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SLEEPLESS NIGHTS: US$523,000 SENDS CHIEF MEDICAL OFFICER AND CO. HOME

The total amount donated by Philanthropists for Primary Health Care and Vaccination Programme to Sierra Leone, which is currently being investigated was to the tune of US$1,090.000. The money was to be used purposefully and productively for the Medical and Health benefits of Sierra Leoneans. If this amount was used as intended, the donors would have since released the US$6Million Dollars to continue Health programme in Sierra Leone. News that the money released was shrouded in controversy and did not benefit the intended beneficiaries the donors launched an investigation, both nationally and internationally, which attracted one of America’s Philanthropists by the name of Bill Gates.
The international investigation according to our sources conducted, was extended to the United Nations Office, where Madam Zainab Bangura is currently employed. Sources say, an Administrative Investigator was secretly hired to find out whether Madam Zainab Bangura, former Minister of Health and Sanitation took part in what could be referred to as donor fund misappropriation and embezzlement. She was proven innocent, which caused the international investigators to travel to Freetown, where they reportedly intensified their investigation and discovered that some Senior Officials of the Ministry of Health and Sanitation have been involved with the plundering of the US$1,090.000 donation.
The money came in tranches and the Ministry of Health and Sanitation account at the Sierra Leone Commercial Bank is where the donation was deposited. The first tranche sources say, was between the range of US$446,000 to US$556,000, while the second tranche was between the range of US$500 and above.
The Official Signatories to the account are the Chief Medical Officer, (CMO) and two others. In most cases, Heads of Projects at the Ministry of Health and Sanitation are made signatories to project accounts with the Chief Medical Officer as the Principal Signatory.

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Had it not been for the alarm raise over the freezing of the Le6Million by Bill Gates, the matter should not have been the subject of investigation by the Anti Corruption Commission. This is just one out of many projects funded by donor organizations and international nongovernmental organizations at the Ministry of Health and Sanitation that are not implemented according to the dictates of the projects. The publication in the international media about how monies donated by Philanthropists for Medical Health Care in Sierra Leone that did not reach the intended beneficiaries and was reproduced by the Standard Times Newspaper attracted the Anti Corruption Commission and the Political Head of the Country.
The World Bank, World Health Organization and UNICEF were reportedly contacted by the Anti Corruption Commission on the matter. In return, confirmation was received about the donated amount and the precondition levied by Bill Gates and other donor organizations that until proper explanations are giving about how the money was disbursed the US6Million would remain frozen.
The ACC investigation has revealed that out of the US$1,090.000, Dr. Kisito Dao and his group have been able to reconcile expenditures relating to the amount and have been able to reduce it to US$523,000 is now the subject of further investigation. The assistance of District Medical Officers (DMO’s) reportedly made valuable contributions to reduce the burden on their colleagues by allegedly falsifying documents and claiming that some of the monies were disbursed to them to undertake Primary Health Care activities in the provinces. This has however helped them greatly, but did not remove them entirely from the perceived criminal acts of defrauding donor funds.
Meanwhile, ten Senior Officials at the Ministry of Health and Sanitation have been asked to officially distance their offices until the ACC concludes its investigation. Among them are the Chief Medical Officer, Dr. Kisito Dao, Dr, Gborie, Dr. Magbeti, Mr. E.B.Kamara former Permanent Secretary at the Ministry of Health and Sanitation who was posted on secondment to the Ministry of Education. The Accountant, Mr. Amara of the Ministry of Health and Sanitation, the current Permanent Secretary Mr. Techman Kanu and others.
Family and other sources say the press release issued out two days back that the Officials should distance their offices has sent a very disturbing message to them that it is no more a trivial issue as was initially perceived by them that they can use political, regional, or tribal connection to put to rest. According to report, the Officials have since been experiencing sleepless nights. They are thinking of ways that the matter could be handle, whether to refund the money so to avoid being charged to court or to continue providing forged documentary evidence in support of their claims
While they are thinking of ways to put the matter to rest, the donors are reportedly paying attention to the investigation through several mechanisms, which included international and local agents on the progress of the investigation.
