According to a source close to the Global Fund in Cambodia, the Cambodian government is refusing to sign a funding agreement for a $12m grant, which could have been put to use since 1 July, because it objects to a requirement to account for travel and accommodation costs.
“The government has 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.”
Millions of dollars are earmarked for travel and accommodation in the Global Fund grants to Cambodia. Government officials did not respond to multiple requests for comment.
The Cambodian government was previously made to pay back hundreds of thousands of dollars to the Global Fund after a former official was accused by the aid body of taking kick-backs.
The source added that the government has also spent virtually none of a $9m grant it has been entitled to use since August 2014, awarded as part of an urgent initiative to combat drug-resistant malaria in the Mekong region.
The impact of the current impasse on the effort to combat malaria in Cambodia is said to be severe.
“The WHO has reported… that in villages, malaria testing kits are running out and drugs are running out,” the source said. “Because of [government] inaction due to the dispute over expenses, village-level malarial workers have not been resupplied with drugs for the last couple of months.”
In addition, at the beginning of this year, mosquito nets worth $2m were purchased with Global Fund money but have still not been handed out because the Cambodian government is responsible for distribution, the source said.
This is not the first time the government has held up grants over control of money. In late 2014, according to the source, it dug its heels in when a stakeholder group, which manages how Global Fund money is spent, said that NGOs, not the Cambodian government, should be responsible for making payments to village malarial workers.
“The government said, ‘No, if NGOs manage local payments, we won’t submit budgets’,” said the source, adding that on this occasion the government got its way and was given control of the payments.
The director of the WHO’s global malaria programme, Pedro Alonso, said his organisation was worried about a recent rise in malaria cases in Cambodia.
“We have seen a significant increase in cases of malaria since June 2014, and we got into a debate about whether to describe it as an epidemic or not,” he said. “The increase has further accelerated in the first six months of this year. I think a 35% increase in cases in the first six months of 2015 is a credible figure.”
The WHO, which wants to eliminate malaria in Cambodia and other countries in the Mekong region by 2025, wants to see an end to the deadlock.
“Our interest is that the Global Fund and the Cambodian government agree a mutually acceptable way forward,” he said. “The Global Fund must reach an agreement where the government has to account in a reasonable way for resources that are used.”
“It is not uncommon to see these levels of increases in a single country. Such increases can be due to cyclical variants, such as climate. El Niño is happening at the moment, for instance.” he said. “My interpretation at this point is that what we are probably seeing in Cambodia is one of these cyclical variations that happen from time to time.”
There has been an overall downward trend in malaria in Cambodia over the last five years.
Approximately 65,000 malaria cases and 279 deaths were recorded in 2009, according to WHO figures, compared to 25,000 cases and just 18 deaths last year.
A spokesman for the Global Fund acknowledged the current delays to the implementation of grants for Cambodia’s malaria programme, but insisted the aid body would not compromise on the issues at stake.
“The Global Fund has a zero tolerance policy for fraud and corruption. In Cambodia, the Global Fund implemented a framework of accountability and insists that all partners follow it, no exceptions,” he said. “The Global Fund looks to Cambodia’s ministry of health to address implementation challenges and to support efforts to further strengthen systems for health to serve the people of Cambodia.”
The Global Fund was also mindful of the recent increase in cases of malaria in Cambodia.
“We are aware of rising rates in some provinces, and we are extremely focused on taking all measures to limit the spread of malaria, which highlights the need for partners to implement programmes swiftly and effectively,” he added.
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