World Bank cuts AIDS funds due to “some issues”

By Kumudini Hettiarachchi

A major five-year World Bank HIV/AIDS prevention project worth US$ 12.6 million is ending its term amidst reports of under-utilization of funds and serious allegations of mismanagement and corruption while in some cases huge sums of money were used on a bus tour with a few musical shows as a publicity drive.

The project, coming under the Ministry of Health and ending on June 30, is not getting the usual extension even though 30 percent of the project fund is yet to be utilized. The World Bank said that due to “some issues” it was not being extended, adding that up to date just 55 percent of the grant has been disbursed, with 65-70 percent expected to be used by the end of June.

The Sunday Times learns that a World Bank Review Mission is in the country to wind down the work. From the time the National HIV/AIDS Prevention Project (NHAPP) was set up it has been dogged by problems. These included the politicization of the project, “musical chair” appointments within the project (five Directors and three Procurement Specialists in five years), infighting between the project and the National STD/AIDS Control Programme which it was meant to support and certain activities decided on correct procedure and awarded to companies being cancelled midway without due reason, informed sources, close to the project, said.

The latest issue to come to light is the shortage of Anti-Retroviral (ARV) drugs being administered through state-run clinics to around 125 people suffering from HIV.

When The Sunday Times raised several queries with the World Bank and requested a meeting with the Review Mission, we were told that they had back-to-back meetings and asked that the questions be sent by e-mail. To numerous and detailed questions, a two-page statement was sent by the World Bank on e-mail on Friday night.

The World Bank statement indicating four “important achievements” under the NHAPP conceded that there has been “limited progress on some key project activities”. These activities are listed by the World Bank as:

• Insufficient effort to reach most-at-risk populations, the most effective response in light of the low prevalence of HIV, throughout the life of the project;

• Aabsence of an effective communications strategy, and an evidence base to guide the content and targeting of interventions, resulting in ad hoc activities, and messages and services that were not as effective as they should have been;

• Inadequate progress in setting up a monitoring and evaluation framework to effectively monitor and steer the response, nor to provide the Bank regular data on project implementation;

“The agreed date of project completion at the time the project was negotiated is June 30, 2008. The Bank extends projects only on an exceptional basis. Given the issues identified above, the Bank is not extending this project beyond the agreed date,” it adds.

When The Sunday Times contacted the current Director of the NHAPP, Prof. Colvin Goonaratna who had taken over not even a year ago, in July 2007, with regard to under-utilization, he conceded that the systems had not been working. “The management was less than optimal,” he said. Other sources closely associated with the NHAPP from its very inception, but fearful of being identified, said ideally the project should have been under the National STD/AIDS Control Programme, because the outright grant from the World Bank was secured in the first place by the then Director of the Programme.

“But the moment the large quantum of money was seen everyone including those at the very top wanted a finger in the pie,” said a Consultant Venereologist, in a view echoed by a cross-section of people, not only doctors but also from various sectors connected to the NHAPP.

Senior specialists from the HIV/AIDS field and also other technical fields linked to HIV/AIDS moved away disillusioned, another source explained, adding that Sri Lanka, a low-prevalence HIV country could have made much progress in the face of a predicted HIV explosion in Asia.

Informed sources told The Sunday Times that by early 2007, four years into the NHAPP, not even US$ 4 million had been utilized.

The NHAPP due to cover the period 2003-2008 was challenged by acute issues from the very beginning. “Sometimes NGOs doing good work with vulnerable groups like sex workers ran into trouble because they seemed unwilling to pay massive bribes,” a medical source said, citing another example of a duly awarded contract (running into about Rs. 150 million) for a major publicity drive on HIV awareness, both in the electronic and print media, being cancelled halfway through after most of the work was done, due to differences of opinion of members of a Health Ministry Committee.

Ultimately, large sums of money were spent to take a bus to a few towns, hold a few musical shows and then give a few speeches on HIV, he said, with even that being cancelled after severe criticism.

The Sunday Times understands from an NGO, the Community Strength Development Foundation, which says it’s the only institution working for the welfare of sex workers, that there were major delays in approving its project proposal with a proposed budget of Rs. 33 million because it was unwilling to pay bribes.

“A person claiming to have high connections brazenly came to the NGO office and demanded firstly Rs. 500,000 to get the project passed and also requested us to put forward another proposal for Rs. 20 million to work in two other areas and hand over that Rs. 20 million to him. When asked how we would be able to show our accounts, the person had allegedly claimed, ‘Api thama eka ballanne’ (‘We are the ones looking into that.’),” an NGO source said.

Complaints to the World Bank Head in Colombo at that time had elicited the response that it had been forwarded to Washington for an investigation and after many written statements by the NGO, it had been verbally informed in November 2006 that “there will be a management change soon at the project”.

To the question in this regard put by The Sunday Times, the World Bank responded: “In general, all allegations are reported to the Integrity Department of the World Bank which carries out an independent investigation of the facts. Till such reports are completed we are not informed as to the results of such an investigation.” While the World Bank statement set out the guidelines it follows when allegations are made, it was unclear whether the Bank had received any allegations or not.

According to the NGO, there had in fact been certain changes in May-June of 2007 at the NHAPP and the NGO had been requested to put forward a 10-month work proposal which too was watered down. Finally a six-month proposal for Rs. 4.6 million had been approved, starting in January 2008 and ending in June. “The work we can do in six months is very limited,” the NGO source lamented.

With the World Bank’s National HIV/AIDS Prevention Project winding up in June, whatever action the World Bank takes, it seems only appropriate that the government and the Health Ministry must conduct an audit to check what happened, what went wrong and whether anyone made undue gains from the funds meant for the needy people living with HIV and also to keep HIV at bay. This is the plea of all those concerned and interested in keeping HIV figures down in the country.

Then, at least, Sri Lanka could learn a bitter lesson, while seeing 30% of the unutilized grant funds (free money) being sent back to the World Bank.