Several shortcomings and in one instance inaccurate information were discovered in the early stages of the implementation of the US President's Emergency Plan for AIDS Relief (PEPFAR) in Guyana, according to an audit done in 2005. These issues, described as "teething problems" by PEPFAR officials here, who described the audit as useful, have since been corrected.

Among the more critical shortcomings highlighted in the audit report, which was published in May last year, were weak financial management practices by some of the sub-grantees (local NGOs); delays in the procurement of antiretroviral drugs; late advancement of cash to sub-grantees and inaccurate reporting of achievements in performance targets.

However, Julia Rehwinkel-Roberts Population Health & Nutrition (PHN) Officer at USAID, under which PEPFAR falls, told Stabroek News in a recent interview that the audit was done when the programme was new and was experiencing what could be described as "teething problems".

She also disclosed that some of the issues raised in the audit had actually been rectified before the audit was done but they were still recorded in the report because the audit looked at a period prior to when the issues were addressed.

She said USAID/Guyana agreed with some of the issues raised in the audit and spent some eight months trying to adjust its programme and has communicated all of its changes to the investigation office in Washington, supplying evidence of the work done. As a result, just recently, a letter arrived from the investigation office informing that the investigation had been closed.

Erroneous information

The audit report had said that the USAID Annual Report and the PEPFAR Report to Congress contained "erroneous information. For example, the Second Annual Report to Congress states that 5,200 orphans and vulnerable children received support while in reality less than 300 received support."

The report said this was because the results reported by Family Health International (FHI), which along with its subcontractors provided technical direction to a network of 19 non-governmental organisations that provide services to the programme's beneficiaries, Ministry of Health and the sub-grantees were inaccurate or unsupported. As a result, it said, USAID/Guyana could "…not reliably determine if programme activities were meeting their objectives or make well-supported programmatic funding decisions."

Rehwinkel-Roberts clarified that the 5,200 in the report to Congress referred to the units of services provided to 289 Orphans and Vulnerable Children (OVCs). She noted that the mission and its strategic information counterpart had corrected that error and reported the actual number (289) of OVCs reached during that six-month period. The audit team felt this error should have been noticed earlier, since the total estimated number of the OVCs for the entire country is 4,000. The PHN officer pointed out that when the PEPFAR programme started here there was no final definition of guidance from Washington and this was not provided until mid 2006, around the same time the audit was done. Since then, she said, a strategic information officer has been put in place to track all partners to ensure that information is verifiable. This, she said, would increase the level of confidence in reporting since indicators can now be tracked and partners have been trained and have guidance. She pointed out that Guyana has a high level of OVCs, but while some are orphaned or directly affected by HIV and AIDS, others are orphaned or affected by other issues. She said in 2004 USAID/Guyana had estimated that over 4,000 OVCs were going to be reached and provided services on two levels: support for all the affected children and a specific package for HIV infected or affected children; all of these were counted as services. But the following year there were no indicators which now see only children directly infected or affected by the virus being assisted through the programme. And instead of the services provided the number of children being assisted is counted. Initially, the programme had some 60 indicators but these have since been reduced to 30. However, the offices in Washington only look at ten of the indicators, Rehwinkel-Roberts said.

She added too that the other OVCs are not left stranded by the programme but they are supported at policy levels through UNICEF and other agencies.

Affected morale

Both Rehwinkel-Roberts and USAID/Guyana Mission Director Dr Fenton Sands agreed that the audit was not good for the morale of some of their employees and at the NGO level. But Dr Sands explained that audits are the way USAID does business. He pointed out that the PEPFAR programme was a new one and there was emphasis on results.

"We have indicators and plans to monitor ourselves and we always monitor ourselves and we have made adjustments since the audit," he said.

According to the auditors, while visiting nine sub-grantee project sites they compared the information included in the progress report supplied to USAID by FHI, which is provided by the sub-grantees in monthly progress reports, with supporting documentation. "We found errors and discrepancies in 50 out of 60 cases reviewed."

But as Dr Sands noted: "There was a lack of clarity when we started the programme, it is a learning process and we saw after the fact that our sub-grantees may not have understood what we wanted."

Rehwinkel-Roberts added that most of the NGOs are not older than six years and it is not that they were being dishonest in their reporting, but rather they may not have understood how it ought to be done. So while they may have had the names of children they helped they may not have had the additional supporting documentation and for the purposes of the audit this would be recorded as inaccurate.

