By: Frank P. Martin
MONROVIA: In an effort to strengthen Liberia’s Health System in the fight against AIDs, Tuberculosis, and Malaria, the Government of Liberia through the Ministry of Health (MOH), in collaboration with Liberia Coordinating Mechanism and other key donor partners, on July 11, 2024, launched the Global Fund Grant Cycle Seven (7) at the Monrovia City Hall.
The launch signifies an unwavering commitment to combat HIV, tuberculosis, and malaria, which have posed significant challenges to the nation’s health care delivery system.
The GC-7 grant, which amounts to one hundred and seventeen million, five hundred and forty-six thousand, six hundred and seventy United States dollars (US$117,546,670), represents a renewed dedication to improving healthcare outcomes for Liberia.
President Joseph Nyuma Boakai led an array of government officials to the colorful event, as he recognized the critical need for a resilient, efficient, and accessible healthcare system in Liberia.
Addressing the gathering including the Minister of Health, Dr. Louise M. Kpoto, representatives of the NGO community, Global Health Partners, foreign diplomats, and esteemed guests, President Boakai expressed immense gratitude for the support of the Global Fund in addressing critical healthcare challenges faced by Liberia.
The President acknowledged the invaluable partnership of the Global Fund, emphasizing its crucial role in supporting Liberia’s development agenda by contributing to the healthcare system and providing crucial assistance in the fight against HIV, tuberculosis, and malaria.
The Liberian leader said: “We will work diligently to mobilize domestic resources, strengthen our financial management systems, and foster partnerships with other stakeholders to secure additional funding for our health programs.”
In a brief remark at the event, Health Minister, Dr. Louise M. Kpoto, lauded President Boakai for placing the country’s health system on top of his government’s development agenda that triggered renewal of the Global Fund grant for the Liberian people.
“I would like to express my deepest gratitude to his Excellency, President Joseph Nyuma Boakai, Sr., for his unwavering commitment and inspiring words. Your leadership and vision are vital to the success of our national health initiative, and we are immensely grateful for your support to our distinguished guests, and donors, including members of the government, international partners, civil society representatives and all stakeholders,” she acknowledged.
The Health Minister stated that President Boakai’s presence during the launch underscores a collective determination towards a shared vision for his government’s fight against HIV, TB, and Malaria that would ensure strengthening the country’s health system.
Dr. Kpoto also lauded Global Fund and its national team lead, Mrs. Caty Fall Sow, as well as donor-partners for their unwavering support and continual partnership to Liberia’s health sector.
“The symbolic check and the signing ceremony we witness today marked a significant milestone in our history towards a healthy Liberia,” the Health Minister disclosed.
A communication, dated May 4, 2024, detailed that for the Grant Cycle-7 implementation period, the Global Fund has renewed its commitment to support Liberia in the fight against HIV, tuberculosis, malaria and for strengthening its health system through an allocation of US$ 87.3 million, as well as two catalytic “Matching Funds” for a total of US$ 5.9 million.
An Executive Mansion release, however, puts the grant figure in the sum of US$117,546,670, which it said, represents a renewed dedication to improving healthcare outcomes for Liberia.
As part of this renewed Global Fund Grant, Liberia will also benefit from two catalytic Strategic Initiatives for integrated laboratory systems strengthening, and for effective Community Systems and Responses.
It may be recalled that President Boakai held sideline meetings with both the leadership of the Global Fund and Millennium Challenge Corporation (MCC), pledging Liberia’s commitment to ensuring straight adherence and scale up performance to meeting the MCC score card and all benchmarks of the Global Fund.
Over the past two years, serious compliance issues were raised at the Ministry of Health, both by the Office of the Inspector General (OIG) investigation and grant oversight mechanisms.
The compliance issues are related to recurrent challenges of accountability at the Ministry of Health, resulting in US$6.7 million of non-compliant expenditures (US$1.9 million confirmed and US$ 4.8 million potential), persistent systemic risks within the Ministry of Health, despite the ongoing implementation of the OIG related Agreed Management Actions and Risk Management Measures.
While acknowledging the Country Team’s and Fiscal Agent’s role in effectively mitigating the identified risks, the outcome of the OIG investigation (April 2022), the Grant Cycle-6 expenditures review (November 2022), and the Fraud Risk Assessment (December 2022) raised additional concerns due to the persistent systemic weaknesses leading to sub-optimal culture’ on accountability, and insufficient management capacities and grant oversight demonstrated by the Ministry of Health as Principal Recipient, resulting in ineffective program delivery.
Almost no HIV or tuberculosis activities were implemented in 2022 under the LBR-C-MOH grant, meaningless access to quality services and leading to a low in-country absorption rate of grant funds (47% as of December 2022).
These issues put the entire portfolio, especially the beneficiaries, at risk since the Ministry of Health manages 48% of grant funds.
As part of the support to improve the grant management and governance framework, the Global Fund stated that it conducted a high-level mission to Liberia from 5 to 7 September 2022.
Following various engagements with the Office of the President and governmental entities, a decision was made to establish a Memorandum of Understanding to increase the oversight and support from the Ministry of Finance and Development Planning.
The Global Fund also decided to sign a Memorandum of Understanding with the General Auditing Commission for the purposes of providing external assurance services to the Global Fund Liberia grants.
As at the date of this letter, both Memorandums of Understanding remain pending for signature by the Ministry of Finance and Development Planning and the General Auditing Commission.
In order to safeguard the Global Fund’s investments in Liberia, the Global Fund leadership decided to invoke its Additional Safeguard Policy1 on the entire Liberia portfolio with immediate effect.
This decision was taken after an extensive internal consultation process. It is expected to trigger a sustained improvement of accountability in the management of grants, which will enable better program results and a greater impact for the benefit of the people of Liberia, according to the Global Fund Investigation.
The further Safeguard Policy is invoked as a temporary measure for the current grant implementation period (Grant Cycle 6) and the upcoming grant implementation period (Grant Cycle 7), includes to revoke this status, the Global Fund has included a draft and indicative list of “Exit Criteria”.
The policy also directs that Liberia will need to demonstrate including the recovery of confirmed non-compliant expenditures, evidence of strengthened internal controls at the Ministry of Health, and an increased government support for effective implementation.
The “Exit Criteria” will be negotiated in consultation with the Country Coordination Mechanism to formalize the Additional Safeguards Policy’s Exit Roadmap.
The Global Fund Secretariat acknowledges Liberia’s achievements despite all the challenges and remains committed to continuing to support the Country in combating HIV, tuberculosis, and malaria and building resilient and sustainable health systems.
The Global Fund counts on the Liberia Country Coordination Mechanism to continue its vital role in overseeing program implementation, and acting as a forum for discussing strategies, opportunities and progress of the Global Fund funded programs.