The Ministry of Health and Sanitation is not new to embezzlement and misappropriation of funds meant for promoting Health Care and its related activities. It is one of the Ministries that always attract huge budgetary allocation and funding from donor organizations. Most of the funds are either diverted or not properly and adequately spent on projects they are meant for. The 2011 Audit Report (Published in This edition) has highlighted major frauds and pilfering of funds by Officials of the Ministry of Health and Sanitation (Read on)
Ministry of Health and Sanitation (2011):Procurement procedures not followed
The following were observed:
Premier Logistics was awarded the contract for the supply of Dressing/Dispensing Syringes, Atranmatic Sutures with Needles, for the sum of $645,939. The Ministry required bidders to submit among other documents, Pharmacy Board License/Registration. However, Premier Logistics did not submit the said document, as required by the ‘’Invitation for Bids’’ while Peoples Enterprise which also submitted a bid for the same lot was licensed with Pharmacy Board and submitted the Pharmacy Board License/Registration with its bid. The Ministry acting contrary to its required specification
awarded the contract to Premier Logistics. It was recommended that the PS should provide justification for the query raised.
Official’s Response: The PS stated in his reply that the documents were now available for inspection.
ASSL Comment: The issue is still outstanding.
Out of the total amount of Le14,510,000 and $600 that were collected from the sale of bidding documents, supporting documents were only provided for an amount of Le6,138,000 leaving a difference of Le8,372,000 and $600 not accounted for. It was recommended that the PS should within thirty days produce all supporting documents relating to the sale of bids.
Bank Accounts operated by the ministry
There were 55 different bank accounts operated by the Ministry. Cash books, bank statements and bank reconciliation statements for 23 of those accounts were not made available for inspection in spite of several requests by the audit team. It was therefore recommended that the PA should ensure that separate Cash Books were maintained for the Ministry’s Bank accounts and they must be regularly up-dated and reviewed
by a senior officer. The PA should also ensure that the Cash Books, bank statements and bank reconciliation statements were submitted for audit inspection within thirty (30) days of the receipt of the report.
Official’s Response: The PA mentioned that some of the documents were then available for inspection.
ASSL Comment: The issue still stands
Maternal Child Health/Expanded Programme on Immunisation.Withdrawals without supporting documents for utilization
It was observed that the total amount of Le10, 999,443,750 was withdrawn from Account number 01 210 – 06589 – 01 held at the Union Trust Bank, for which the audit team was unable to link the supporting documents provided to the cheque withdrawals. It was recommended that the FO should ensure that all transactions, from inception to completion, were supported by the relevant documentation which should be numbered and cross referenced so that in cases of missing documents, such documents could be easily traced. It was therefore recommended that the Programme Manager should ensure that the supporting documents to back up the individual withdrawals were submitted for audit inspection within thirty (30) days of the receipt of the report; otherwise, he must refund the whole amount into the Project’s bank account and evidence of payment to bank forwarded to ASSL for verification.
Official’s Response: The PS stated that they were in constant touch with the funding agency (WHO) for the provision of relevant documents in support of those expenditures which would be forwarded in due course.
ASSL Comment: This issue is still outstanding.
Central Medical Stores.Receipts and issuing of free health care drugs
Drugs amounting to $9,951,988 were purchased in 2011 in respect of the Free Health Care Programme instituted by the Government. However, documentary evidence such as Parking List, Invoices, Receipt and Issue Vouchers, Store Ledgers, Stock Record Card and Approved Distribution List to indicate that the Free Health Care Drugs were received and issued were not provided by the Store Keeper. It was recommended that the PS should institute an investigation into the alleged receipt distribution and of the various items and
the report of the investigation forwarded to the ASSL for audit verification within thirty (30) days of the receipt of the report.
Official’s Response: The PS mentioned in his reply that the investigation report had been done and the report was available for
inspection. The report was seen by the auditors. However supporting documents were yet to be physically verified.
Connaught Hospital (2011)Revenue not brought to account
A review of the dental cash book submitted for audit inspection revealed that only registration fees were recorded. Moreover, based on the number of registered patients, it was noted that dental extraction fees totaling Le52,760,000 should have been collected and paid into the Hospital’s account by the dentist. However, the amounts collected were neither recorded in the cash book nor banked. It was recommended that the FO should ensure that all monies collected were banked intact daily or the next banking day. The
dentist should ensure that the amount of Le52,760,000 must be refunded to the Hospital’s account within thirty days of the receipt of the report and evidence of payments forwarded to the Audit Office for verification.
