Press Release: Global Fund Report- IRD taking legal action against sweeping, unfounded allegations

Interactive Research & Development (IRD) categorically rejects the sweeping and groundless allegations in the Global Fund for AIDS, TB and Malaria (GFATM) Investigation Report on the TB grant published on 1 April 2021. We are taking appropriate legal action to defend IRD from the unfounded allegations and findings made against it.

IRD will also commission an independent firm to conduct a forensic investigation into the allegations. We believe such a forensic investigation will vindicate IRD and expose the Global Fund’s report as deeply flawed and baseless.

IRD has dealt extensively with each allegation in direct correspondence with the Office of the Inspector General (OIG) at the Global Fund. We have provided strong evidence against each allegation, none of which is based on actual facts. A summary of the key allegations and the facts provided to the Global Fund are appended below this press statement.

Despite our evidence-backed explanations, the OIG at the Global Fund has proceeded to publish this baseless and defamatory report. We are left to speculate as to the motives behind the OIG’s incorrect conclusions and false accusations.

The accompanying letter from the GF states, “These oversight decisions by the Secretariat do not, however, mitigate the prohibited practices in the management of grant funds by the Principal Recipient.” This paradoxical statement must compel all current and future Global Fund recipients to question the validity of written approvals from the Secretariat and leaves unclear the authority of the Global Fund’s own Fund Portfolio Managers (FPM). In any event, there were no prohibited practices.

The queries raised during the audit process and the findings in the report strongly suggest that OIG did not possess the technical expertise to review or comment upon public health research projects. There is a world of difference between evaluating service delivery and scientific research projects, especially when research teams are piloting innovative field approaches.

Of grave concern are the consequences for the 14,000 tuberculosis (TB) patients who were being treated by our consortium as part of the project funded by the Global Fund. IRD is deeply saddened that the Global Fund has acted in this reckless fashion and, in the process, endangered thousands of lives.  It is only after IRD last week pointed to the potentially devastating consequences of the GFATM’s actions, that the Global Fund hastily put together a transition plan. The 1-month extension they offered the Indus Hospital (Principal Recipient on the grant) to hand over these thousands of patients and records is grossly inadequate and endangers patient lives.

We can reveal today that our concerns are shared by none other than the Senior Fund Portfolio Manager at the Global Fund. In an unusual and forthright text conversation – the first communication in almost a year –  the FPM approached IRD’s Executive Director on 24 March 2021.  He alleged that the OIG had prejudged the matter (“OIG is extremely biased”), confirmed the inaccuracy of the OIG report (“The OIG report is wrong. I know”), alluded to the cowardice of his superiors (“And to see how they are all cowards…”), and the Global Fund’s abject lack of concern for these 14000 patients (“This organization is not so concerned about it” …. “Big organizations tend to forget about the human condition”). He reported the Global Fund’s inflexibility in providing continuity of care to these 14000 patients, and his personal loss of faith in his own organization (“I like the work you are doing”….”abrupt end of TIH implementation was not my decision at all. That came from above. I share your concerns about the 14000 patients.”… “Have lost hope”).

This extraordinary communication reveals the inner workings of the Global Fund from a senior employee and its top representative in Pakistan for almost a decade till March 2021.  These candid comments simply underscore the unfairness and opacity of the process, the illegitimacy of the OIG’s findings and that the investigators have acted as a law onto themselves, irrespective of the significant reputational and financial harm to IRD.

For the last 17 years in over 9 countries, IRD has developed an evidence-based track record of developing innovative, scalable, cost-effective solutions to complex healthcare issues ranging from maternal and child health, mental health, neglected tropical diseases, and infectious diseases. Our programs have helped deworm over 3.2 million children; immunized more than 4.6 million children and 1.5 million women; provided mental health support to over 10,000 people; generated evidence on new TB drugs; implemented randomized clinical trials to find better, shorter, and less toxic treatment regimens for multidrug-resistant TB (MDR-TB) patients; supported local community members to become advocates and agents of change and much more.

IRD is immensely proud of its work and the local capacity it has built across Asia and Africa over the last two decades. However, despite IRD’s stellar track record, and even though we have repeatedly rebutted every allegation leveled against us, we now find ourselves the subject of a baseless and defamatory report in the public domain.

The Global Fund did not even afford IRD the opportunity to have a copy of the final report and to challenge it in court prior to publication, despite the IRD’s request in this regard.

