Anxiety grows over depleted HIV, malaria, TB drug stocks

David Ohito & Elizabeth Mwai | 01 Apr 2009
The Standard (Kenya)
The country's drug stores are running low on Anti-retrovirals (ARVs) and essential treatment drugs for malaria and tuberculosis.

Experts have warned the country faces a big challenge possible suspension of Global Fund (GF) grants and pointed accusing fingers at Ministry of Finance and the two ministries in charge of health.

This came against the backdrop of a strong indictment of Government officials by the GF.

In a recent retreat to Naivasha by the Country Co-ordinating Mechanism (CCM), it emerged that the management of donor funding for the management of HIV, malaria and TB is so poor that Kenya risks losing the funding altogether.

Participants at the retreat were told that Kenya's grant performance is almost the world's worst — 110th out of 114 — and that the Global Fund Executive Director has serious concerns about the way their donations to Kenya are managed. Some Sh680 million from GF was returned unused because officers in the two ministries did even realise their accounts had the funds.

Anti-retrovirals, drugs for malaria treatment (Coartem) and multi-drug resistant (MDR) tuberculosis face stock shortages because Kenya is heavily dependent upon Global Fund financing to pay for these drugs.

"The potential consequences of the stock-outs for the people of Kenya are enormous," Mr Bernard Rivers who monitors the Global Fund in Kenya said in a confidential report presented at the retreat.

Parts of the report are a harsh indictment of officers tasked with the management of the programmes.

Unused funds

On one occasion, the report says, Sh280 million sent by the GF remained unused for a year in a ministry bank account because, according to an insider, the relevant manager "didn't realise" that it was there."

In another example as the Round Two HIV grant was nearing the end of its five-year term, approximately Sh400 million already disbursed by the GF, sat in a bank account in Kenya, ready for use. But programme managers never spent that money, despite an approaching ARV stock shortage. Now the grant's term is over, the money has to be returned to the GF."

To prove how careless Kenya Government officials have been, Global Fund Website posted information regarding the Round Two Kenya HIV, malaria and TB grants to June 2004.

During this period, each grant had received one disbursement from the GF. The total value of the disbursements was Sh608 million. The audits revealed that 99 per cent of this money, about Sh600 million, had been withdrawn but not accounted for.

Worse still the power conflicts between Ministry of Health and Ministry of Finance was blamed for the woes which deepened when the health docket was split into Medical Services under Prof Anyang' Nyong'o and Public Health led by Mrs Beth Mugo.

So deep are the differences that National Aids and Sexually Transmitted Diseases Control Programme (Nascop) is now split into two.

When we reached Nyong'o by telephone yesterday, he said he was not aware of the situation, as he did not have his notes and files in New York where he is attending a meeting.

One wing of Nascop is headed by Dr Ibrahim Mohammed who is in charge of care and treatment services (Medical Services) while the other is headed by Dr Nicholas Muraguri (Public Health) who is in charge of HIV/Aids prevention.

Donors have decried the fight between the ministries saying, "the problems caused by splitting Ministry of Health into two is that Governmental Aids programmes, in particular, are now divided between the two ministries, with prevention being dealt with largely by the Ministry of Public Health and Sanitation, and the provision of ARVs being dealt with largely by the Ministry of Medical Services. As a result, one or more pre-existing teams had to be divided between the two ministries."

Last year when there were audit queries, which led to the cancellation of Sh24 billion GF grant Round Eight, Nyong'o and Mugo held separate news conferences to clear the air.

Nyong'o said the money could be accounted for but Mugo said no money was lost and she could account to the last coin.

At the retreat that was attended by PSs from both health ministries, the Government admitted it had failed to provide leadership for the project that would have helped millions of sick Kenyans.

The audit said most grants to Kenya are currently inactive: "Nearly all Kenya's GF grants are inactive. Kenya's three Round Two grants have reached the end of their five-year terms, with a total of 47 per cent Sh5.3 billion of the agreed Phase One and Two funding undisbursed and no longer available.

Example: The Round Two malaria grant received not a single disbursement from the GF during its three-year Phase Two.

"This is the first time that such a thing has ever happened to any GF grant worldwide." Mr Rivers said.

The Government also admitted it failed to use the funds diligently.

Out of Kenya's eight proposals to the GF, six have been rejected as being unsatisfactory.

The meeting was told that Kenya does not lack experts who could draw up winning proposals and the example of Tanzania's Round Eight HIV proposal that was approved for Sh47 billion over five years was cited because it was authored by a Nairobi-based Kenyan.

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