Inadequate control over the collection and recording of financial transactions
The amount indicated in the Revenue Cash Book for some of the units in the Hospital was greater than the total from the Receipt Books submitted by Le 54,793,300. Furthermore, the sum of Le4, 800,000 should have been paid by the Individual running the hospital canteen for the period under review. However, only Le4, 300,000 was paid, leaving a balance of Le500,000 which was still outstanding. Moreover, there was no
formal signed agreement between the Hospital and the Individual running the canteen.
It was recommended that the FO should ensure that the Accountable Documents Register was properly maintained so as to reflect the actual quantity of accountable documents received and issued. He was also requested to submit the receipt books to account for the amount of Le54, 793,300 within thirty days of the receipt of the report. The difference of Le500,000 still not paid over by the individual running the canteen should be retrieved and evidence of payment to bank forwarded to ASSL for verification within 30 days of the receipt of the report.
Government’s share of hospital proceeds
Out of the total amount of Le1, 131,364,800 collected the amount of Le 56,568,240 representing 5% of total hospital proceeds should have been paid to NRA in respect of government’s share of hospital proceeds; however, there was no evidence of such payment into the CRF.The Medical Superintendent was advised to ensure that the amount of Le56, 568,240 should be paid into the CRF within thirty days of the receipt of the report and evidence of payment forwarded to ASSL for verification.
Revenue not banked intact
We observed that the total amount of Le110, 718,500 was collected by the X-Ray and Cost Recovery units and Mortuary Ambulance on various dates but not banked intact. Moreover, supporting documents to substantiate the utilization of the funds were not provided for audit inspection. It was recommended that the FO should ensure that all monies received must be banked intact and that supporting documents for the
utilization of the Le110, 718,500 should be produced for audit scrutiny; otherwise, the whole sum must be recovered from the authorities concerned and evidence of receipt forwarded to ASSL for audit verification.
Receipt and issue of store items
Essential drugs amounting to Le 59,931,692 and Laboratory Reagents amounting to Le10, 000,000 supplied to the hospital were neither taken on ledger charge nor were documents produced to substantiate their utilization. It was recommended that the Store Keeper should produce the supporting documents in respect of essential drugs and laboratory reagents supplied to the hospital within thirty days of the receipt of the
report; otherwise, the amount of Le 69,931,692 must be paid back into the CF and evidence of payment forwarded to ASSL for audit verification.
General conditions of the store
A general inspection of the stores operation and facilities revealed that proper supervision and control were lacking, as there were no fire extinguishers to protect the stores in the event of a fire accident and the walls of the store just below the cost recovery unit where consumables and non- consumables including drugs were kept were very damp due to a faulty wash-hand basin upstairs. It was recommended that the MS should straight away regularize those anomalies.
Unpresented documents
Accountable Documents were not produced to the auditors for inspection in spite of several requests to have access to them. It was recommended that the Hospital Manager should ensure that all the documents requested were produced for audit inspection; otherwise, section 18(1) of the Audit Service Act, 1998 would be invoked.
Environmental concerns
The following were observed: An Incinerator where medical waste was destroyed, built in 2003 was out of use. As a result medical waste was disposed of approximately 10 meters from the Annex kitchen. The workers at the Dark Room were exposed to serious danger, as a result of the non-provision of protective gears (such as Leather apron). Moreover, the members of staff working at the Dark Room were not on the Hospital’s Payroll and were only working on voluntary basis. The following were recommended: The Hospital Management should ensure that a proper waste management system must be put in place. The Hospital Care Manager should ensure the provision of protective clothing to all workers at the Dark Room, to prevent them from contacting harmful diseases. The Hospital Care Manager should ensure adequate motivation for the workers as the work they were doing was a risky one and efforts should be made to absorb them into the main service of the hospital.
General observations
There were leakages observed on the floor of the Cost Recovery Unit which if not attended to would result in serious damage to the room.
The tap, air conditioner and wash hand basin at the Cost Recovery Unit were all faulty. It was recommended that the MS should regularize the situation without delay.
The MS did not respond to the observations and had therefore violated Section 64 (3) of the Government Budgeting and Accountability Act 2005 which states that: “Every query or observation under Section (2) received by Accountant General or any other person shall’ within thirty days after its receipt by that person, be returned by him with the necessary reply to the Auditor General”.
District Medical Office (2011)Revenue not accounted for
An examination of store records revealed that 5,000 yellow cards were printed and distributed to the Yellow Card Department. Out of the amount of Le25, 000,000 expected to have been generated, only Le 13,265,000 was collected and paid to the Finance Unit and receipts issued, leaving a balance of Le 11,735,000 not accounted for. It was recommended that the District Medical Officer (DMO) should ensure that the amount of Le11, 735,000 unaccounted for was paid by the responsible individual(s) into the institution’s bank account within thirty (30) days of the receipt of the report.
