On Oct. 29, Togo's health minister, Komlan Mally, reported that the government audit had revealed that roughly a third of the antimalarial medicines provided by the Global Fund, worth well over $1 million, had been stolen. What is worse, CAMEG's own chief financial officer is alleged to be involved. He, along with four other CAMEG officials, including another senior manager, an operations manager, a warehouse manager, and a storekeeper, are under investigation for theft and trading in stolen products. Several remain in Togolese custody, considered potential flight risks. The investigation is ongoing. But the losses are considerable. The Togolese government managed to recover some of the stolen drugs from the markets, but much has simply disappeared, possibly to other African markets.
Corruption can occur anywhere, and it is to the credit of the Togolese government, and to Assih of CAMEG in particular, that it has been relatively transparent about these problems. But the Global Fund never should have allowed malfeasance to reach this level. The organization took too long before sending investigators to Togo -- they arrived in autumn, months after the first credible reports of widespread corruption -- which meant the trail had gone cold well before they arrived. A more cynical interpretation, though, is that by acting slowly, much of the evidence of a problem had disappeared by their arrival.
Unfortunately, Togo is not an isolated instance of abuse. The Global Fund has a long history of problems with stolen funds and failing projects. In 2005, it suspended grants to Uganda for mismanagement, and in 2010 it stopped giving funds to Zambia's Health Ministry, preferring instead to work with the more transparent UNDP.
My research into criminal drug distribution has revealed a steady increase in stolen drugs over the past three years. As many as 30 million donated malaria treatments are "diverted" every year, leaving malaria sufferers to pay in private markets for poorly stored products they should have received for free. Unsurprisingly, criminal gangs are now gaining greater control over medicinal distribution systems in many emerging markets across the globe. Rich international donors, by exponentially increasing the formerly limited drug supply, have also unwittingly expanded the opportunities available to criminal drug traders, from Pavel Garg's team in India to the Bryntsalov family in Moscow. In short, this is a huge and growing problem. Yet the Global Fund grant system continues unchanged and unaffected by the evident corruption in the states that receive funding. Currently, the organization only temporarily cuts the flow of funds from Geneva before again turning the funding tap back on.
Theoretically, that could change in the near future. At next week's meeting, the Global Fund will convene law enforcement and health officials to draw up a plan to combat the problem. Their efforts, however, are likely to amount to mere talk. This is a problem that requires not bureaucratic hand-wringing, but the attention of an international criminal-justice organization like Interpol.
One model for the Global Fund may be the U.S. medicinal aid system, which controls its own drug purchases for the developing world far more tightly. First, unlike the Global Fund, the U.S. government doesn't simply provide funds to recipient countries. Rather, it comes to an individual agreement with each country regarding which drugs the country wants; then it buys the drugs and has U.S. contractors deliver the products to the government distributors. When it encounters a problem with public-sector drug distributors, as it has in Angola, it completely bypasses the troublesome actor -- in this case the Angolan government -- and looks for other private distribution networks, including direct handoffs from U.S. contractors to in-country clinics. The global health community doesn't approve of this approach, however, suggesting that it wastes funds that could in principle be used to treat more people. Perhaps, but it's indisputable that the drugs at least get to where they're supposed to go.
The new U.S. Congress is lead by a Republican Party that has promised to take a hard look at wasteful spending decisions. The Global Fund, and its broken distribution systems, would be a good place for them to test their mettle.