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Vol XI No 7

The tendency sometimes to protect perpetrators for the sake of peace...doesn't help society. Impunity should not be allowed to stand. - Kofi Annan on Waki report

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8.23. CONNAUGHT HOSPITAL (2012)

8.23.1. Receipt Books not submitted By Revenue Collectors

Twenty-four (24) receipt books issued to revenue collectors were not returned. Their value was estimated at Le45,500,000. It was recommended that the Finance Officer should ensure that all receipts books given to collectors were returned. It was also recommended that the receipt books must be made available for verification within thirty (30) days of the receipt of the report, or the amount of Le45,500,000 refunded into the hospitalís account. 163

Officialís Response

The HM said that the twenty four (24) receipt books in question had been retrieved from the out gone Finance Officer and were available then for verification.

Auditorís Comment

Out of the twenty-four receipt books only one(1) was verified leaving a balance of twenty-three (23) valued at Le45,250,000.

8.23.2. Cash Book Not Properly Maintained

Some entries in the cashbooks were made in pencil. It was recommended that the Finance Office should explain why entries in the cash book were not done in ink, within thirty (30) days of the receipt of the report.

Officialís Response

The HM said that the entries in the hospitals cash book in pencil were done by the Revenue Collector when he was out of the country on official matters. He said that he had ensured that those mistakes were regularised and available for verification.

Auditorís Comment

The irregularity has not been amended.

8.23.3. Revenue And Proceeds Allegedly Paid To Bank And The CRF

For revenue amounting to Le621,357,876 bank statements were not presented to confirm that the said amount was banked. The auditors were also not able to confirm that Le32,500,000 representing 5% of the revenue generated was paid into the CRF as bank paying-in slips were not presented for inspection. It was recommended that the Finance Officer ensured that all revenue generated were paid into the bank accounts of the hospital. In addition, evidence relating to the payment or usage of the Le621,357,876 must be made available for verification within thirty (30) days of the receipt of the report, or, the said amount be refunded by the Finance Officer. Furthermore, evidence of payment of the Le32,500,000 must also be made available for verification within thirty (30) days of the receipt of the report, or the amount paid into the CRF by the Finance Officer.

Officialís Response

The HM said that the said amount was indeed deposited in the hospitalís account under his supervision. The revenue collectors he noted, were denied requesting for the bank statements because they were not signatories to the account. He said that he had formally requested for the bank statements and they were available for verification. According to the HM since he assumed office he had ensured that 5% of whatever was collected as revenue was transmitted to the CRF. The paying slips in respect of the said amount he noted were available for verification.

Auditorís Comment:

Out of the Le621,357,876 unaccounted for, bank statements were submitted to confirm the payment of only Le193, 673,438 leaving a balance of Le427,684,438 for which bank statements were not submitted to confirm payment made to the bank. Bank paying-in-slip to confirm the payment of Le32,500,000 to account no: 1100856 held at Bank of Sierra Leone was submitted and verified. However no bank statements were produced to confirm payments made to the bank.

8.23.4. Documents Not Presented For Audit Inspection

The following documents were not produced to the audit team for inspection: bank statements for accounts numbered; 007-0014802244401 Eco Bank, 01-3001-11-0200008364 SLCB and complete set of the other accounts: bank reconciliation statements, cheque stubs, records on the operation of the ambulances, minutes of management meetings, minutes of drugs and therapeutic committee meetings. It was therefore recommended that the said documents should be made available for inspection or verification within thirty days of the receipt of the report, by the Hospital Care Manager. The Secretary, Drugs and Therapeutic Committee was also to make available minutes of meetings for verification, within thirty days of the receipt of the report.

Officialís Response

The HM said that bank statements and monthly reconciliations of the said accounts were available but were locked up in his cabinet when he was away. The said documents were available for verification. Also, he said that efforts had been made by the Hospital Management to get the minutes of all management meetings held and they were available for inspection.

Auditorís Comment

Out of the two bank accounts, bank statements were only submitted for one account i.e. Ecobank Account No. 007-0014802244401. Evidence of monthly bank reconciliations for all the bank accounts maintained by the Hospital were not submitted to the audit team for verification.