The actions of the Global Fund are disappointing, lamentable and raise serious questions regarding its ability to undertake and oversee an independent and transparent investigation. In consultation with our lawyers, IRD is taking legal steps against the Global Fund and those responsible for the OIG Report.

ENDS

Media Enquiries:

Name: Myra Khan

Mobile number: +92 333 0330937

Email address: myra.khan@ird.global

 Appendix: Summary of key allegations and the facts as provided to the Global Fund

Allegation: Finding 2.1 Unmitigated conflicts of interest, collusive and anti- competitive practices resulted in US$1,062,076 of non-compliant expenditures, of which US$341,791 is considered a loss.

Summary response: The Secretariat was fully aware of and approved both the declaration of conflicts of interest between TIH and IRD, and the subsequent procurement process resulting in the award of the projects to IRD. All COIs and discussions pertaining thereto were provided to OIG. The bidding on tenders was known to GF from the outset. At no point did the GF Secretariat inform us that IRD could not bid for tenders after declaring extant conflicts of interest. It is confounding why the OIG maintains that “IRD engaged in collusive and anti- competitive practices.” While the GF may not approve of the TIH-IRD relationship, two main facts remain: GF approved the relationship and there was nothing undeclared at any point. As OIG itself notes, “The Secretariat ultimately endorsed the procurement process for the four projects. There is no evidence the conflict of interest and potential mitigation measures were specifically considered by the Secretariat when making its determination.”

Allegation: “IRD overcharged the Indus Hospital in the course of implementation of three out of the four projects, which show evidence of non-delivery, fabricating and inflating programmatic achievements, and unsupported expenses. In some cases, these were found to have constituted a loss to the program.”

Summary response: IRD consistently engaged with and updated the Global Fund Country Team on the progress of these projects. All the expenses were within the budgeted line items and scope of the work. There was no failure to deliver, fabrication or inflation of achievements of any sort. All the results and claims were fully justified with evidence and appropriate results. Often, estimates were met or exceeded. Where estimates were not reached, there were full, scientific reasons provided for this, which proved that not reaching the target was either evidence of success or where the targets were impossible to reach, despite IRD’s resources having been fully mobilised. Moreover, the GF team responded: “Given that an eventual loss of value is difficult to estimate, and that the PR has undergone a certain learning curve we declare these expenditures eligible.”

Allegation: The OIG alleges poor implementation of the Psychosocial Support project, indicating “….out of 240 Multi-Drug Resistant TB patients selected to receive services under the project, only 16 received life-skills training, none received vocational training, and only 10 patients’ homes were renovated“.

Summary response: We provided the OIG concrete evidence of the falsity of the above: a) 345 patients and their families, and not merely 16 as alleged by the OIG, received life skill training (115% of target); b) 36 patients, and not “none” received vouchers for vocational training; c) it is true many fewer homes (7) were renovated. We found during the project that the homes were rented and not owned by the patients. They would thus derive no sustained benefit of having GF funds spent on renovation.

Allegation: The OIG insinuated that we lied about training courses: “…..two training courses were supported by the same photographs, indicating that reports were at least in part fabricated and that one training most likely did not take place.”

Summary response: We have shared project reports with the GF We are baffled as we have brought it to GF’s attention numerous times that, initially, erroneous photographs for the training courses were shared in one report. We have repeatedly provided the correct documentation indicating the 2 training courses were held.

Allegation: Regarding the TB Prevalence Survey, “….the survey was supposed to reach 40,000 adults and 6,000 children, it only managed to reach a total of 5,231 people in 2017 and had to be fully re-performed at an additional cost to the Global Fund of US$154,136.”

Summary Response: This is false. The Survey was indeed completed and enumerated 44,565 individuals 15 years and older, and 2,511 children aged 2 to 4 years old. We recorded 47,076 people and not 5,231 people as alleged, thus exceeding the total target of 46,000 people. This resulted in a robust prevalence survey which was successfully completed in May 2019. The pilot survey was executed from January to July 2018 to promote efficiency and accuracy in executing the large-scale survey. This was paid for by GF in the amount of USD 154,136; the budget for the Survey was restructured based on the learnings from the pilot; approval was requested by TIH for an additional amount of USD 225,845 to complete the survey (August 2018 to May 2019); TIH received overall approval for its reprogrammed budget from the Global Fund in March 2020. All expenditure was within budget, but it is noteworthy that approved payments by the Global Fund remain outstanding.

