Audit of USAID/Bangladesh"s child survival activities

The Mission has obligated and expended CSD funds under mission strategic objectives (SOs) to reduce fertility and improve family health (SO 1) and finance household income and food-based nutrition (SO 2). Of the $9 million obligated for SO 2, $7.8 million went to activities that contribute only indirectly to improving infant/child health and nutrition and reducing infant/child mortality, e.g., income-generation, sustainable agriculture production, and biodiversity. Agency officials maintain that it is difficult to distinguish between direct and indirect, and feel that many of these activities could have an impact on children. While this may be the case, the Mission did not avail itself of established procedures to obtain advance approval for activities where there might be a question of qualifying for CSD funding. Recent policy has strengthened the requirements and procedures for demonstrating an impact on child and maternal health. Additionally, the Mission"s method of allocating and accounting for the use of CSD funds under SO 1 is imprecise. Under this integrated family planning/health program, CSD funds are co-mingled with development assistance-population funds. The Mission"s current method does not require recipients to account for CSD funds separately. As a result, USAID/Bangladesh does not have reasonable assurance that CSD funds are used for allowable CSD activities. Because the Mission uses the USAID-wide system to allocate and account for CSD funds and because the CSD funds are no longer simply an earmark, but are now also subject to appropriations law, this issue has been referred to the Office of the Inspector General (OIG) Headquarters in Washington, D.C., for possible follow up. USAID/Bangladesh has achieved some of the intended results of its child survival activities encompassed under SO 1. For example, more people are visiting the program"s clinics to use both family planning and health services. Other intended results under SO 1 have not yet been achieved. For example, the program has not significantly affected children"s immunization coverage rates in the country. The audit found several areas needing attention: (1) Although the Government of Bangladesh (GOB) is supposed to provide vaccines to the program"s clinics to immunize children, only 51 of the 175 rural clinics in the program receive vaccines from the GOB. As a result, 124 of the 175 rural clinics were unable to directly provide immunizations -- an important maternal health and child health service. (2) The Mission"s grantee for its Rural Service Delivery component has not yet resolved questioned $52,084 in costs identified for one of its problem subgrantees and has not accounted for fixed assets totaling $26,782 procured by this subgrantee. (3) Two of the eight program clinics visited are located too close to GOB health facilities that provide similar services. As a result, the two clinics have difficulty attracting patients. Program resources could be better used in more neglected areas. (4) The program has been withholding approximately 2,135 boxes of unused oral rehydration salt (ORS) packets purchased during the major flooding in 1998. Thus, the packets were not used to treat and control diarrhea, potentially one of the most fatal childhood diseases. No course of action has been developed for the recommendation that the Mission work with the Ministry of Health and Family Welfare to obtain a regular supply of vaccines for rural clinics and ensure that NGOs provide regular child and mother immunization services at their rural clinics. All other audit recommendations have been addressed by the Mission. (Author abstract, modified)