8.23.5. Drugs Procured For The Hospital and Not Put Into Use

Regular drugs amounting to Le7,897,500 and Free Health Care Drugs valued at $13,701 were procured and not consumed. Upon inspection, the auditors noted that those drugs had also been expired but had not been disposed of. It was therefore recommended that the pharmacist should provide plausible explanation, within thirty (30) days of the receipt of the report, why the drugs were kept until they expired and why they had not been disposed off.

Officialís Response

The HM stated that the pharmacist had his own method of disposing expired drugs and that he had been contacted on this issue.

Auditorís Comment

The issue remains the same.

8.23.6. Reagents And Other Working Instruments Not Supplied To The Laboratory And Dental Units

Reagents and instruments needed for the running of the laboratory and the dental units were not supplied to the units. It was recommended that reagents and consumables should be made available to those units for the effective execution of their work and that the Hospital Care Manager must provide documentary evidence on why reagents and consumables were not provided to those units. It was also recommended that the processing tank in the X-ray unit should be replaced within thirty days of the receipt of the report.

Officialís Response

The HM said that the said contract was awarded by the Hospital Management.

Auditorís Comment

The issue remains the same.

8.23.7. Contracts Awarded Not Completed

Contracts which were awarded for the rehabilitation of the Dialysis Unit amounting to Le250,691,043 and the rehabilitation of the Connaught Hospital amounting to Le1,231,694,200 were not satisfactorily executed. There was a leaking roof in the Dialysis Ward, damaged toilets, and fans not in working order in the Hospital, while a work completion certification had been issued to the contractor. However, interviews with some personnel revealed that the consultant in post had taken up the rehabilitation of the unit, from her own personal funds. A generator was procured for the Hospital but has still not been installed. It was recommended that the Procurement Officer, Ministry of Health, should submit a written explanation within thirty (30) days of the receipt of the report as to why those contracts were not satisfactorily carried out or refund the amount of Le250,691,043, and Le1,231,694,200 for the rehabilitation of the Dialysis Unit and Connaught Hospital respectively. It was recommended that the Facilities Officer should provide an explanation as to why the generator had still not been installed.

Auditorís Comment

No response was proffered by the Hospital Management. The issue remains the same.

8.23.8. Unverified Staff Members, And Incomplete Attendance Register

Eighty-two (82) staff members did not show up for verification. Pages were removed from the attendance register and dates were not in order. Salaries paid to those staff amounted to Le834,421,980. It was recommended that the matron should provide an explanation as to why pages were removed from the Attendance Register. Those staff members should also make themselves available for verification within thirty (30) days of the receipt of the report; otherwise, their names would be recommended for deletion from the payroll.

Officialís Response

The HM said that the matter had been forwarded for the attention of the Matron

Auditorís Comment

The issue remains the same, as the staff in question were not presented for physical verification.

8.23.9. Poor Environmental And Sanitary Facility In The Hospital

The environment of the hospital had the constant smell of urinary waste and was infested with rats and cockroaches. In addition, the toilet facilities in the wards were not good and most of the fans in the wards were not working whilst the sum of Le332,000,000 had been paid to a contractor (AFWEN) for the cleaning of the wards. The auditors observed that the monitoring of the cleaning was difficult as the terms and conditions of the contract agreement were not known by the end users. It was recommended that the Hospital Care Manager should address those anomalies within thirty days of the receipt of the report and the Facilities Officer must submit the contract agreement for the cleaning of the hospital within thirty (30) days of the receipt of the report.

Officialís Response

The HM said that the audit recommendations on the matter had been noted and the personnel concerned had been in complete.

Auditorís Comment

The issue remains the same.

Refer to the Table of Common issues (Page 129) for further observations.  

8.24. OLA DURING CHILDRENíS HOSPITAL (2012)

8.24.1. Diet Short-Supplied

A difference of Le 125,706,650 was observed between the schedule of requirement and the Diet Receipt Ledger for the period under review. It was recommended that the Medical Superintendent should ensure that the amount of Le125,706, 650 must be recovered from the supplier within thirty (30) days of the receipt of the report and evidence of recovery forwarded to the ASSL for audit verification.

Officialís Response

The MS stated that the items short supplied had been delivered and evidence of that was ready for verification.

Auditorís Comment

A balance of Le 8,944,000 worth of items was not delivered.

