MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEATH SYSTEMS PREPAREDNESS PROJECT GRANT NO. D6200-MW GRANT NO. D8870-MW GRANT NO E0980-MW CREDIT NO 7177-MW FINANCIAL STATEMENTS FOR THE YEAR ENDING 31 MARCH 2024 National Audit Office P0 Box 30045 Lilongwe 3 October 2024 CONTENTS PAGE Controlling officer's report 3 Statement of management's responsibilities 7 Auditor General's Report 8 Statement of receipts and payments by category of expenditure I I Statement of receipts and payments by component 12 Statement of Designated account reconciliation 14 Notes to the financial statements 16 2 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 CONTROLLING OFFICER'S REPORT BACKGROUND AND PROJECT IDENTIFICATION The Malawi COVID-19 Emergency Response and Health Systems Preparedness Project is a five-year project being financed by the International Development Association (IDA). The Project Development Objective (PDO) is to prevent, detect and respond to the threat posed by COVID-19 in Malawi while at the same time strengthening national public health systems preparedness. The total project is now at USD 96.9 million comprising of original grant of USD 7 million, additional (grant) financing I USD 30 million and additional (grant and loan) finance 2 worth USD59.9 million. The Secretariat facilitating the project is under PHIM in Lilongwe. A special account of the project is maintained at the Reserve Bank of Malawi (account no 0013001600103) while the operating account is at the First Capital Bank, Capital City Branch (account no 0004707000493). The Ministry of Health (through the Public Health Institute of Malawi (PIIlM) is the Lead Implementing Agency. The project has three components as follows: - Component 1, Emergency COVID-19 Response, was allocated $87.8 million; Component 2, Supporting National and Sub-National Prevention and Preparedness, a total of $3.4 million and Component 3, Implementation Management and Monitoring and Evaluation was allocated $5.70 million and component 4 Contingent Emergent Response Component OVERALL PROJECT GOAL The Project Development Objective (PDO) is to prevent, detect and respond to the threat posed by COVID-19 in Malawi while at the same time strengthening national systems for public health preparedness. The project is meeting its goals by the implementation of activities that are tailored to prevent the spread of COVID-19 through surveillance and containment strategies including providing support to vaccinate 30% of the population; strengthening the capacity of the public health system for preparedness and responding to COVID-19 pandemic and to future pandemics and other threats to health security; and supports project management and coordination, monitoring & evaluation (M&E), operational reviews to assess implementation progress and logistical support. The component also supports the grievance redress mechanism (GRM) and other activities in the Environmental and Social Commitment Plan (ESCP). 3 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 SPECIFIC OBJECTIVES The objective of the project is to prevent, detect and respond to the threat posed by COVID-19 in Malawi and strengthen national systems for public health preparedness The MDGS Ill and the Health Sector Strategic Plan II prioritize improved health outcomes and quality of health services for sustainable socio-economic development. The Program is focused on preparedness and response and is also critical to achieving Universal Health Coverage. It is also aligned with Malawi Health Sector Strategic plan and global commitments to strengthen pandemic preparedness and response through three key actions: (i) improving national preparedness plans including organizational structures; (ii) promoting adherence to the IHR; and (iii) utilizing international framework for monitoring and evaluation of IHR. The project contributes to the implementation of IHR (2005), Integrated Disease Surveillance and Response (IDSR), and the OIE international standards, the Global Health Security Agenda, the Paris Climate Agreement, the attainment of Universal Health Coverage and of the Sustainable Development Goals, and the promotion of a One Health approach. PROJECT PERFORMANCE The project became effective on 140 April 2020 after meeting the Project Appraisal Document (PAD) requirements. The project uses annual work plans and annual budgets in its implementation. In FYE March 2024, the project utilized $24.10 million of the total work plan and budget of $44.39 million, representing 44%. The disbursement rate as at 31st March, 2024 was 49.94% ($48.31 million disbursed of total ($96.9m). This was the fourth year of implementation and it registered some good progress in Project implementation as all implementing players worked hard towards achieving targets set in the annual work plan budget. In terms of overall objective, the project has strengthened Malawi's capacity to detect, prevent, diagnose and treat COVID-19 through (i) procurement of critical medical and diagnostic supplies and equipment; (ii) training of Health Surveillance Assistants (HSAs), health workers and lab technicians; (iii) support to rapid response teams and treatment and eradication of Cholera. Several interventions were implemented to achieve the project objectives.; To support the emergency COVID-19 response, through the World Bank, the project provided immediate support to prevent the spread of COVID-19 in Malawi. This was achieved through surveillance, containment strategies, and the strengthening essential health services; 4 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 1.To ensure that during a disease outbreak, cases are detected, confirmed, contact traced, recorded, and reported, the project was able to strengthen the laboratory management system. In this regard, the installation of two Laboratory Information Management System (LIMS) servers was done in June 2023 at Gateway Clinic in Blantyre and Mangochi molecular Laboratories. Quarterly Supply chain supervision, data collection and targeted mentorship to underperforming laboratories and quarterly Supply Chain review meeting were conducted in February 2024. 