Inadequate control over the collection of revenue
Amounts totaling Le 17,679,320 were not paid by various Peripheral Health Units (PHUs) in respect of drugs supplied to them to be sold on a cost recovery basis. It was recommended that the DMO should recover the amounts from the various PHUs and forward evidence of recovery to ASSL for verification within 30 days of the receipt of the report.
Kingharman Road Hospital (2011)Revenue not banked intact
The total amount of Le193, 865,000 collected by the Hospital on diverse dates was not banked intact. It was recommended that the FO should ensure that all monies collected were banked intact daily or the next banking day. The FO was instructed to produce all supporting documents for the utilization of the amount of Le193, 865,000 for audit scrutiny; otherwise, the whole sum must be recovered from the authorities concerned and evidence of receipt forwarded to ASSL for audit verification.
Official’s Response: The MS stated that the hospital’s expenditure was on a daily basis and that most of the expenditures were urgent and so required urgent attention. He said because of that management thought it fit that some amount of money should be kept as petty cash for urgent hospital expenditure. He said furthermore that money paid for medicines, consumables, professional services, etc. was often paid direct as soon as it was collected and that was the reason why all the money collected had been deposited in the bank. He said however that the FO was putting together all documents supporting the utilization of Le193, 865,000 for inspection. He mentioned that management had already taken the recommendation of the Audit Team and had commenced the daily depositing of all moneys collected since September 2012.
ASSL Comment: The supporting documents were not produced for verification.
Receipt books not presented for audit inspection
Revenue Cash Books for Laboratory and Registration units were greater than the totals from the Receipt Books submitted by Le20,473,112 and Le54, 247,000 respectively. One Hundred and Ten Receipt Books were not presented for audit inspection. It was therefore recommended that the FO should ensure that a proper mechanism was put in place wherein the receipt books were properly controlled and securely kept and were
produced for verification within 30 days of the receipt of the report.
Official’s Response: The MS stated that books were not presented because the FO couldn’t find them in spite of rigorous search. He explained that used Receipt books were usually kept by the revenue collectors and because of space constraint; the books might have been inadvertently placed elsewhere. He said however that the FO had taken full responsibility of keeping all used receipt books.
ASSL Comment: The receipt books were not produced for verification.
Loan not repaid
The amount of Le20, 000,000 was given as a loan to the Hospital’s Pharmacist on the 22nd of September, 2011 for the purchase of Cost Recovery Drugs. However, there was no evidence to confirm that the amount in question has been refunded. The Medical Superintendent was therefore requested to ensure that the amount of Le20,000,000 was retrieved from the Pharmacist within thirty days of the receipt of the report and evidence of payment forwarded to ASSL for verification.
Official’s Response: The MS said that the Pharmacist in charge was putting together his report which would be sent to ASSL as soon
as he finished it.
ASSL Comment: No evidence of recovery was produced for verification.
Absence of a standard payment voucher system
A proper Financial Management System was not in place. The payment voucher system in use was not detailed enough to allow for a complete segregation of duties by those charged with the responsibility of authorizing, approving, processing and recording transactions. It was recommended that the Medical Superintendent must ensure that a Payment voucher system in the prescribed form should be put in place, wherein transactions were initiated, verified and authorised.
Official’s Response: The MS stated that the Payment Voucher system in use at the time was recommended by the ACC.
ASSL Comment: The audit recommendation has not been addressed.
Diet short supplied
A comparison of the Contract Schedule of Requirements and the Ledger maintained for the receipt of diet revealed that diet for the period under review amounting to Le 28,600,000 was short supplied. It was recommended that the Medical Superintendent should ensure that the amount of Le 28,600,000 was recovered from the supplier and evidence of recovery forwarded to ASSL for audit verification.
Official’s Response The MS mentioned that the Caterer was bereaved at the time and said that she would give a response as soon as she was back at work.
ASSL Comment: No evidence of recovery was produced for verification.
Drugs not accounted for
Drugs supplied to the Hospital totaling $1,020 by the Central Medical Stores were not taken on Ledger Charge. It was recommended that the Pharmacist should ensure that all drugs and medical supplies were taken on Ledger Charge as soon as they were received. The Medical Superintendent should also ensure that the amount of $1,020 was recovered from the Pharmacist and payment made to the CRF within thirty days of receipt of the report and evidence of payment forwarded to ASSL for verification.
