R 121116Z MAR 09
FM AMEMBASSY NOUAKCHOTT
TO SECSTATE WASHDC 8214
INFO AMEMBASSY ACCRA 
USMISSION USUN NEW YORK 
USMISSION GENEVA

UNCLAS NOUAKCHOTT 000199 
 
 
DEPT FOR AF 
ACCRA FOR USAID/W 
 
E.O. 12958: N/A 
TAGS: EAID PGOV UNDP KHIV MR
SUBJECT: GLOBAL FUND ALLEGES FRAUD AND MISMANAGEMENT IN MAURITANIA 
 
SENSITIVE BUT UNCLASSIFIED - PROTECT ACCORDINGLY 
 
¶1. (SBU) Summary: The Geneva-based Global Fund issued a formal 
complaint letter to its Mauritania Country Coordinating Mechanism 
(CCM) February 13 alleging fraud and mismanagement of the country's 
$32 million Global Fund aid package for malaria, tuberculosis and 
HIV/AIDS.  All funding has been frozen in Mauritania until the 
underlying problems can be addressed.  While the Global Fund 
criticized the CCM for lack of oversight, its allegations of fraud 
and mismanagement are directed at the two principal beneficiaries: 
UNDP and the National Executive Secretariat for the Fight Against 
AIDS (SENLS).  The Global Fund's formal complaint follows the CCM's 
recent trimestrial progress report submission and a December 2008 
Global Fund technical verification visit to Mauritania.  The two 
principal recipients have both responded to the allegations.  While 
the response and action plan from UNDP were generally considered 
adequate, SENLS has not provided a sufficient response and there are 
still many concerns about problems within it.  The CCM has yet to 
respond to the Global Fund, although it is expected to do so 
shortly.  Criticism of the CCM for lack of oversight is not 
surprising given the disorganization and chaos that have existed 
within it for quite some time.  The CCM is now moving forward with 
restructuring plans intended to address some of the most serious 
issues.  The Global Fund is planning a follow-up investigation of 
the program in Mauritania and is looking at ways to improve 
management, such as employing Grant Management Solutions.  End 
summary. 
 
The Global Fund and Mauritania's CCM 
------------------------------------ 
¶2. (U) The Global Fund is an international financing institution, 
which has committed $14.9 billion to date in 140 countries to 
support large-scale prevention, treatment and care programs for 
tuberculosis, malaria and HIV/AIDS.  The United States is the 
largest donor, with pledges totaling over $4 billion between 2001 
and 2008, and a recent pledge of $500 million for 2009.  The Global 
Fund uses a performance-funding approach, meaning that funding is 
transferred to principal recipients upon completion of certain 
performance indicators.  At the country-level, the Country 
Coordinating Mechanism (CCM) is responsible for programmatic 
oversight and achievement of these performance indicators.  The CCM 
comprises all key stakeholders, including representatives from the 
Ministry of Health, technical partners, the private sector, civil 
society, principal recipients, and donors.  While the CCM does not 
have direct financial responsibilities, it is responsible for 
submitting proposals, nominating the entities accountable for 
administering the funding, and overseeing grant implementation. 
There are two principal recipients in Mauritania: UNDP which 
oversees the malaria and tuberculosis portfolio and SENLS (National 
Executive Secretariat for the Fight Against AIDS) which oversees the 
HIV/AIDS portfolio.  The principal recipients receive the money 
directly from the Global Fund and are charged with implementing the 
programs.  They are also charged with writing the trimestrial 
progress reports.  UNDP and SENLS both have several sub- and 
sub-sub-recipients. 
 
The Global Fund's Accusations 
----------------------------- 
¶3. (SBU) In its February 13 letter, the Global Fund accused UNDP of 
a lack of sub-recipient financial management transparency; a lack of 
supervision of sub- and sub-sub-recipients; difficulty 
reconstituting and justifying data (financial and programmatic) 
previously transmitted to the Global Fund; and inadequate human 
resource capacity to manage key functions of the program.  The 
Global Fund accused SENLS of fraudulent practices and a lack of 
transparency.  It noted SENLS' lack of an archiving system that 
would allow reconstitution of data (financial and programmatic) and 
justification of expenses; lack of supervision of sub- and 
sub-sub-recipients; and inadequate human resource capacity to manage 
key functions of the program.  The more serious of the allegations 
are directed at SENLS.  Recipient NGOs have also made accusations of 
fraud against SENLS, complaining most often that they have to pay 
SENLS employees in order to be reimbursed.  Post has shared these 
accusations with Global Fund Portfolio Manager for Mauritania 
Vanessa Rousselle. 
 