Allegation: Also in relation to the Survey, the OIG states that: “Notably, IRD’s Principal Investigator for the survey was physically located outside of Pakistan for most of the survey period in 2017 while reporting working 80% on this project.”

Summary Response: This statement is false and reflects a lack of understanding of how a Principal Investigator on global health projects operates generally. The PI in question was assigned to 60% effort and not 80% as stated by the OIG. The PI was physically in Karachi for approximately 16 weeks during 2017 (note, a PI is not required to reside at the project site), but dedicated in excess of 60% of her time to the project.

Allegation: The OIG asserts that “…the Indus Hospital also procured ultraviolet germicidal lights directly from IRD without any tender process, contravening its own procurement rules, resulting in a non-compliant amount of US$88,022.”

Summary Response: This is also not factually accurate. TIH did not procure these lights from IRD. We believe they procured the lights from AeroMed, an entity unconnected to IRD in any way. The OIG should correspond directly with TIH concerning this matter.

Allegation: Finding 2.2 “Unmitigated conflict of interest, collusive, fraudulent and anti-competitive practices in the procurement of IT services resulted in US$1,070,085 of non-compliant expenditures, of which US$519,624 is considered a loss.”

Summary response: IRD has always been fully transparent. The OIG notes “The evidence does not indicate that the Secretariat took tangible or effective action beyond receiving the initial conflict of interest declaration to mitigate the overarching conflicts of interest.” It is thus unclear, given the internal processes at the Secretariat, what the OIG suggests IRD should have done differently beyond what we did: informing the Global Fund at the outset of pre-existing conflicts of interest and continuing to keep the Global Fund apprised of all processes.

Allegation: Finding 2.2 “The procurement and award of the contract for IT services was compromised by unmitigated conflicts of interests proving IHS an undue advantage.”

Summary Response: We shared IRD’s relationship with IHS and its intention to apply as a supplier as a part of the declared COIs in November 2016. At no point did IRD participate in alleged “decision making pertaining to terms of agreement, negotiations, contract-signing and/or transactions” during TIH’s procurement and award process. The LFA and Secretariat were fully aware of all the relationships and reporting structures within the GHD. Neither IRD nor TIH attempted to conceal or misrepresent the organisational structure.

Allegation: “…IRD included in their accounts, under a salary cost item, “Board of Directors allowance” and “Benefit pool to cover cost outside of policy”, costs of surgical procedures for IRD employees and owner. By comparison such benefits and operating costs significantly exceeded those agreed by the GF for the TIH staff.”

Summary Response: We adhered to stated Global Fund Budgeting Guidelines which provides on page 50 under the sub-heading ‘Allowances’, that “Other fringe payments: minimum amounts may be budgeted as required under local labor laws or local market practice” and in a footnote that “This may include expatriate benefits for international nongovernmental organization or other multilateral organizations.” We again note that the parties to the LTTA were TIH and IRD FZC (2016-2017) and TIH and IRD Global (2018); IRD FZC and IRD Global are both international not-for-profit organizations.

Allegation: The OIG stated “…IRD’s status as a third-party service provider meant that the Local Fund Agent could not directly access IRD’s financial, HR or programmatic documents during its routine reviews, beyond the reporting provided by IRD to the Indus Hospital; if IRD had been a grant sub-Recipient, the Local Fund Agent would have had full visibility on these books and records.”

Summary Response: We note that the OIG itself stated: “In this case, the Secretariat did not mitigate conflicts of interest, such as budget design and service implementation being performed by the same individuals (referenced in 2.2), contrary to the Global Fund processes governing technical assistance supplier selection and budget approval.”

“The Secretariat had endorsed this situation and did not ask for a competitive process to be undertaken.”

“In endorsing IRD as a LTTA provider, the Secretariat did not follow the aforementioned budgeting guidelines….”

“…the Secretariat approved an undetailed, lump sum amount of US$1,918,801 for the services for the 2016-2017 period, without any of the usual routine budget assumptions validation such as consultants’ rates, budgetary assumptions for other costs, and without any documented benchmarking process or specific review of the final amount. This runs contrary to the principles of the Global Fund Guidelines for grant budgeting; however, this is not currently prohibited, or subject to a specific internal approval process.”

Despite the numerous lapses and shortcomings on the Secretariat’s part, as found by the OIG, IRD remained fully transparent. As requested, all of IRD’s financial, HR and programmatic documents were available to the LFA during its routine reviews.