General observations
The following were observed: The sanitary condition of the hospital was poor;
The toilet facility available was unsightly; the pediatric wards were congested;
There were instances in which three patients of diverse diseases were clustered on a single bed; and the space was too small to accommodate the number of patients visiting the Hospital. As a result, patients were admitted on beds placed on the corridor.
It was recommended that: The Medical Superintendent should ensure that a general cleaning of the hospital was carried out regularly. Regular checks should be done by the Hospital Secretary to ensure the cleanliness of the Hospital. The officers responsible at the Ministry of Health and Sanitation should ensure that the other Health centers were equipped to handle referred cases to avoid the clustering of patients.
Official’s Response: The Medical Superintendent explained that the Hospital was generally small for the number of patients and due to the tremendous influx of patients, the waste expected from those patients would be plenty. He added that it was extremely difficult to control many people in the proper placement of waste in the waste bins and the use of the toilet. He said furthermore that the Hospital had only one Government employed porter and that management employed seven workers to help in the hospital cleaning. He mentioned that the Pediatric Ward had four beds which were definitely insufficient for the large number of children who visited the Hospital and in order to serve many patients, the hospital accepted short-stay admission and referred critical cases to the Children’s Hospital or elsewhere. He concluded that several children without contagious diseases occupied one big bed so that many children could benefit from the Free Health Care.
ASSL Comment: The issue still remains the same.
Ola During Children’s Hospital (2011)Diet not fully supplied
A comparison of the Contract Schedule of Requirements and the Ledger maintained for the receipt of diet revealed that diet for the period amounting to Le 34,044,000 was short supplied. It was recommended that the Medical Superintendent should ensure that the amount of Le 34,044,000 must be recovered from the supplier and evidence of recovery forwarded to ASSL for verification.
Official’s Response: The MS replied that management acknowledged the fact that diet amounting to Le 34,044,000 was short supplied notwithstanding the fact that the Hospital owed diet to make up for the queried short fall. Supporting documents, he said, were available for inspection.
ASSL Comment: The audit recommendation was not adhered to as the amount of Le 34,044,000 was not recovered from the supplier. Furthermore, supporting documents to justify that supplies were made to settle the short supply were not presented for verification.
Poor condition of the store
It was observed that the general condition of the store was not conducive for the keeping of drugs, as leakages were observed in the store. Also drugs and other store items were placed on the floor instead of shelves. The office itself had no air conditioner and security was lacking as people moved in and out of the office without any authorization. It was recommended the Medical Superintendent should expedite the regularization of those anomalies by ensuring that strategies were put in place to have a proper and adequate
storage facility for drugs.
7.19.3. Revenue not brought to account
The payment of the sum of Le2,893,000 in respect of cost recovery drugs issued to a member of staff of the Cost Recovery Unit of the hospital was still outstanding as at 31st December, 2011. It was recommended that the Pharmacist should recover the amount still outstanding from the sales representative and forward evidence of recovery to the Office of the Auditor General for verification within thirty days of the receipt of the report.
Official’s Response: The MS stated that the amount of Le2, 893,000 had still not been reconciled by the member of staff attached to the cost recovery unit. He added that the pharmacist In-charge had decided to refer the case to the Director of Drugs and Medical Supplies at the Central Medical Stores for resolution. Correspondences, he said, were available as evidence.
ASSL Comment: The amount of Le2, 893,000 was not recovered from the Sales representative. However, evidence was submitted to justify that the pharmacist In-charge had referred the matter to the Director of Drugs and Medical Supplies at the Central Medical Stores for resolution
7.19.4. No strict internal medical waste control system
The hospital lacked an Incinerator where medical waste should be disposed of; as a result, medical wastes were disposed of in every corner of the hospital. Furthermore, it was noted that there was no Medical Waste Management Policy in place in the Hospital- a system which should guide staff on issues like waste storage and disposal. In order to mitigate the risk associated with medical waste, the Hospital Management was advised to make frantic effort to develop an internal Medical Waste Management Policy. Such a policy should
include how wastes were stored, transported and disposed of.
