The Centers for Disease Control and Prevention's South Africa Office Did Not Always Properly Monitor Recipients' Use of the President's Emergency Plan for AIDS Relief Funds

Through its Global HIV/AIDS Program, CDC implemented the President's Emergency Plan for AIDS Relief (PEPFAR), working with ministries of health and other in-country partners to combat HIV/AIDS by strengthening health systems and building sustainable HIV/AIDS programs in more than 75 countries. CDC's office in Pretoria, South Africa (CDC South Africa), is responsible for PEPFAR funds awarded to government agencies and for-profit and nonprofit organizations (recipients) in South Africa.

Our audit found that CDC South Africa did not always monitor recipients' use of PEPFAR funds in accordance with HHS and other Federal requirements. There was evidence that CDC South Africa performed some monitoring of recipients' use of PEPFAR funds. However, most of the recipient cooperative agreement files did not include required documents or evidence that CDC South Africa had monitored all cooperative agreements.

CDC South Africa did not have written policies and procedures to help ensure that it consistently monitored the cooperative agreements for recipients in accordance with HHS and other Federal requirements. As a result, CDC South Africa did not have assurance that PEPFAR funds were used as intended by law. Subsequent to the audit period that we reviewed, CDC South Africa drafted standard operating procedures for managing cooperative agreements, including monitoring. We did not test these procedures and cannot comment on their effectiveness.

We recommended that CDC South Africa implement standard operating procedures for monitoring recipients' use of PEPFAR funds. CDC concurred with our recommendation.