Safeguarding Medicines and Commodities

Enhanced oversight measures, better controls, and public awareness campaigns are essential to prevent mismanagement and protect the integrity of Global Fund programs. Read more on mitigating health product diversion.

Availability of quality medicines, health products and commodities at health facilities and service delivery points is critical in defeating HIV, tuberculosis and malaria. About US$2 billion, roughly half of the Global Fund’s investments every year is spent on lifesaving health medicines and commodities. These significant investments and programmatic ramifications make it critical to safeguard medicines and commodities.

The Global Fund and implementers continue to take actions to ensure availability of medicines and commodities at service delivery points, but mismanagement and diversion of essential medicines and commodities present a pressing challenge, as shown through Office of the Inspector General (OIG) reports.

OIG’s audits and investigations highlight the negative impact of weaknesses in in-country controls that resulted in confirmed commodity diversion of resources, theft of drugs and illicit resale of certain medicines. OIG’s cases highlight that issues in the oversight and distribution of crucial medicines and commodities can jeopardize the effectiveness of Global Fund programs.

Commodity Diversion

Country	GUINEA
	Investigation Report ENGLISH or FRENCH

An OIG investigation uncovered a diversion of malaria nets from a long-lasting insecticidal nets (LLINs) mass distribution campaign in Guinea. Manipulation of data, particularly the inflation of population counts in certain areas, created an environment in which commodity diversion was possible. Commodity diversion refers to the unauthorized transfer or use of resources meant for a specific purpose, in this case, LLINs for malaria prevention.

The investigation was initiated after it was suspected that 117,500 LLINs were diverted from the 2019 Guinea LLIN mass campaign to neighboring Mali. The OIG confirmed that this diversion included over 10,000 nets financed by the Global Fund preventing people in Guinea from having access to them. While the value of these diverted nets may not have been significant, the data manipulation highlighted that the actual number of diverted LLINs could be higher, raising concerns about the effectiveness and integrity of the campaign.

Malaria Drugs Theft in Malawi; Subsequent Actions Have Improved the Situation

Country	MALAWI
	Investigation Report ENGLISH or FRENCH

When malaria drugs arrived in Malawi, they were transported to a state warehouse in preparation for distribution to hospitals and clinics. However, a portion of these crucial medications had been stolen from the warehouse, finding their way into the country's black market, and even being diverted to other countries for sale. Remarkably, the drug packaging clearly had the warning "Not for Retail Sale."

Malaria patients seeking treatment at public health clinics, where they were entitled to receive free medication, were turned away. The medication shortages were the direct result of drug theft and diversion.

Strong country ownership and actions taken by the Global Fund and partners have since strengthened controls and processes. This has addressed issues at the central level where OIG’s subsequent audits successfully traced all medicines at the central level though some vulnerabilities in inventory controls remain at health facility level.

Strong Outreach Activities and Controls Help Reduce Illicit Resale of TB Medicine

Country	CÔTE D'IVOIRE
	Investigation Report ENGLISH or FRENCH

An investigation by the OIG revealed that substantial amounts of TB medicine funded by the Global Fund were illicitly resold in various markets throughout the country. These antibiotics were being purchased by consumers for purposes unrelated to TB treatment, such as using them as remedies for common issues like headaches or stomach pains, or even as stimulants and aphrodisiacs. Using TB medicine for non-TB purposes causes to build up a tolerance to the medicine, meaning that it is less effective when someone is diagnosed with TB. Furthermore, it makes less TB medicine available to those who really need it.

The OIG investigation determined that the primary source of this illicit TB medicine in the markets was the central medical store responsible for managing the national supply chain. This central facility handled the reception, storage, and distribution of medicine to healthcare facilities nationwide, including those funded by the Global Fund. An examination of drug stock records revealed significant discrepancies in accounting for these medications. The absence of adequate controls allowed for the theft to occur, as the central medical store failed to effectively monitor and secure the TB medicines. OIG's audit published in 2016 acknowledged these weaknesses and found that mitigating actions had been undertaken. However, material challenges remained at the health facility level.

Mitigating Product Diversion

The systemic issues in the oversight and distribution of medicines and commodities in all these cases demonstrate how enhanced oversight measures, better controls, and public awareness campaigns are essential to prevent future instances of mismanagement and protect the integrity of Global Fund programs.

Product diversion can happen at various levels of the supply chain and requires targeted mitigation measures adapted to different contexts. Some actions at different levels include:

Central level:

• Well designed and implemented inventory management system and controls including procedures for receipt, storage, and issue of commodities and stock adjustments.
• Regular and frequent inventory counts by non-warehouse staff and investigation of variations between physical quantities and electronic/book balances.
• Triangulation of purchasing, logistics and service delivery data.
• Controlled access and exits of warehouses and use of CCTV where appropriate.
• Controlled monitoring of expiries and expiry dates.
• Use of reliable data for quantification and forecasting of medicine needs.

In Transit level:

• Tracker on delivery vehicles.
• Use of trailer locks and switches to monitor when trucks are opened.
• Proper screening and monitoring of performance of third-party logistics service providers. This includes routine validation of delivery notes by central level.
• Submission of delivery notes signed by health facilities to central level.

Health Facility level:

• Maintain inventory records such as Goods Received Notes and copies of signed delivery notes.
• Routine physical inventory counts and reconciliation to patient consumption registers.
• Triangulation of logistics, consumption and service delivery data.
• Leverage current advances in technology for traceability of commodities and medicines where feasible.

The Global Fund plays a crucial role in fighting AIDS, tuberculosis and malaria and ensuring the proper distribution of resources is essential to its mission.

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