8.24.2. No Strict Internal Medical Waste Control System

Even though several recommendations had been made in the past for the Hospital Management to institute written guidelines regarding the management of medical waste, no such action was taken. It was also noted with dismay that in some instances medical waste (Including sharp object and used needles) were not separated from the general waste that was eventually transported to a general dumping site. Furthermore, there was a garbage dumping spot closer to the Hospital premises designated for the transfer of rubbish, even though, the Hospital through the Freetown City Council, was paying the Freetown Waste Management Company, a total amount of Le 3,000,000 per month for the clearing and transfer of rubbish to the general dumping site. In order to prevent the spread of communicable diseases and to mitigate the risk associated with medical waste, it was recommended that the Hospital Management should make every effort to develop an internal Medical Waste Management Policy. Such a policy would address issues relating to the identification of the various forms of waste, the storage, transporting and the risks associated with medical waste which would will have the benefit of ensuring that all the concerned parties were aware of the cause of action to take when dealing with waste.

Officialís Response

The MS said that modalities had been put in place and would be ready for the next audit for 2013 financial year.

Auditorís Comment

The issue still remains the same.

8.24.3. Review of the Free Health Care System

The following were observed:

Due to the presence of the Free Health Care Programme, the wards were congested;

There were instances where more than two patients of diverse diseases were clustered on a single bed;

There was a serious shortage of medical doctors at the Hospital;

There were only three doctors attending to an overwhelming number of patients;

Interviews with key personnel revealed that doctors were usually not on duty at night; and

Several patients of diverse ailments were using one oxygen cylinder at the same time.

It was therefore recommended that the responsible officers at the Ministry of Health and Sanitation should ensure that the other health centres were equipped to handle referred cases in order to avoid the clustering of patients. In addition, the Ministry of Health and Sanitation were urged to put mechanisms in place to address the chronic shortage of doctors at the Hospital. Furthermore, it further recommended that the relevant authorities should put mechanisms in place for the procurement of more oxygen cylinders, so as to ameliorate the situation.

Auditorís Comment

There was no response to the query; therefore the issue is outstanding.

8.25. PRINCESS CHRISTIAN MATERNITY HOSPITAL (2012)

8.25.1. Poor Condition Of The Store

The store was poorly ventilated and shelves were not adequate as some drugs were scattered on the floor, and no fire extinguisher was at the store. It was recommended that the Medical Superintendent should remedy the situation as quickly as possible.

Officialís Response

The MS stated that Management was working hard to ensure that the above anomalies and other deficiencies in the operation of the store were rectified. He mentioned that the pharmacist who supervised the store had the mandate to deal with those issues, most of which had been addressed.

Auditorís Comment

Though a lot of effort had been made to improve the storage condition by fitting air conditioners in the store, the auditors however realized that there were insufficient shelves, pallets and even the store space was too small for the quantum of drugs delivered to the Hospital.

8.25.2. Congested Labour Ward

The Labour Ward was congested and untidy as there were more patients than beds. It was recommended that the Medical Superintendent must expedite action to remedy the situation.

Officialís Response

The MS said that the labour ward had four beds which were definitely insufficient for the large number of patient visiting the hospital. Therefore the hospital accepted short stay admissions.

Auditorís Comment

The issue still remains the same.

8.25.3. Poor Waste Management

Medical waste was not properly managed in the Hospital as a lot of wastage was observed around the compound. In order to mitigate the risk associated with medical waste, it was recommended that the Hospital Management should make every effort to develop an internal medical waste management policy. Such a policy should include how waste must be stored transported and disposed of.

Officialís Response

The MS stated that the hospital was generally small for the number of patients who visited it; because of tremendous influx of patients. He further said that, it was extremely difficult to get people to place waste in the bin.

Auditorís Comment  

The issue still remains the same.

8.26. PRIMARY HEALTH CARE TONKOLILI DISTRICT (2011)

Refer to the Table of Common issues (Page 129) for further observations.

8.27. PRIMARY HEALTH CARE TONKOLILI DISTRICT (2012)

8.27.1. Fuel Allocation Not Brought To Account

A comparison of the fuel allocations received from the Tonkolili District Council and the amount of fuel consumed by the PHC Tonkolili District revealed a difference of Le18,508,000 that was not brought to account. It was therefore recommended that the DMO should within thirty (30) days of the receipt of that report provide an account of the Le18,508,000 to the ASSL; otherwise, the whole amount must be refunded. In future, all allocations made to the PHC Tonkolili District in respect of fuel should be properly accounted for.

