The 2023 Auditor General’s Report highlights multiple financial irregularities and systemic failures within the Ministry of Health and Sanitation (MoHS) exposing critical deficiencies in financial management, procurement, contract oversight, and healthcare service delivery.

One of the major findings concerns the failure of the Ministry to submit expenditure returns for significant funds allocated to the Malaria Control Programme. A total of NLe17,087,713 was transferred into the programme’s bank account, yet expenditure returns for NLe933,901 remained unaccounted for. This lack of financial transparency raises concerns about potential misuse of funds and failure to ensure that resources are being utilized for their intended purpose.

The report also exposes payments made without adequate supporting documents, including bank withdrawals amounting to NLe2,738,955 that lacked essential documentation such as concept notes, receipts, back-to-office reports, and signed beneficiary lists.

This gap in accountability makes it impossible to confirm whether these funds were properly utilized, leading to potential financial losses.

Non-compliance with the Ministry of Finance’s recommendations is another significant issue highlighted.

The Ministry took over a construction project from the National COVID-19 Emergency Response Centre valued at US$3,984,014.96 for administrative and infrastructural development in Mathaska village, Port Loko District. Despite a field visit in April 2024, 35 months after the contract was awarded, the construction remained incomplete. As a result, the Ministry of Finance recommended reassessing the project scope, canceling the previous addendum, and establishing a Contract Management Committee, yet there was no evidence of these recommendations being implemented. The continued delay in completing the project poses a risk of additional financial costs due to inflation and rising construction expenses.

The report further highlights unauthorized procurement activities, with the Ministry exceeding its budget for diet and cleaning services by NLe12,771,234. Despite a total budgeted amount of NLe48,716,000, the actual expenditure reached NLe61,487,233.84, and no approval from the Ministry of Finance was provided to justify the overspending. This unauthorized commitment of public funds raises concerns about potential budget overruns and financial mismanagement.

Serious inefficiencies were identified in the procurement and management of medical supplies, leading to the distribution of expired or substandard medicines.

At Connaught Hospital, large quantities of expired drugs were found in storage, with no evidence that pharmacists had requested their timely disposal. Additionally, expired and unexpired drugs were stored together, increasing the risk of administering ineffective or harmful medications to patients. Lakka Government Hospital faced similar issues, where potent and expired drugs were not properly separated or disposed of, highlighting severe lapses in quality control and supply chain management.

Infrastructure problems were also documented, with hospitals lacking adequate medical equipment and facing challenges in maintaining basic utilities. The Bo Government Hospital suffered from unpaid contracts for cleaning services and patient diets, leading to threats of service disruption that could negatively impact patient care. Furthermore, the hospital’s water reservoir was found to be in a state of disrepair, leaving the facility with an inadequate water supply, which posed significant sanitation risks.

Medical equipment shortages were another major issue, with hospitals such as Bo Government Hospital reporting inadequate supplies of critical tools like blood pressure machines, thermometers, oxygen machines, incubators, and patient monitors. Faulty and outdated equipment further compromised healthcare service delivery, potentially endangering patients.

Additionally, the audit uncovered financial mismanagement in the National Emergency Medical Services (NEMS), where withholding taxes amounting to NLe273,276 and PAYE taxes of NLe1,760,232 were not paid to the National Revenue Authority (NRA). Similar revenue mismanagement was identified at Connaught and Jui Government Hospitals, where substantial amounts of public funds were not properly accounted for.

The National Medical Supplies Agency (NMSA) was found to have failed in timely distribution of essential drugs and medical supplies to district health facilities, leading to shortages that negatively affected patients’ care. The warehouse management system was also flagged for serious deficiencies, including the distribution of Free Healthcare drugs to private medical facilities without justification. Several district medical stores lacked basic security measures such as CCTV cameras, and in some cases, medical supplies were stored in poor conditions without proper ventilation, leading to deterioration of stock.

The report concludes that the Ministry of Health and Sanitation’s systemic failures in financial accountability, procurement, contract management, and healthcare delivery require urgent intervention. Strengthening regulatory oversight, implementing stricter procurement guidelines, and enforcing financial transparency measures are critical to ensuring that public health funds are utilized effectively and that citizens receive the quality medical care they deserve.