THE government was forced to reimburse some donations to international vaccine alliance, Gavi, because of weak internal protocols and ineffective management processes, acting Auditor General (AG), Monica Besetsa, has said.
So poor are the management systems that some vaccines expired while they were still in the shelf before being dispensed because health workers haphazardly used their inventory.
This and other unsupported expenses in different vaccination programmes cost the government US$333 901 (about M 5, 2 million) in reimbursements to Gavi.
Based in Geneva, Switzerland, Gavi focuses its support on low-income countries, with eligibility based on the country’s national income. Countries become eligible for Gavi support if their average gross national income (GNI) per capita has been less than or equal to US$1580 (about M 24 402) over the past three years as determined annually by the World Bank.
From 2002 to 2017, the total cash and vaccine support provided by Gavi to Lesotho amounted to US$ 7 547 630 (about M116, 6 million). The total cash grant for health systems strengthening was US$2 055 710 (M31, 7 million) while the total value of vaccines was US$5 491 920 (M84, 7 million).
However, Ms Besetsa said the donations were grossly mishandled by the Health ministry to the extent that Gavi demanded reimbursements.
“I have noted from the report on the programme audit of support to the Ministry of Health about the dissatisfaction of Gavi on inadequate internal controls and processes and ineffective vaccine management, which called for the government to reimburse some funds to Gavi,” Ms Besetsa said.
She established that there were weaknesses in the internal processes including that the oversight and governance mechanisms in the Health ministry did not provide adequate assurance or stewardship over Gavi’s support to the immunisation programme.
Due to understaffing of the national immunisation team, Gavi-supported activities were not adequately implemented, monitored or managed, she said.
“The budgetary financial management and internal controls were ineffective, resulting in budget overruns and expenditures being incurred without ensuring availability of sufficient funds. Not all expenditures were evidenced with adequate supporting documents.”
She said the vaccine management was unsatisfactory so much that “a significant amount of measles Rubella vaccine shelf-expired, and other vaccines were effectively written-off in the records in 2016 and 2017 without adequate explanation”.
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“The forecasting and logistics were ineffective in managing the vaccines appropriately; record keeping for vaccines was inadequate, notably 32 146 doses of Gavi-supported vaccines were unaccounted for (9166 in 2016 and 22 980 in 2017).”
There was also weak vaccine management, including failure to adhere to the “earliest-expiry-first-out” principles, she said.
“Gavi therefore, requested the Ministry of Health to reimburse a total amount of USD333 901, which constituted unsupported and ineligible expenditure. The Ministry of Health has reported that the reimbursement was not made, as there was a reallocation of M3 million per directive of the Ministry of Finance leaving a balance of M2 million which was not enough to cover the due amount of US$333 901 equivalent of M4 923 790 at that time.
“The Ministry of Health should have treated this issue as a matter of urgency to secure future assistance and to protect the image of the government,” Ms Besetsa said.