Officialís Response

The DMO stated the issue was as a result of the late disbursement of the first and second quarterly allocation of funds in 2012 and because of that, the sector took fuel on loan to carry out health activities. He said that the amount might have been for the fuel the sector used before the allocation. He however promised that the Primary Health Care would ensure that records in respect of fuel were properly maintained in the future.

Auditorís Comment

An account was not given on how fuel amounting to Le18,508,000 was consumed by the PHC.

8.27.2. Revenue From The Sale Of Cost Recovery Drugs Not Brought To Account

A comparison of the Supply Vouchers of cost recovery drugs and the Bank Statements revealed that the sum of Le89,365,048, in respect of the sale of cost recovery drugs by the PHUs, was not brought to account. It was therefore recommended that the DMO should give a full account of the outstanding balance in respect of the cost recovery drugs sold, to the ASSL within thirty (30) days of the receipt of the report; otherwise, the sum of Le89,365,048 must be immediately refunded. In future, the DMO should ensure prompt payment of revenue generated from the sale of cost recovery drugs into an authorized bank account of the Ministry of Health and Sanitation.

Officialís Response

The DMO stated that upon the audit finding, the District Health Medical Team of the Primary Health Care conveyed a meeting and came up with a decision that all the defaulted PHUs should be called to a meeting in November 2013 to inform them that defaulted PHUs would not get access to their PBF funds until their debts were honored, failing to do so, the DMO would write to the Ministry of Finance through the Permanent Secretary, Ministry of Health for the said amounts to be deducted from the salaries of the defaulters. The DHMT came to realize that some PHUs paid without taking their pay-in-slips to either the Finance Officer or the District Pharmacist.

He mentioned that those issues would be discussed in the meeting.

Auditorís Comment

The recommendation was not implemented.

Refer to the Table of Common issues (Page 129) for further observations.  

8.28. PRIMARY HEALTH CARE BOMBALI DISTRICT (2011)

8.28.1. Fuel Allocation Not Brought To Account

A comparison of the fuel allocations received from the Local Councils and the amount of fuel consumed by the PHC Bombali District revealed a difference of Le20,014,000 that was not brought to account. It was recommended that the DMO should within thirty (30) days of the receipt of the report provide an account of the Le20,014,000 to the Audit Office; otherwise, the whole amount must be refunded and in future, all allocations made to the PHC Bombali District in respect of fuel should be properly accounted for.

Officialís Response

The DMO stated that the fuel allocations to the PHC from the Local Councils were paid directly to the filling station and all records for the use of fuel were available with the Transport Officer and Finance Officer.

Auditorís Comment

The issue is outstanding.

Refer to the Table of Common issues (Page 128) for further observations.

8.29. PRIMARY HEALTH CARE BOMBALI DISTRICT (2012)

8.29.1. Records Of Outstanding Cost Recovery Drugs Not Made Available

A comparison of the value of cost recovery drugs supplied to the Primary Health Units for sale and the bank statements revealed that the sum of Le48,553,900 was still outstanding. The auditors also noted that the returns from those PHUs, in respect of the outstanding balances, were not made available for audit inspection. It was recommended that the District Medical Officer (DMO) should give a full account of the outstanding balances in respect of the cost recovery drugs, to ASSL within thirty (30) days of the receipt of the report; otherwise, the sum of Le48,553,900 must be immediately refunded. In future, the DMO should ensure that the revenue generated from the sale of cost recovery drugs must be promptly banked. The PHC Bombali District should also be furnished with returns in respect of outstanding balances on a regular basis and those returns must be retained for audit and reference purposes.

Officialís Response

The DMO stated that it was a stated policy that revenue in respect of Cost Recovery Drugs must be paid into the Cost Recovery Account as soon as sales were done, but most In-Charges were now doing their payments with receipts forwarded to the Pharmacist at the District Medical Stores and copies available with the Finance Officer.

Auditorís Comment

The audit recommendation was not implemented. An account was not given on the outstanding balances in respect of Cost Recovery Drugs.