Weak financial management

The audit report pointed out that the programme's accounting firm Maurice Solomon Services, which was responsible for handing over monthly grants to the sub-grantees, required that they submit liquidations by the tenth day of the following month but several of the sub-grantees submitted liquidations late and included unsupported misclassified costs in their liquidations. This weak financial management, according to the report, resulted in four sub-grantees being placed on a three-month probation period and they were subjected to extra scrutiny by the accounting firm's financial analysts when they reviewed monthly liquidations, which further resulted in disallowances or delays in receiving funds needed for care and prevention activities.

"Weak financial practices may also create vulnerabilities to fraud, waste and abuse," the report said, citing the three NGOs that were placed on three months probation and two which had the period extended to another three months. USAID/Guyana ag-reed that there were institutional weaknesses, which have since been addressed. But it said the audit should have also taken into consideration the context and civil society in Guyana. In relation to the NGOs being placed on probation Rehwinkel-Roberts said the practice was to conduct a "rolling assessment" of the institutional capacity of the NGOs during the proposal review process and throughout the implementation cycle. The two NGOs listed in the report have since been taken off the probation but others have been placed on probation.

"Once it is determined that specific NGOs lack the requisite institutional capacity they are placed on diverse probationary periods.

Such decisions are based on our knowledge of the NGOs, the accuracy and timeliness of their reporting, and the technical evaluation of their programmes," Rehwinkel -Roberts said.

She agreed that weak financial practices result in disallowance and delays in receiving funds and the ability to implement the programme, but added that USAID/Guyana strictly respects its responsibility to account for funds distributed and as such follows the contractual obligations while strengthening the NGOs financial management system in order to correct the weaknesses.

Dr Sands noted that the NGOs are doing very good work at the community level and they need the support.

The report mentioned that some NGOs lacked the capacity to sustain themselves after the PEPFAR programme would have ended, but Dr Sands said most of the NGOs receive funding from other organisations and the Government of Guyana provides funding to most of them and that is a step towards sustainability. "They are gaining the capacity that they need and we would work on their weaknesses but they have come a long way," he said.

Slow procurement of ARVs

On the issue of the procurement of ARVs, the report said: "Treatment supported by USAID/Guyana did not progress as expected due to delays in procuring ARV drugs. Interruptions in the supply of ARV drugs may literally be life threatening. To cope with the shortages caused by the procurement delays… [drugs] were borrowed from Mercy Hospital from October 25, 2005 to November 23, 2005."

But USAID/Guyana disagreed with this. It said there were no treatment delays or interruption in treatment that resulted from the procurement process. It was pointed out that prior to the arrival of paediatric ARVs procured by GHARP, no paediatric formulations were available. It also pointed out that no patients were denied treatment as a result of any delays in the procurement process but it was recognised that frustration was created by the unavoidable time-consuming process.

And, according to the mission, the need to borrow drugs was as a result of an inaccurate assumption provided by stakeholders during the quantification activity. "There was an assumption that far more patients would be converted from liquid to solid formulation than actually occurred. This resulted in the borrowing of two liquid preparations. Utilisation patterns are somewhat unpredictable and a system to share inventory between partners was developed for this reason. For example GHARP borrowed drugs from the CRS [Catholic Relief Services which provides drugs through Mercy Hospital]. In early 2006 CRS borrowed other drugs from GHARP."

Rehwinkel-Roberts noted that the mission has a lot of partners who provide ARV treatment and they have been collaborating to ensure that there are no gaps or overlapping.

The audit report also found that of the 27 USAID-financed activities listed in the 2005 country operational plan, four activities exceeded planned output, 17 did not achieve planned outputs, and six could not be evaluated because targets were not established or because sufficient information on actual accomplishments was not available.

But the mission said weaknesses of 23 indicators were recognised and removed from the reporting responsibility, six of which were directly applicable to the performance evaluation. The date by which the programme had to achieve its results was March, 2006 and not September, 2005. When this is taken into consideration, of the 21 activities listed in the report, 13 fully achieved or exceeded planned outputs and eight did not fully achieve planned outputs. But of those eight, five achieved 70% to 98% and only three achieved levels of less than 50%.

Rehwinkel-Roberts noted that prior to the PEPFAR programme, which is US$30 million, USAID/Guyana had a programme which was just US$200,000, hence the teething problems experienced. "What audit reports don't look at is success stories; they only look at the weaknesses and that is good as we can address those weaknesses," she said. But she said the mission ensured that its partners were aware of the success stories so as to boost their morale. She noted that the auditors had no medical background nor did they work in the area of HIV and as such did not understand the indicators.

Dr Sands said the mission accepted some of the principles of the report, and as USAID preached accountability to its partners it must be accountable at all times. And while the report may have given a lot of "heartburn" it was useful, he said.

"The [auditing] process is difficult as you have to stop what you are doing and provide them [the auditors] with the information they need," he said, while adding that many more audits would be done.