Poor records
plague Bush AIDS effort

President Bush's ambitious AIDS-fighting program in poor countries has pushed so hard for fast results that basic record keeping and accountability have often gone by the wayside, making it hard to judge the program's success, according to government audits and officials. Investigators found the three-year-old, $15-billion program has in some cases overcounted and in others undercounted by thousands the number of patients it helped or was unable to verify claims of success by local groups that took U.S. money to prevent the spread of HIV or care for AIDS patients and their children.

Bush administration officials say they have worked to remedy the problems that were found in multiple countries and outlined in several audits reviewed by the Associated Press. "It's not good enough for the auditors to hear from the mission that we did A, B, and C, but we can't prove it to you, or there's no documentation to prove that we did it," said Joe Farinella, a top watchdog with the U.S. Agency for International Development. Farinella is the assistant inspector general who oversaw the investigations into how U.S. AIDS money was spent overseas in 2004 and 2005. He said many recipients failed to keep records that would provide "reasonable assurance that what they say was done was in fact carried out." The inspector general will recommend that the Administration clarify its directives and improve reporting methods. Administration officials acknowledge the lapses and say they have imposed tighter reporting systems that have improved the accuracy of information. Officials blame the shoddy record keeping on an eagerness to get money into the field to help people with AIDS. "You could've waited for three years to get all these systems in place, and an awful lot of people would have died," said Ambassador Mark Dybul, the administration's global AIDS coordinator. "Our approach was get the services out, start moving the programs. In many of the cases where they say we can't find documentation, that doesn't mean people aren't getting services; that just means the reporting systems are not in place," he said. Dybul said he has "extraordinary" confidence in the overall numbers. For at least one country, Guyana, incorrect numbers made it into this year's annual report to Congress. It cited services to 5,200 AIDS orphans, but auditors documented fewer than 300, many of them not even affected by AIDS. The opposite occurred in South Africa. Some provincial governments refused to disclose information on HIV tests and counseling, causing "severe underreporting" in the number of people who were helped with U.S. money, an audit dated August 11 concluded. Officials said that problem was now resolved. After reporting that millions of people were reached by mass media promoting sexual abstinence and use of condoms, the Administration now has dropped that measurement completely, on the grounds that it is impossible to know how many people hear radio messages. The numbers are important because Congress and others closely track administration strategies for a program that is pumping unprecedented sums into AIDS-stricken nations in Africa. The Administration demands that programs make progress toward specific targets each year and report tallies in dozens of categories. Bush's goals are ambitious: to treat 2 million HIV-infected people by 2008, prevent 7 million new infections, and provide support and care for 10 million people who have HIV or AIDS or have been orphaned by the disease. "The accuracy of the numbers is essential and is something Congress should look at," said the incoming chairman of the House Government Reform Committee, Rep. Henry Waxman, a Democrat from California. Another California Democrat, Rep. Barbara Lee, said she will seek oversight hearings into the questions raised by the audits. Dybul said early problems were expected, but standardized improvements are creating a growing "culture of accountability" in the field. "We are putting into place reporting mechanisms that have never existed," he said. "Our numbers are the tightest in the world. Yes, we have problems around the margins. We've put enormous effort into them and are improving them all the time." Current counts of people helped from each country are "within scientifically acceptable ranges of numbers," said Win Brown, a data quality consultant to Dybul's office. USAID's inspector general focused on care and prevention in 2004 and 2005 but did not highlight drug treatment, which Dybul said is easy to monitor and had good accountability. Tracking care for orphans has been especially troublesome. Local groups were found tallying individual handouts such as meals or clothing and not measuring true care. That led the Administration to impose a new rule in July that a child can be counted only if he or she is provided with three of six key services. The Administration also is working to avoid double counting when a child gets help from more than one program. Auditors also found confusion about reporting timetables and errors by U.S. officials, some of whom said the heavy workload interfered with their ability to monitor and document grant recipients' work. Development experts say local groups were often ill-equipped to meet record-keeping demands. The Administration has pushed to enlist new religious and community organizations to provide services, and often they work as subcontractors under more established nonprofits that are used to receiving government money and accounting for its use. "This whole push for new partners is a double-edged sword. You have to build their capacity to manage U.S. government money and particularly meet the reporting guidelines," said Patty Mechael, former program director for the charity CARE. One of the largest recipients of grant money, Family Health International, experienced 83% inaccurate or unverified tallies from its subcontractors in impoverished Guyana and could document only 345 of 9,000 people with HIV or AIDS reported as receiving tuberculosis treatment in Nigeria, auditors said. The organization has since strengthened training for its local partners, "making sure the people clearly understand what they're measuring," senior vice president Sheila Mitchell said. Susan Krenn is Africa director for the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, which also partners with local groups in Africa. "It is all about being able to show at the end of the day the results and accountability for that money. How that translates to the field is challenging for some local organizations," Krenn said. Some groups that did not measure up have been dropped and others that complained about reporting demands have warmed to the new systems that also help them track their own needs, Dybul said. He said the updated numbers the Administration reported on World AIDS Day, December 1, are accurate: 822,000 people receiving lifesaving drugs and 4.5 million receiving care. (Rita Beamish, AP)