8.29.2. Deceased Staff Members Still On Staff List

The names of five (5) deceased staff members were still appearing on the official staff list and payroll of the PHC Bombali District. The total amount that had been paid to those deceased staff members from the date of death to date (according to information from the Accountant Generalís Department) was Le25,312,350. It was recommended that the DMO should ensure the following:  

The deceased staff names should immediately be removed from the Official Staff List of the PHC and the details should be forwarded to the Accountant General for the deceased names to be removed from the payroll.

The Le25,312,350 that had been paid into the deceased accounts from the date of death to date should be recovered and paid into the CRF within thirty (30) days of the receipt of this report; and

In future, information on deceased staff members should immediately be forwarded to the Accountant Generalís Department for prompt action to be taken.

Officialís Response

The DMO stated that all deceased staff members were reported immediately to the Finance Office and Human Resource Management Office (HMRO) of the Ministry of Health and Sanitation. He mentioned that monthly payment for all staff working was done according to the daily attendance register sent to the HRMO and there was a column for deceased staff that was filled monthly by the Monitoring and Evaluation Officer even when their names were appearing.

Auditor Comment

There was no evidence to indicate the extent of implementation of our recommendations.

8.29.3. Vehicles And Motor Bikes Not Licensed And Insured

It was observed that fifteen (15) motor bikes and two (2) motor vehicles used by the Office of the DMO were not licensed and insured for the period under review. It was recommended that the DMO should ensure that all the vehicles and motor bikes owned and controlled by the PHC Bombali District were licensed and insured with immediate effect, and the evidence of that forwarded to ASSL for verification.

Officialís Response

The DMO stated that vehicles and motor bikes licenses and insurance were funded by the Councils on a yearly basis and the Transport Officer had forwarded all licenses and insurance documents to the Councils for action to be taken.

Auditor Comment

Out of the fifteen (15) motor bikes and two (2) motor vehicles, the auditors were able to verify license for two (2) vehicles and three (3) bikes. The licenses for the remaining twelve (12) bikes were not made available for verification.

8.30. GOVERNMENT HOSPITAL MAGBURAKA (2011)

8.30.1. Records Of Diets And Firewood Not Maintained

The Hospital did not make available any record in the form of store ledgers, request forms and distribution list, to justify how diets and firewood supplied to them for Le182,383,238 were consumed/utilized. It was recommended that the Medical Superintendent should provide all the records in respect of diet consumption to the Audit team for verification within thirty (30) days of the receipt of the report; otherwise, the full amounts should be refunded and in future, the Medical Superintendent should ensure the maintenance of records of all diets received and consumed by the Hospital.

Officialís Response

The Hospital superintendent replied that records relating to the utilisation of diets and fire wood had been maintained based on the recommendation.

Auditorís Comment

The records in respect of the consumption of diets and firewood were not made available for verification.

8.31. MAKENI GOVERNMENT HOSPITAL (2011)

8.31.1. Book/Duplicate Copies Of Receipts Not Maintained

It was observed that the book copies of thirty four (34) receipts, with an estimated value of Le970,000 were blank. It was recommended that the Medical Superintendent should submit the details of the receipts in question to the ASSL within thirty (30) days of the receipt of the report and the amount of Le970,000 refunded to the hospital account. It was further recommended that in future, book copies of all receipts issued for the collection of revenue must be maintained for audit and reference purpose.

Officialís Response

The Medical Superintendent stated that the observation was true as they had checked the receipt books and confirmed that the duplicate carbon copies were blank. He said that was a problem they had inherited and because they considered the matter to be serious, they had instituted a monitoring mechanism wherein, all receipts books returned by various collectors were thoroughly checked by the Finance Officer to ensure that all carbon copies were clearly written.

Auditorís Comment

The book/duplicate copies of the receipts were not submitted for verification.

8.31.2. Fuel Used For Non Official Purposes

It was observed that 116 gallons of fuel, valued at Le2,030,000, were given to people who were not employees of the Hospital. It was recommended that the Medical Superintendent should refund the amount to the Hospitalís account within thirty (30) days of the receipt of the report and the evidence of refund forwarded to the ASSL for verification and in future, fuel meant for official purposes should not be put into private use.