¶4. (SBU) The Global Fund criticized the CCM for a lack of oversight, 
but did not accuse it of fraud or mismanagement.  The CCM has only 
received $43,000 from the Global Fund for its oversight activities. 
The program funds are given directly to the principal recipients; 
they are not channeled through the CCM.  The principal recipients 
are required to maintain data and provide trimestrial reports to the 
Global Fund, which they submit via the CCM.  The CCM does not 
actually write the reports, it only reviews them. 
 
UNDP Response 
------------- 
¶5. (SBU) UNDP Resident Representative Maria do Valle Ribeiro 
responded to the allegations in a letter dated February 27.  In the 
letter, Ribeiro summarized UNDP's action plan, which is designed to 
correct the deficiencies identified by the Global Fund.  Similarly, 
Ribeiro sent a February 18 letter to the President of the CCM 
requesting his assistance in responding to the allegations and 
implementing UNDP's action plan.  Moreover, she requested that he 
improve CCM oversight of the Global Fund sub-recipients' financial 
and programmatic activities, which UNDP infers are at the root of 
the problem.  The CCM president responded in writing to Ribeiro's 
February 18 letter and stated that the Ministry is considering these 
allegations very seriously and that the anticipated CCM 
restructuring should help correct the CCM deficiencies identified by 
the Global Fund. 
 
SENLS Response 
-------------- 
¶6. (SBU) In its February 26 response to Global Fund, SENLS Executive 
Secretary Dr. Abdallah Ould Horma attempted to respond to the Global 
Fund's accusations.  While Horma responded to many of the technical 
aspects raised by the Global Fund, his response to other aspects of 
the letter was insufficient.  The SENLS did not address all of the 
Global Fund's concerns nor did it present a detailed action plan on 
par with the one the UNDP presented.  While SENLS said in its letter 
that it welcomes further investigation by the Global Fund, there are 
still serious concerns about fraud and mismanagement within the 
SENLS that have yet to be addressed. 
 
The Ministry of Health/CCM's Non-Response 
----------------------------------------- 
¶7. (SBU) While UNDP and SENLS have both responded to the Global 
Fund's letter, the CCM has yet to respond.  The reasons for the 
delay are not clear.  It may be due to the current political crisis 
and the fact that the CCM is barely functioning and has not been 
organized enough to prepare a response.  However, French Cooperation 
representative Michel Treutenaere suggested that there is more than 
meets the eye.  He suggested that the Ministry of Health is trying 
to maintain control of the situation by: 1) waiting to see to what 
extent the primary recipients (UNDP and SENLS) implicate the 
Ministry in the fraud and general mismanagement charges; 2) planning 
for a "house cleaning" within the Ministry of Health, which would 
allow the Ministry to save face in light of allegations because they 
will get rid of the culprits; 3) waiting to pass the buck - and the 
blame - on to the next CCM President, once the group is restructured 
and a new President is named; and 4) avoiding the confession that 
the Ministry is part of the problem, and attempting to stay "clean." 
 
 
Turmoil within the CCM and Ministry of Health 
--------------------------------------------- 
¶8. (SBU) During the past two years there have been five ministers of 
health, two of whom have been very political.  This has led some to 
conclude that health policy has been politicized, although others 
disagree with this assessment.  In any case, the rapid turnover of 
ministers and other top officials within the Ministry of Health has 
created a lack of stability and continuity within the Ministry, 
affecting the implementation of many programs.  The latest 
junta-appointed minister, Mohamed Abdallahi Ould Syam is a public 
law specialist trained in international relations.  Likewise, the 
Secretary General Dr. Mohamed Abderrahmane Ould Ahmed Sidatt is from 
a non-health background, but politically astute and with a good 
reputation as a man of action by most stakeholders.  Sidatt is a 
long-standing government civil servant and known organizational "fix 
it" man. 
 