7.19.5. Free health care system
Due to the presence of the Free Health Care Programme, it was observed that the wards were congested. It was disturbing to note that there were instances where three patients of diverse diseases were clustered on a single bed. In addition, the oxygen available in the Hospital was inadequate. As a result, priority had to be given to those children who were extremely vulnerable and on a first come first served basis. Furthermore, the shortage of Doctors at the Hospital posed a serious threat as only patients who were helpless and needed emergency treatment were attended to. It was recommended that the officers responsible at the Ministry of Health and Sanitation should ensure that the other Health Centres were equipped to handle referred cases to avoid the clustering of patients.
Official’s Response: The MS representations will continue to be made to the appropriate authorities at the Ministry to speedily resolve that matter.
ASSL Comment: The issue still remains the same.
Pujehun Government Hospital (2007- 2010) Inadequate control over the use of funds allocated by the Pujehun District Council
Imprests, totaling Le7, 000,000 were not retired. It was recommended that all supporting documents in relation to the imprest utilized must be submitted to ASSL for inspection within 30 (thirty) days of receipt of the report; otherwise the amount involved should be paid back into the Hospital’s Account by the FO and MS.
Official’s Response: In his response the DMO stated that copies of imprest retirement were retained and could be verified.
ASSL Comment: The retirement details in respect of imprests, totalling Le7,000,000 were still not available for verification.
Inadequate control over collection and recording of financial transactions
The examination of Receipt Books, Cashbooks and Revenue Registers revealed that out of the total Le144,395,049 only the sum of Le38,956,000 was banked leaving a balance of Le75,439,049 not banked. That amount was alleged to have been put into use without authority. In an interview with personnel of the Hospital, it was revealed that revenue collected was to be allocated (on percentage basis) for various purposes including a certain percentage being paid into the Consolidated Fund. The breakdown as to what was used
and for what purpose was not made available for inspection. It was therefore recommended that the MS should ensure that the difference of Le75,439,049 must be
recovered without delay from those concerned within 30 days of receipt of the report and paid into the Hospital Account.
Official’s Response: The DMO stated that under normal circumstances, all revenue collected should be banked intact before withdrawals. He mentioned however, that there were instances where not all monies collected were banked. For instance:
Payment of incentives to Volunteer Nurses Emergency cases resulting in payment for repairs to vehicles, generator When imprest was not forth coming from council
Payment of top – up allowances to staff Expenditure records and documents in respect of any such expenditure were retained, he added.
ASSL Comment: It was however observed that adequate documents were not available to support issues highlighted in the response.
Fixed assets/inventory register not detailed
A review of the Fixed Assets Register revealed that: Vital information such as the value of assets, date of purchase, serial numbers, etc. was absent. Fixed Assets were not marked/coded. Three unserviceable vehicles (ABQ 957, ADY 637 and ACQ 425) were still held by the hospital and no effort was being made to service or dispose them.
It was recommended that the FO should ensure that assets owned by the Hospital were recorded in the Assets Register with other details such as the name of the asset, cost, date of purchase, code or identification number, individual location and total quantity held, and whether they were inherited, donated or purchased by the Hospital. The Medical Superintendent should also ensure that necessary steps were taken to either service or dispose of the unserviceable vehicles.
Official’s Response: The DMO stated that training was needed to ensure that a proper Fixed Assets Register as recommended by the auditors, was maintained by the FO and promised that all unserviceable vehicles would be disposed of by the appropriate authorities.
ASSL Comment: The Fixed Assets Register was yet to be properly maintained as details such as cost, location, serial numbers, etc. were yet to be recorded in the Register. In addition, it was noted that Unserviceable Vehicles had been disposed of by the appropriate authorities.
Free health delivery services
The software channel package used for the receipt and issue of drugs was prone to risk as there was no provision for back up (on site or off site). It was recommended that the Medical Superintendent should expedite the introduction of a back-up system for the receipt and issue of all drugs using the Channel System
Unauthorised withdrawals from hospital bank accounts and without supporting documents
An examination of the Hospital’s Bank Statements revealed that some amounts were withdrawn from Accounts maintained by the hospital without the approval of corresponding authorities. In addition, there were no supporting documents such as; invoices, receipts, bills, claim sheets, etc. to justify those withdrawals.
See summaries of those withdrawals in Table 4: It was recommended that the MS must ensure that the relevant authorities and supporting documents in respect of the amounts stated were forwarded to ASSL for verification; failing which the whole amount should be recovered from the officers concerned for the period in question and receipt details forwarded to ASSL for verification.