Officialís Response

The Medical Superintendent said that that was a matter they considered very serious, since the hospital was in much need of fuel always. He however said that after discussion with the Transport Officer they noted that the fuel in question was used during the joint monitoring exercise with other health related partners.

Auditorís Comment

There was no evidence to indicate that the audit recommendation had been implemented.

Refer to the Table of Common issues (Page 129) for further observations.

8.32. GOVERNMENT HOSPITAL KENEMA (2012)

8.32.1. General Observations

The general management and condition of the Kenema Government Hospital was far from being pleasant. This was evidenced by the following observations: 172

Paediatric Ward:

Beds for hospitalised children were insufficient; the situation resulted in bed sharing;

There was poor ventilation and low visibility in the Ward; and

No electricity, water and toilet facilities existed for hospitalised children.

Male Ward:

There was no toilet facility for hospitalised patients, resulting in the use of plastic kettles for defecation;

There were no trolleys for the movement of medication within the Ward

Surgical Ward:

No electricity and toilet facilities existed for hospitalised patients.

Laboratory:

Basic equipment and consumables like needles, syringes and gloves that should facilitate the smooth and efficient delivery of medical services to patients were not available.

Store:

The following were observed:

The floor space for the proper storage of drugs was insufficient;

Air conditioners required for the recommended temperature of drugs were not available; and

There was no shelf, electricity and furniture for the efficient running of the store.

It was recommended that the Medical Superintendent should ensure that the needs of the various Hospital units were met to facilitate the smooth and efficient delivery of medical services to the general public.

Officialís Response

Regarding the Paediatric Ward, the MS stated that the overcrowding of patients in the ward was due to the free Health Care Service. He said that the ministry of Health and Sanitation had decided to extend the ward to accommodate the increase with beds which would solve the issues queried.

He further mentioned that management had solicited funds from the City Council to re-wire the entire and other facilities mentioned.

Regarding the Male Ward the MS stated that the bad state of the toilet facilities of the ward was as a result of the cesspit that felled. He however said that they had constructed a new one which was now in use and two new toilets had seen supplied to the said unit for use.

For the Surgical Ward, he mentioned that the electricians of the said ward had taken care of the situation and the toilet facilities were to be done by either Goal S/L or SAWACO within a very short time as promised.

Regarding the Laboratory the MS stated that the basic equipment and consumables had been supplied by the Ministry of Health and Sanitation, GLOBAL Fund and International Rescue Committee to facilitate the smooth and efficient delivery of Medical Services to patients.

In the area of Stores the MS stated that the Hospital had no standard that would be able to have all those facilities but the Hospital Management and the Kenema City Council had decided to be rehabilitating existing structures until they were able to contract a standard facility as budgeted in the 2014 Health plan.

Auditorís Comment

Our recommendations were not implemented.

8.33. GOVERNMENT HOSPITAL ĖBO (2012)

8.33.1. Inadequate Doctors And Other Specialists

There were inadequate medical and other specialist doctors assigned to the Hospital. In an interview with a key hospital management personnel, it was revealed that only three (3) doctors were assigned to the hospital during the period under review and that one (1) of them was on maternity leave. In addition, the audit team made several visits to the Hospital at night and it was noted that there was no doctor on duty or one on call at night in case of emergency. Assigned nurses were however always on duty during those visits. It was however noted, throughout the night visits, that the Pharmacy was closed, making it impossible for patients to access drugs in cases of emergencies at night. It was recommended that the Chief Medical Officer in the Ministry of Health & Sanitation should ensure that adequate doctors and other specialists were assigned to that hospital. Furthermore, the Hospital Pharmacy must be opened 24 hours daily.

Officialís Response

The HM stated that the Chief Medical Officer in the Ministry of Health and Sanitation was making efforts to address the issue by sending adequate doctors and other specialists to the Bo Government Hospital. He mentioned that the Hospital Management had also taken action on doctors on call at night in case for an emergency and that management had addressed the opening of the Hospital Pharmacy to 24 hours daily.

Auditorís Comment

ASSL recommendations were yet to be implemented by the Hospital.

