PEPFAR in 2004, 2005 Did Not Keep Accurate HIV/AIDS Service Delivery Data, Effectively Monitor Grant Recipients, Audits, Officials Say

The President's Emergency Plan for AIDS Relief's push for "fast results" has meant that "basic record keeping and accountability often went by the wayside," according to several government audits and officials who looked at 2004 and 2005 services delivered to people living with HIV/AIDS through PEPFAR grant recipients, the AP/Yahoo! News reports. Government investigators said PEPFAR "overcounted and undercounted" people targeted by the program and could not authenticate local groups' claims of success in preventing the spread of HIV or caring for people living with the virus. According to the AP/Yahoo! News, the Bush administration has worked to fix the problems found in the countries cited in the audits. PEPFAR, which was launched in 2003, aims to treat two million HIV-positive people by 2008, prevent seven million new HIV infections, and provide care and support services to 10 million HIV-positive people and orphans. Joe Farinella, assistant inspector general for USAID, oversaw the investigations into how PEPFAR money was spent overseas in 2004 and 2005. He said that many recipients neglected to keep records that would provide "reasonable assurance that what they say was done was in fact carried out." The 2006 annual PEPFAR report to Congress said 5,200 AIDS orphans in Guyana received services under the program, but auditors documented fewer than 300 orphans received services, and many of those who did receive services were not affected by AIDS, according to the AP/Yahoo! News. According to auditors, about 83% of the records from subcontractors in Guyana for Family Health International, one of the largest recipients of PEPFAR grants, were erroneous or unsubstantiated. An Aug. 11, 2006, audit found that some provincial governments in South Africa declined to give information on HIV/AIDS testing and counseling, leading to "severe underreporting" in the number patients who were helped by PEPFAR funding.

Potential Reasons for Inaccuracies
Often the groups receiving PEPFAR funds work as subcontractors under more established not-for-profits that are experienced at receiving and accounting for federal money, the AP/Yahoo! News reports. Some development experts said local groups seldom were prepared to meet bookkeeping demands. In addition, some local groups have been found to be tracking care for orphans by counting individual items, such as meals or clothing, instead of by recording care for orphans, according to the AP/Yahoo! News. To address this issue, the administration in July began requiring that a child only be counted if provided with three of six key services. Auditors found there were some miscommunications about reporting timetables and mistakes by U.S. officials, some of whom said their heavy workload inhibited their ability to manage and record grant recipients' progress.

Reaction
"It's not good enough for the auditors to hear from the mission that we did A, B and C, but we can't prove it to you, or there's no documentation to prove that we did it," Farinella said. Ambassador Mark Dybul, who serves as the U.S. global AIDS coordinator and administers PEPFAR, said, "You could've waited for three years to get all these systems in place, and an awful lot of people would have died," adding, "Our approach was get the services out, start moving the programs. In many of the cases where they say we can't find documentation, that doesn't mean people aren't getting services; that just means the reporting systems are not in place." He added, "We are putting into place reporting mechanisms that have never existed." Dybul said that some PEPFAR-funded groups that were not meeting program goals have lost funding and others that have called for improvements in reporting methods have welcomed the new system. "Our numbers are the tightest in the world," Dybul said, adding "Yes, we have problems around the margins. We've put enormous effort into them and are improving them all the time." According to Dybul, revised numbers released last month -- which show that 822,000 people are receiving antiretroviral drugs and 4.5 million are receiving care -- are accurate. According to the AP/Yahoo! News, the inspector general said he plans to recommend that the administration clarify its directives and improve reporting methods. "The accuracy of the numbers is essential and is something Congress should look at," Rep. Henry Waxman (D-Calif.), incoming chair of the House Government Reform Committee, said. Rep. Barbara Lee (D-Calif.) said she will seek oversight hearings into the issues presented by audits (Beamish, AP/Yahoo! News, 12/26/06).