Background

The Sierra Leone Ministry of Health and Sanitation (MOH&S) has one of the most complex accounting systems within the public sector. In order to accomplish its Mission, in providing health services for the people of Sierra Leone at affordable cost, the Ministry is structured into nine divisions with sixty-two programs. Each of these programs carry out diverse activities and functions under five expenditure categories in the health care delivery system countrywide.

To ensure a comprehensive finance and budget procedure the Ministry’s budget and accounts are drawn up through careful planning and inclusion of activities, programs and functions funded from various sources including:

-                     The Government of Sierra Leone annual approved Budget

-                     The World bank supported Integrated Health Sector Investment Project (IHSIP) and now the Health Sector Rehabilitation and Development Project (HSRDP);

-                     The European Union Support to the Health Sector (EUSH);

-                     Islamic Development Bank (IDB) supported Project;

-                     The African Development Bank (ADB) supported Health Services Rehabilitation Project (HSRP);

-                     Other programs, activities and functions in the health sector supported by  UNICEF, UNFPA, ICRC and other Local and International Non-Governmental Organizations.

The Budgeting Procedure In The Ministry Of Health & Sanitation

At the end of every financial year an Annual Planning and Budgeting Workshop is organized by the joint Directorates of Planning and Information and Financial Resources. In that workshop all Units and Program Directors or Managers respectively submit their scheduled plan of activities for the coming Financial Year. These scheduled plans of activities have to be prepared bearing in mind, on one hand, the successes, failures, costs and challenges faced in the implementation of the activities in health care delivery process of the previous years. On the other hand, the planned schedule of activities must have the element of forecasting what is expected and how managers intend to tackle these expectations during the coming financial year with the meager resources “budget ceilings” at their disposal.

Once these planned schedules of activities have been agreed upon, they are incorporated into the Ministry’s budget. The activities in the budget are then translated into procurement plan for either goods or services. Copies of the procurement plan will then be made available to all Program Directors and Managers so that they can write to request for the implementation of their approved activities as and when necessary.

During the previous years some District Medical Officers and other Heads of Health Care Delivery Institutions that satisfied laid down criteria for accountability, were given subventions to take care of their operational costs like traveling, fuel, minor repairs and minor purchases of office stationery. Some of these criteria include:

-                       the institution’s proximity to a bank to be able to operate a bank account,

-           the institution being equipped with a money safe

-                       the existence of a trained Finance Officer to be assisted by accounts clerks charged with the responsibility to collect revenue, spend monies and account for all revenues and expenditures on behalf of the Heads of the institutions.

Within this complex set – up, the Ministry of Health and Sanitation is involved in the decentralization of its activities and functions. With some the activities and functions decentralized, the District Health Management Teams (DHMT) and other Health Care Delivery Institutions at District level are given the opportunity to plan, coordinate and control the affairs and activities of the various units and divisions.

In the process of health care delivery by the various health institutions, there is increase requirement for transparency and accountability characterized by the public’s demand for the production and maintenance of accurate data and financial information about the Ministry’s elaborate programs and activities. The government, donor support institutions and the public at large want and need to know whether funds allocated are being handled properly. In particular, they want to know whether the various institutions and programs are conducting their activities in compliance with the rules and regulation. They also want to know whether the institutions are achieving the goals for which their activities are funded and are doing so economically and efficiently.

The Directorate of Internal Audit

As a strategy to manage these complexities, the Internal Audit Unit of the Ministry of Health and Sanitation was created to provide an independent appraisal function to help the Ministry improve on its risk management, control and governance. The Unit is to provide this service through a systematic and disciplined evaluation of policies, procedures and operations that management puts in place to ensure achievement of the Ministry’s objectives. The Unit should also conduct periodic compliance verifications of existence, effectiveness and continuity of operations of those controls and provide timely suggestions to management for improvement in decision-making.

Terms of Reference and Scope of work of the Internal Audit Unit

Once the activities have been funded and carried out, the role of the internal audit unit is to examine the documents and evaluate the systems of internal controls in the implementation of these activities. During the process of examination of records, the auditors assess the control environment and the systems of internal controls to ensure that:

·        the conduct of activities and financial transactions is in compliance with established policies, procedures, laws and regulations;

·        there is economical, effective and efficient use of resources;

·        there are adequate measures to safeguard the Ministry’s assets from loses of all kinds including those arising from fraud, irregularity or corruption;

·        there is integrity and reliability of accounting data and information;

Quality Of The Audit

The staffs of the Internal Audit Unit must ensure that they conduct their work with due professional care characterized by the use of appropriate audit skills, be fair and not to allow prejudice or bias to override their objectivity and judgment. They must ensure effective audit reporting resulting from systematic and adequate planning and designing of effective audit programs and procedures to an extent practicable to satisfy the transparency and accountability interest of Management, the government, donor agencies and other contributing agencies into the Health Sector.