Official’s Response: The DMO stated that all withdrawals from the
hospital accounts were approved by the appropriate authorities and that the
relevant signatures were the Chairman PDC, CA, MS and FO as the case may be. He also added that all relevant supporting documents were retained in the Finance Department.
ASSL Comment: Authority for withdrawals and supporting documents such as invoices, receipts, bills and claim sheets to justify the withdrawals of Le120,841,100 from the hospital accounts, were not submitted for verification.
Supply of diets to hospital
The following were observed: The sum of Le15,000,000 was paid to a supplier for the supply of special diets for quarters one (1) and two (2) in 2010. There was no evidence such as a Delivery Note and Distribution List to indicate that the supply was made and used by the targeted beneficiaries. Requisitions from the Hospital Cook were not available to ascertain whether supplies amounting to Le 129,829,900 received by the Hospital Matron were issued to the Cook for the consumption of patients. It was also observed from examination of selected Payment Vouchers that there was no indication as
to the number of patients for whom diets, totalling Le131,504,700 were supplied to the hospital. It was therefore recommended that the Matron should ensure that:
Store items were recorded in the relevant Stores Ledger;
Table 7.5 – Unauthorised Withdrawals
Account Le
Account 1 21,000,000
Account 2 90,229,000
Account 3 9,612,100
TOTAL Le 120,841,100
Actual account numbers withheld for security reasons
Delivery Note and Distribution List in respect of Special Diets, totalling Le15,000,000 must be submitted for inspection; otherwise, the amount involved should be recovered and paid back into the Consolidated Revenue Fund; Requisitions (giving number of patients) must always be received from the hospital Cook before store items were issued.
Official’s Response: The DMO stated that on the issue of Delivery Note for Q1&2 (2010), he was unable to explain as he was not in post then and for issues concerning requisition, he said it was purely based on the approved Hospital menu. He emphasised here that most of their cooks were illiterate. Therefore issues on menu were only signed for by those cooks on a daily basis. He further explained that
procurements of diets were wholly and solely the responsibility of Headquarters and Council and that during the year statistics were given on the needs of the hospital and that Stores ledgers were maintained for all received and issued diets. He added that during his tenure, all receipts and issues were recorded in ledgers and issues were always signed for by recipients.
ASSL Comment: Delivery Note and Distribution List in respect of Special Diets, totaling Le15,000,000 were not submitted for verification.
General observations
Records management was a major problem in the ministry. Copies of most accounting records in respect of allocations received from the Pujehun District Council were not retained by the ministry.
Government Hospital Kenema (2011) Inadequate control over the collection and banking of revenue
A comparison of the Hospital’s Admission Chart to the Receipt Books and Bank Statements presented for audit, revealed the following: A difference of Le5,105,000 was noted between the revenue generated as per the Hospital’s Admission Chart and the revenue generated as per the Receipt Books issued in collection The total sum of Le35,475,000 in respect of revenue generated by the various Hospital units, was not
banked and there was also no evidence to justify how that money was utilized.
It was therefore recommended that the MS should ensure the following: Proper receipts should be issued at the same time that public funds/revenues were received by the
Hospital and they must be accurately recorded in the revenue register and properly safeguarded for reference and audit purposes; All funds/revenue generated by the various units, should be promptly paid into the Hospital’s bank account and no use of such funds must be made by any Hospital Staff in any manner between the time of its receipt and payment into the bank; and An account must be given to ASSL on the issues highlighted within thirty (30) days of the receipt of the report. Otherwise, the amount of Le35,475,000 involved of must be refunded as a matter of urgency.
Official’s Response: The MS stated that at the time of the audit, one of the revenue receipt books was misplaced. He said however, that it had been traced for the auditors’ verification. He also mentioned that all other recommendations were noted and would be implemented in future adding that the documentary evidence in respect of the amount utilized was ready for verification.
ASSL Comment: ASSL’s recommendations were not implemented.
Inadequate control over the distribution and usage of fuel
It was observed that the management of the GHK was not following any policy/procedure for the distribution and usage of fuel and other lubricants. In addition, there were no control mechanisms in the form of fuel chits and fuel register to monitor and reconcile the distribution and usage of fuel. As a result of those weaknesses, the Hospital could not properly account for fuel allocation of Le52,218,000 that was made
to them through the Kenema City Council during the period under review. It was therefore recommended that the Medical Superintendent should ensure that a policy was followed to guide and control the distribution and usage of fuel. In addition, the use of a fuel register and fuel chits must be introduced to help monitor and reconcile the distribution and usage of fuel. Furthermore, the MS should forward a detailed
breakdown together with the relevant documentary evidence on how the amount of Le52, 218,000 was utilized on fuel, within 30 days of the receipt of the report; otherwise, the full amount must be refunded forthwith.
