own wedding."
The entire program was rotten at its core. Between 2004 and 2008, the SENLS managed its HIV grant with no procedures, no accounting, no technology. Sub-recipients and sub-sub recipients operated with no supervision from the principal recipient. The management system for drugs and other commodities was pathetically lacking. Those program and financial results that should have triggered warnings and suspicions from the local funding agent (LFA) were not archived, which resulted in a massive undertaking to try and put the pieces of the puzzle back together; by its own estimation, the OIG team had to scan, enter and analyze more than 50,000 pages of program documentation. Investigators interviewed close to 800 people.
Things were not much clearer when it came to TB and malaria grants managed by the UN Development Program. Investigators were refused access to bank accounts on the grounds that, in the case of a UN agency serving as PR, "the Global Fund waives many of the fiduciary tools it has to work with other PRs," according to a citation by the High Level Independent Review Panel in the OIG report.
Thus the investigation was limited exclusively to SR and SSR where the OIG was able to uncover a systematic and deliberate effort to falsify receipts and to collude in bids and tenders in the markets. Compounding the fraud was the absence of a monitoring and evaluation plan for both SRs and the lack of a system -- or even a database -- to collect and manage performance indicator data.
In total, the OIG identified losses of some $2.5 million in fraud perpetuated under the UNDP-administered grant -- a sum contested by UNDP, which said that from its own internal audit that losses due to fraud amounted only to $1.06 million.
Shock treatment to restore confidence
Following the suspension of all Global Fund support for HIV in July 2009, Mauritania undertook a series of measures to address the situation (the TB and malaria grants administered by UNDP were not renewed). First off, most of the members of the SENLS team involved with the Global Fund grants were sacked and replaced. The executive director, the finance manager and the director of administration and finance were jailed. The accountant remains on the lam after evading arrest.
To satisfy one of the conditions to lift the suspension of the HIV grant, the government reimbursed some $4.2 million in misappropriated funds identified by the OIG. With respect to UNDP, there are some $1.5 million to recover but Fund spokesman Andrew Hurst told Aidspan that "corporate-level discussions" were ongoing, with the expectation that "the issue [will] be resolved soon".
To mitigate the conflicts of interest that were rife, the CCM was dissolved and reconstituted, said René-Fréderic Plain, a senior CCM specialist at the CCM hub in the Fund's Grant Management Support Unit.
"As part of the country’s efforts to fulfil one of the Global Fund’s conditions for reinstating the HIV grant, the Mauritania CCM was entirely restructured with the technical support of GMS," he said. "Thanks to the mobilization of national stakeholders and partners, as well as to the CCM’s leadership, it is now functional and recently performed its evaluation and performance assessment (EPA) with the financial support of [the French government's] 5 percent initiative."
Now, with the lifting of the HIV grant suspension, an agreement for continuity of services was signed to pay for the French Red Cross to provide treatment for 1,900 people living with the disease, said Emina Rye-Florentz, who is the new FPM for Mauritania.
“Since the suspension of the Round 5 HIV grant was lifted, the Global Fund has worked closely with the national PR (SENLS) and the SR (French Red Cross)," she told Aidspan. "They have established an innovative and collaborative partnership, while introducing thorough grant implementation monitoring systems to ensure that essential services supported through the grant are delivered to people living with HIV.”
Since 2012, these surveillance tools use a computerized tracking system to monitor stock levels "down to the pill level," said Dr Heyine Ely Cheickh, a pharmacist who watches commodity and drug levels for the French Red Cross in Mauritania.
From test case to role model
Mauritania has traveled far in its relationship with the Global Fund. So far that in Geneva, it is hailed as a success story.
"The CCM officially launched the Country Dialogue in May 2014 to submit three concept notes, and the Global Fund Secretariat is assured that it is well placed to conduct an inclusive and transparent Concept Note development process," said Plain.
"These measures have restored confidence between us and our partners," according to Idoumou Ould Mohammed Vall of SENLS. "We have earned their respect."
An affirmation confirmed by Joseph Serutoke, the Fund's Middle East and North Africa regional director.
"The Mauritanian government and partners have been responsive in addressing the issues and recommendations that followed the OIG investigation," Serutoke told Aidspan. "The constructive engagement by Mauritania and partners in resolving the issues is encouraging, and the Global Fund looks forward to continuing to work with all stakeholders as we are reengaging in Mauritania as part of the rollout of the new funding model."