8.34. DISTRICT MEDICAL OFFICE ĖBO (2012)

8.34.1. Inadequate Control Over Revenue Administration

An evaluation of the control over revenue administration in the Births & Deaths Units revealed that printed receipt books were not taken on charge in the Accountable Documents Register. It was recommended the DMO posted receipt books received there and then into the Accountable Documents Register for accountability and control.

Officialís Response

The DMO stated that the Accountable Register was now in use, and all printed receipt books had been taken on charge including printed materials received from the Government Printer in adherence to audit observations.

Auditorís Comment

The Accountable Documents Register provided was not updated with the series of the receipt books received and issued during the period.

8.34.2. Inadequate Control Over The Distribution And Usage Of Fuel

The Ministry could not account for fuel costing Le136,113,500 as no form of a log book/ operating record or fuel register was maintained. It was recommended that the Finance Officer forwarded a detailed breakdown and evidence of how Le136,113,500 was utilised to the ASSL within thirty (30) days of the receipt of the report; or the amount stated above immediately refunded.

Officialís Response

The DMO stated that there were operation log books to all vehicles attached to that sector and a fuel register where fuel consumed, purchased by both the City and District Councils were recorded and maintained. He mentioned that all the books for fuel verification may not have been verified for evidence at the time of audit. However the relevant documents referred to were readily available to ascertain the evidence of fuel consumed for verification.

Auditorís Comment

The issue is still outstanding.

8.34.3. Inadequate Control Over The Issue Of Drugs And Other Medical Supplies

There were instances where store items issued using the manual GRIN Cards were not updated in the Channel Delivery System operated by the IT Unit in the District Store. In addition, significant errors were noted in the information relating to the Cost Recovery Drugs generated by the Channel Delivery System operated by the IT Unit in the District Store. In some instances the cost of drugs indicated on the printed and signed Channel Delivery was far greater than the actual cost of drugs supplied and received by selected Health Units. Furthermore, the stock records in respect of each item entering the District Medical Store and its distribution list were not submitted for inspection. It was recommended that the DMO should ensure that the I.T. Channel Operator and the District Pharmacist were properly supervised and the Channel System periodically interrogated by the DMO, by comparing the reports generated with the supporting documents. Any discrepancies should be investigated. The Storekeeper should also submit the relevant stock records to ASSL for verification within thirty (30) days of receipt of the report.

Officialís Response

The DMO stated that management acknowledged the auditors findings of disparity between the actual cost recovery drug quantities and the high prices allocated to them. He said it was as a result of typographical error but that had now been rectified by the IT Channel operator and the actual equivalent costs that must be paid made available to all the facilities that benefited from the cost recovery supplies. He also mentioned that management affirmed the auditorís observation that stock records in respect of each item entering the District Medical Store and its distribution list were not submitted for inspection. He said that it was as a result of inadequate logistics in term of paper and print cartridge to print out the requested document under the review period. He however assured that the soft copy of the document was available for inspection.

Auditorís Comment

The stock records in respect of each item entering the District Medical Store and its distribution list were not submitted for inspection.

8.34.4. General Observation of the Peripheral Health Units (PHUs)

The DMO was to ensure that a thorough review was done on PHUs operations in the district. Appropriate measures/actions must be taken to upgrade their operations by addressing the few observations that had been raised in the report.

Officialís Response  

The DMO stated that management acknowledged the findings made regarding selected centres visited and that some centres were indeed provided with Solar panels, unfortunately those had been carted away by thieves, for which reports were made both to headquarters and the police. He said that frantic efforts had been made to supply both fuel and lubricants to few centres provided with generators for alternate power supply; particularly BENMOCK Centres. He mentioned that the few vehicles available to promote Health Care delivery service in the District had almost outlived their usefulness because of depreciation and topography outlay of the road network could not be overemphasized. He further said that motor-bikes supplied to the Health facilities had actually eased the problems of mobility particularly hard to reach areas; but those also needed periodic maintenance. The limited funds provided for the repairs and maintenance of vehicles and motor bikes were absolutely inadequate, hence compounding the problems of mobility, he stressed. He however mentioned that management would ensure a thorough review of the operations of the PHUís in the District thereby enhancing appropriate measures to upgrade their operations and would address the few observations raised by ASSL.

Auditorís Comment

ASSLís recommendations are yet to be implemented.

Refer to the Table of Common issues (Page 129) for further observations.

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©Sierra Herald 2002