Poor management of stores
The following were observed: 16,254 assorted drugs and 87,806 consumables and other usable items, were received by the Hospital Store, but they were not taken on ledger charge; 23 equipment and consumable items were recorded in the Hospital’s Ledger as receipts. However, there was no evidence in the form of Delivery Notes to justify that the quantity and specification of the items were accurate and complete; a comparison of the quantity of Africana Soap received as per the Delivery Note and the quantity
recorded in the Allocated Store Ledger revealed that a difference of 24 packets of Africana Soap was not brought to account; and there was no evidence in the form of Delivery Notes and Allocated Store Ledger to justify the quantity and specification of Cost Recovery Drugs received and issued/sold for the period under review. As a result,
ASSL could not verify the accuracy and completeness of the Cost Recovery Drugs received and issued/sold for the period under review.
It was recommended that the Medical Superintendent should ensure that all items of receipts should be brought on charge in the Stores Ledger on a timely basis and they must be accompanied by delivery notes and supported by the relevant receipts, in accordance with Section 188 (1) of the Financial Management Regulations, 2007.
The following must be forwarded to ASSL within thirty (30) days of the receipt of the report: The Delivery Notes in respect of the 23 equipment and consumable items recorded in the Hospital’s Ledger as receipts; The Delivery Notes and Allocated Store Ledger in respect of the Cost Recovery Drugs received for the period under review; and an explanation as to why the 24 packets of Africana soap were not brought to account.
Official’s Response: The MS stated that the heavy work load of the store keeper must have prevented him from posting into the ledger, however, he had taken on charge the 16,254 assorted drugs and 87,806 consumable items. He mentioned that it was also unfortunate that delivery notes were not presented at the time of the audit but evidence of delivery note had been made available for verification. The situation
had been corrected and evidence of delivery notes to justify the quantity and specification of drugs had all been made available for verification, he
further mentioned.
ASSL’s recommendations were implemented and store ledgers and stock cards were maintained. However evidence of delivery notes for items delivered to the hospital were not seen.
Official’s Response: The MS mentioned in his reply that:
Basic equipment and consumables had been put in place and were ready for verification; The Annex Ward was in need of extension and plans were in place to correct all deficiencies; Reagents for the laboratory had been requested from the central medical stores and small purchases had been made; and the cooling system in the mortuary had been budgeted for and the Medical Electronics team had been contracted to do the repairs.
ASSL Comment: ASSL’s recommendations were not implemented
Fixed Assets not verified
A review of the Inventory Register revealed that items of Furniture and Equipment were owned and controlled by the Hospital. However, the items were not made available for verification/inspection during the course of the audit. It was therefore recommended that the MS should ensure that all the Hospital’s Furniture and Equipment were properly controlled and secured and were only transferred to other locations when authorized. The Medical Superintendent should also make the items of Furniture and Equipment available for physical verification/ inspection, within thirty (30) days of the receipt of the report; otherwise, those items must be paid for forthwith at the then market prices.
General observations
The general management and condition of the GHK was far from being satisfactory as was evidenced by the following observations: Basic equipment and consumables like temperature measuring machine/thermostat, bandages, cotton wool, toiletries, IV fluids, mosquito nets and bed sheets that should facilitate the smooth and efficient delivery of medical service to patients were not available in the Hospital’s Annex Ward; Wheel chairs in the Annex Ward were not enough to cope with the number of hospitalized patients;
Sitting facilities for nurses on duty were lacking and the ones available were in a deplorable condition; it was noted that the majority of the laboratory kits had expired; the use of expired laboratory kits may put the lives of patients at risk; there was no Cold Chain in the Hospital’s Mortuary for the preservation of corpses; and Personnel working in the Mortuary unit lacked the protective clothing and equipment to execute their daily activities.
Official’s Response: The MS mentioned in his reply that: Basic equipment and consumables had been put in place and were ready for verification; The Annex Ward was in need of extension and plans were in place to correct all deficiencies; Reagents for the laboratory had been requested from the central medical stores and small purchases had been made; and The cooling system in the mortuary had been budgeted for and the Medical Electronics team had been contracted to do the repairs.
ASSL Comment: ASSL’s recommendations were not implemented

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