US President George W. Bush's ambitious AIDS-fighting program in poor countries has pushed so hard for fast results that basic record keeping and accountability often went by the wayside, making it hard to judge the true success, government audits and officials said.
Investigators found that the three-year-old, US$15 billion program has overcounted and undercounted thousands of patients it helped or was unable to verify claims of success by local groups that took US money to prevent the spread of disease or care for AIDS victims and their children.
The Bush administration says it has worked to fix the problems that were found in multiple countries and outlined in several audits.
"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 at the US Agency for International Development.
Farinella is the assistant inspector general who oversaw the investigations into how US AIDS money was spent overseas in 2004 and last year.
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.
The administration acknowledged the lapses and said it had 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 AIDS victims.
"You could [have] 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 AIDS tests and counseling, causing "severe underreporting" in the number of victims who were helped with US money, an audit dated Aug. 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 grounds 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 countries 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 infected people by 2008, prevent 7 million new infections and provide support and care for 10 million HIV/AIDS patients and orphans.
"The accuracy of the numbers is essential and is something Congress should look at," said Representative Henry Waxman, the incoming chairman of the House Government Reform Committee.
Representative 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.
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