WASHINGTON, 25 December: President George Bushs ambitious AIDS-fighting program in poor countries has pushed so hard for fast results that basic record keeping and accountability often went by the wayside, making it hard to judge the true success, according to government audits and officials.
Investigators found the three-year-old, 15-billion US dollar program has overcounted and undercounted thousands patients it helped or was unable to verify claims of success by local groups that took US money to prevent the spread of disease or care for AIDS victims and their children.
The Bush administration says it has worked to fix the problems that were found in multiple countries and outlined in several audits.
– It is not good enough for the auditors to hear from the mission that we did A, B and C but we can not prove it to you, or there is no documentation to prove that we did it, said Joe Farinella, a top watchdog inside the US Agency for International Development (Amerikas Danida).
Farinella is the assistant inspector general who oversaw the investigations into how American AIDS money was spent overseas in 2004 and 2005.
He said many recipients failed to keep records that would provide “reasonable assurance that what they say was done was in fact carried out.” The inspector general will recommend that the administration clarify its directives and improve reporting methods.
The administration acknowledges the lapses and says it has imposed tighter reporting systems that have improved the accuracy of information. Officials blame the shoddy record keeping on an eagerness to get money into the field to help AIDS victims.
– You could have waited for three years to get all these systems in place and an awful lot of people would have died, said Ambassador Mark Dybul, the administrations global AIDS coordinator.
– Our approach was get the services out, start moving the programs. In many of the cases where they say we can not find documentation, that does not mean people are not getting services; that just means the reporting systems are not in place, he said. Dybul said he has “extraordinary” confidence in the overall numbers.
For at least one country, Guyana, incorrect numbers made it into this years annual report to Congress. It cited services to 5.200 AIDS orphans, but auditors documented fewer than 300, many of them not even affected by AIDS.
The opposite occurred in South Africa. Some provincial governments refused to disclose information on AIDS tests and counseling, causing “severe underreporting” in the number of victims who were helped with US money, an audit dated Aug. 11 concluded. Officials said that problem was now resolved.
After reporting that millions of people were reached by mass-media promoting sexual abstinence and use of condoms, the administration now has dropped that measurement completely, on grounds it is impossible to know how many people hear radio messages.
The numbers are important because Congress and others closely track administration strategies for a program that is pumping unprecedented sums into AIDS-stricken nations in Africa. The administration demands that programs make progress toward specific targets each year and report tallies in dozens of categories.
Bushs goals are ambitious: to treat 2 million infected people by 2008, prevent 7 million new infections and provide support and care for 10 million HIV/AIDS patients and orphans.
– The accuracy of the numbers is essential and is something Congress should look at, said the incoming chairman of the House Government Reform Committee, Democratic Representative Henry Waxman of California.
Current counts of people helped from each country are “within scientifically acceptable ranges of numbers,” said Win Brown, a data quality consultant to Dybuls office.
The USAID’s inspector general focused on care and prevention in 2004 and 2005, but did not highlight drug treatment, which Dybul said is easy to count and had good accountability.
Tracking care for orphans has been especially troublesome. Local groups were found tallying individual handouts such as meals or clothing and not measuring true care. That led the administration to impose a new rule in July that a child can only be counted if provided with three of six key services. The administration also is working to avoid double counting when a child gets help from more than one program.
Development experts say local groups often were ill-equipped to meet record keeping demands. The administration has pushed to enlist new religious and community organizations and often they work as subcontractors under more established nonprofits that are used to getting and accounting for government money.
One of the largest recipients of grant money, Family Health International, experienced 83 percent inaccurate or unverified tallies from its subcontractors in impoverished Guyana and could document only 345 of 9.000 HIV/AIDS infected people reported as receiving tuberculosis treatment in Nigeria, auditors said.
The organization has since strengthened training for its local partners, “making sure the people clearly understand what they’re measuring,” senior vice president Sheila Mitchell said.
Dybul said the updated numbers the administration reported on World AIDS Day December 1st are accurate: 822.000 people receiving life-saving drugs, and 4,5 million receiving care.
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On the Net:
The Presidents Emergency Plan for AIDS Relief:
http://www.pepfar.gov
US Agency for International Development background on AIDS:
http://www.usaid.gov/our_work/global_health/aids/
Family Health International: http://www.fhi.org
Kilde: The Push Journal
