The Ethiopian Public Health Institute Did Not Always Manage the President's Emergency Plan for AIDS Relief Funds or Meet Program Goals in Accordance With Award Requirements

Through its Global HIV/AIDS Program, the Centers for Disease Control and Prevention (CDC) implemented the President's Emergency Plan for AIDS Relief (PEPFAR), working with ministries of health and other public health partners to combat HIV/AIDS by strengthening health systems and building sustainable HIV/AIDS programs in more than 75 countries. Through a 5-year cooperative agreement, CDC awarded PEPFAR funds totaling $6.9 million to the Ethiopian Public Health Institute (the Institute) for the budget period September 30, 2010, through September 29, 2011.

The Institute did not always manage PEPFAR funds or meet program goals in accordance with award requirements. With respect to financial management, specifically financial transaction testing, $4,300 of the $4.7 million reviewed was unallowable.

Additionally, the Institute (1) did not accurately report expenditures and cash disbursements for this cooperative agreement on its annual Financial Status Report (FSR), (2) submitted its annual FSR to CDC 2 months late, (3) had $3.8 million of unresolved advances to regional facilities at the end of the budget period, (4) used $163,000 of funds to pay potentially unallowable value-added taxes (VAT) on purchases, (5) did not have an annual financial audit completed and the report submitted on time as required by United States Government (Federal) regulations, and (6) did not submit its annual financial audit report to the National External Audit Review Center in accordance with the award requirements.

Our program management review showed that, of the 64 goals from its cooperative agreement, the Institute reported accomplishments for all goals in its annual progress report. Our sample review of 38 reported accomplishments showed that 20 were fully supported by documentation, 14 were partially supported, and 4 were not supported. Also, the Institute submitted its annual progress report to CDC almost 2 months late.

These errors occurred because the Institute did not have adequate policies and procedures.

We recommended that the Institute (1) refund to CDC $4,300 of unallowable expenditures, (2) work with CDC to resolve whether VAT was an allowable expenditure under the cooperative agreement and to seek reimbursement from the Ethiopian Government for the $163,000 of VAT paid, (3) require regional facilities to submit quarterly expenditure reports and reconcile the outstanding cash advances, and (4) develop and implement adequate policies and procedures.

Institute officials concurred with our recommendations.