Millions of dollars of aid money granted to Cambodia by the Global Fund to combat malaria have been left sitting in a bank account for more than a year, official documents seen by the Post show.
The money remains untouched because the National Malaria Centre (CNM) is refusing to sign a funding agreement for a $12 million Global Fund grant it could have accessed since July because it objects to a request to provide detailed accounts of the spending, a source close to the Global Fund in Cambodia said, a move that could potentially put thousands of lives at risk.
The source said that the CNM had spent virtually none of a separate $9 million grant it has been entitled to use since August 2014, which was awarded as part of an urgent initiative to combat drug-resistant malaria in the Mekong region, a claim backed up by documentation.
“The management team at CNM has downed tools and taken the grant-making process hostage,” the source said. “They have frustrated attempts to finalise grant negotiations because they don’t want to provide receipts for travel and hotel expenses.”
There are millions of dollars in the travel and accommodation budgets of such grants, the source added.
“The government is sitting on a heap of money, crying there is a malaria outbreak, but refusing to do anything about it, unless they are allowed to steal the money.”
Officials at CNM and the Ministry of Health were previously ordered to pay back hundreds of thousands of dollars to the Global Fund after they set up fake bank accounts to allegedly receive bribes and kick-backs.
Multiple calls to the CNM and the Ministry of Health went unanswered.
Financial records the Global Fund requested for an investigation into widespread corruption in health grants were withheld and censored by grant recipients in Cambodia, and significant portions of those files that were made available were missing crucial information, suggesting a cover up, the fund’s probe noted.
The impact on the effort to combat malaria has reportedly been severe.
“The World Health Organization (WHO) has reported to us that in villages, malaria testing kits are running out and drugs are running out,” the source said. “Because of CNM inaction due to the dispute over expenses, village-level malarial workers have not been re-supplied with drugs for the last couple of months.”
Early this year, $2 million worth of mosquito nets were purchased with Global Fund money. they have still not been handed out because CNM is responsible for distribution and “has refused to do its job” due to the dispute over expenses transparency, the source said.
At the same time, figures compiled by the government, in conjunction with the WHO, show that the number of cases of malaria in Cambodia have increased by 35 per cent in the first six months of this year, according to the source.
“While CNM has been obstructing, malaria cases have been increasing, and work in the field is not being managed properly,” they said.
WHO is reportedly worried the increase in cases of malaria in Cambodia may represent an increase in resistance to an antimalarial drug which is the last line of defence, a combination of the drug artemisinin and another known as DHA-PIP.
However, when the Post contacted the WHO, the global health body rejected this claim.
“As of today, there is no evidence of increase of multi-drug resistance in Cambodia,” a WHO spokeswoman said, adding that between June and July this year, about 2 million mosquito nets and 600,000 hammock nets had been distributed. Additionally, Cambodia’s stock of anti-malarial drugs was sufficient to supply the country’s needs for the next two years, she said.
However, the source close to the Global Fund in Cambodia said the mosquito nets referred to by the WHO were not the ones purchased early this year with money from the Regional Artemisinin Initiative (RAI) Global Fund grant. Those nets had yet to be distributed.
The current row over expenses is not the first time CNM has held up grants over control of money. In late 2014, according to the source, CNM dug its heels in when the fund argued that NGOs, not CNM, should be responsible for payments to village malarial workers.
“CNM said no, if NGOs manage local payments, we won’t submit budgets,” said the source, adding that on this occasion, CNM got its way and was given control of the payments.
According to the source, the current impasse is part of a growing trend.
“The Cambodian government is putting increased pressure on global organisations to turn a blind eye,” the source said.
CNM’s alleged failure to carry out planned anti-malarial work could have global consequences.
“Resistance to anti-malarial drugs developed in Cambodia is often exported to Africa and Latin America and makes malaria resistant there,” the source said. “An increase in malaria such as the one we are currently seeing in Cambodia could lead to an increase in resistance to the last line of defence drug. If a drug resistant malaria parasite spreads to Africa, it could be a disaster.”
Millions of Africans died in the 1990s when a malaria parasite which had developed resistance to the drug chloroquine spread to Africa from Cambodia.
The source added that CNM’s failings could result in its share of the RAI money being withdrawn.
“In November this year, there is a RAI regional committee meeting in Hanoi about the Global Fund’s $100 million grant to combat malaria drug resistance, of which Cambodia has been allocated $15 million. but due to mismanagement, Cambodia may lose its allocation and get nothing,” the source warned.
The fund on December 9, 2013, threatened to suspend or reduce more than $100 million of grants to Cambodia if the recipients failed to meet a 30-day deadline to return funds identified as “misused” by the Global Fund probe.
It later relented, saying that the fraction of returned funds showed a desire to cooperate.
ADDITIONAL REPORTING BY CHHAY CHANNYDA