¶9. (SBU) Mauritania's 23-member CCM has been fraught with problems 
since its creation.  There have been discussions since early 2008 
about restructuring the CCM to make it a more effective oversight 
body.  Until recently the meetings were disorganized to the point of 
being chaotic.  While the CCM reports to the Global Fund, not the 
Ministry of Health, it has been affected by the rapid turnover and 
lack of continuity within the Ministry of Health.  The Secretary 
General of the Ministry of Health is also the President of the CCM. 
With each new Minister, there has usually been a new secretary 
general.  The constant change in leadership of the CCM has meant a 
lack of continuity and stability.  Thus the Global Fund's criticism 
of the CCM for negligence and lack of oversight is not surprising. 
Since his appointment, Sidatt has improved the functioning of the 
CCM, but it remains far from perfect.  There are significant 
internal communication and organizational problems which continue to 
impede its effectiveness.  CCM members such as Treutenaere and World 
Health Organization representative Dr. Lamine Ciss-Sarr are 
convinced that CCM President Sidatt will indeed improve CCM 
functioning and transparency, but it will take time. 
 
¶10. (SBU) Donors have long complained that their calls for better 
oversight on the part of the CCM are not being heard.  On March 2, 
the donor's group collectively presented a letter to the 
junta-appointed Minister of Health urging him to recognize that 
there is a management problem within the CCM and within the Global 
Fund Mauritania portfolio, and to respond to the Geneva letter.  To 
date, the Ministry has responded neither to the Global Fund's letter 
nor to the donor's letter. 
 
CCM Restructuring 
----------------- 
¶11. (SBU) There are already preliminary efforts underway to 
restructure the CCM.  At the last CCM meeting February 19, the 
president announced that members would receive a draft restructuring 
proposal.  One of the main concerns is membership, especially the 
role of the sub- and sub-sub-recipients in the decision making 
process.  Because the Ministry of Health is both a sub- and a 
sub-sub-recipient, there is concern about a potential conflict of 
interest if the Secretary General of the Ministry of Health presides 
over the CCM.  For example, the CCM determined at its February 19 
meeting that the vast majority of goods purchased under the Fund's 
Round Two, a $2.4 million USD tuberculosis and malaria program, 
would be turned over to the Ministry of Health, including all five 
vehicles. 
 
¶12. (SBU) There are questions as to whether the Secretary General of 
the Ministry of Health should continue to preside over the CCM.  In 
most countries, the Ministry of Health is a principal recipient. 
When the Global Fund began programs in Mauritania, it determined 
that the Ministry of Health did not have sufficient capacity and 
thus gave the malaria and tuberculosis portfolio to UNDP rather than 
the Ministry of Health.  The Ministry of Health has expressed its 
interest in becoming the principal recipient for the tuberculosis 
and malaria programs for well over a year.  The Global Fund has 
given no indication that it is prepared to accept this change at the 
current time.  If it ever were to, there would be serious questions 
about oversight and whether the Ministry of Health should directly 
manage several million dollars in donor funds given the current 
political situation. 
 
Conclusion - unanswered questions 
--------------------------------- 
¶13. (SBU) There are many unanswered questions about the future of 
the current CCM, its possible restructuring, the role of the 
Ministry of Health, and even the continuation of Global Fund funding 
due to these recent allegations.  The CCM response to Geneva's 
allegation letter will likely be forthcoming once Geneva provides an 
initial reaction to UNDP's and SENLS' responses.  It is not clear if 
the Ministry of Health will also respond as the Global Fund letter 
was addressed specifically to the CCM.  Rousselle informed the donor 
group that she anticipates a follow-up investigation in early 2009, 
but is unsure of exact timing.  She told EconOff and LES March 8 
that she is tentatively planning a trip to Mauritania March 18-19 to 
meet with the CCM and donors.  She also discussed the likelihood of 
employing Grant Management Solutions, a USAID-funded program to 
provide urgent technical support to countries receiving Global Fund 
funding.  In the meantime, the allegations stand, and the HIV-AIDS 
Global Fund funding for HIV-AIDS programming remains frozen. 
 
HANKINS