2. In order to strengthen the health system, to respond to the COVID 19 and other respiratory diseases, capacity building initiatives were conducted during the year. One hundred and fifteen health workers were trained in the management of critically ill patients and use of respiratory care equipment that include oxygen use for all facilities in the South Eat Zone. Forty-four (44) health workers and 50 rehabilitation personnel had their capacity built on rehabilitation of post COVID 19 disorders (long COVID and other disorders) and Cardiopulmonary management of COVID 19 patients. The capacity building of 7 health workers for Master in Paediatric Critical Nursing and diploma in anaesthesia for 60 students at Malawi College of Health Science was also achieved. There were also preparations for the enrolment of students into BSc in Critical Care Nursing programme. 3. To improve radiologic diagnostic capacity for infectious diseases, contracts for a CT Scanner for Kamuzu Central Hospital, 2 Magnetic Resonance Imaging machines for Kamuzu Central Hospital and Mzuzu Central Hospitals, 3 Static Digital X-ray Machines for Ntchisi District Hospital, Chitipa District Hospital and Mzuzu Central Hospital including service contract for 2 years. were signed for supply, delivery, install and commission of the equipment. 4. Points of entry (POE) were strengthened through quarterly supportive monitoring visits to PoEs to monitor progress in COVID 19 response activities at Songwe, Mbilima, Mchinji, KIA, Dedza, Biriwiri, Mwanza, Chileka, Nayuchi, Muloza. The POEs were supported with stationery, airtime and internet. The Port Health guidelines, IHR guidelines and Standard Operating Procedures(SOPs)for Port Health were reviewed and refined in view of emerging issues. 5. To ensure COVID 19 and other routine vaccines are deployed in the health facilities, 49,600 doses of Pfizer, 3,327,997, 5 ml syringes and 131,783 safety boxes were delivered during the year. 377 Health workers from all the five health zones were trained on Periodic intensified Routine Immunisation with an aim of scaling uptake of the vaccine while focusing on COVID 19 vaccine integration. Eighty (80) health personnel were trained on AEFI Detection and Reporting and Communication Management, reaching the target of 1424. 40,099 people were vaccinated out of the 89754 households that were reached during the community engagement activities that were conducted in 16 districts in the form of door to door meetings during the April to May 2023 vaccination campaign. 29, 8000L climate-friendly ultra-low temperature freezer, 29 desktop computers, 32 printers were procured and distributed to the district EPI offices for vaccine management and coordination. 5 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 6. To ensure good communication engagement, the Health Education unit was provided with 29 public address system, a heavy duty printer, one digital camera, and 4 Laptop computers shared with the districts. Two Public Service Announcements (PSA) were produced, one in Chichewa and another in Tumbuka were aired from September to November 2023through 28 community radio broadcasting houses. 46 Health Promotion Officers (HPOs), 81 media house and traditional leaders were trained in RCCE on Grievance Redress Mechanism, Cholera, Anthrax, Viral Conjunctivitis, Measles Rubella GBV and other Public Health Emergencies. 7.Health care waste management was strengthened through orientation of 119 health workers were oriented on waste management, conducting two Biannual review meetings for health care waste management focal persons, supervision and mentorship and benchmarking exercise to best performing districts. 18 Infection Control and Waste Management Plans of the disirict and central hospitals were developed and followed up. 200 litres of diesel per district hospital and 400 litres per central hospital was provided for health care transportation and treatment. The HCWM draft policy and guidelines were reviewed and submitted to cabinet for approval. The Health care waste management guidelines, were edited in preparation for presentation to the TWG. To strengthen community surveillance and enhancement of EOC call centre, TNM and Airtel credits and TNM backup internet for CHSU data centre were procured for a 12 months' period. 8. To maintain essential health services, 490 HSAs were trained for 90 days on the initial HSA's training, 3000 pushbikes have been procured and distributed to HSAs and all districts conducted engagement meetings with Community Health structures (HCMCs, CHAGs and VHC, VDC, ADCs, school committees) on COVID-19 response and vaccine implementation. Community Health Workers, and Community Midwifery Assistants and other health workers in the 29 districts were supported to conduct home and follow up visits to COVID 19 patients and other home based care patients on home isolation and in schools. In strengthening Infection prevention and control (IPC), the national IPC policy was reviewed, [PC Training Manual for technical staff, junior staff and administrators were finalized and pilot tested, 253 Technical staff, junior staff and administrators were trained on IPC-WASH and health facility IPC -WASH assessments were conducted. 30 Skilled Birth Attendants (SBAs)were trained as trainers in Essential New-born Care and led to the training of 157 SBAs. 15 Skilled Birth Attendants were trained as Master trainers in Basic Emergency Obstetric and new-born care (BEmONC) and another 25 Master BEmONC trainers SBAs were refreshed. Medicines & Medical Supplies worth US$ 5 million were procured through UNICEF and distributed by Central medical stores to all health facilities and indicator and process monitoring of the essential health services coordinated was strengthened and institutionalized through the implementation of the Harmonized Health Facility Assessment (HHFA)/SARA). 28 districts have been trained on District Planning Tool who managed to train 506 facilities in Facility Planning Tool. 6 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 9. In a bid to support national and subnational prevention and preparedness, districts that were affected by tropical Cyclone Ana, a field visit by district rapid response team and a supportive supervision by central team to affected districts to affected districts of Phalombe, Mulanje, Nsanje, and Chikwawa was conducted. 60 trainer of trainers (TOT)were trained in event Based Surveillance and district and national level media scanning and hotline in the districts of Mangochi, Nkhotakota, Ntchisi and Kasungu and National level staff. This led to training of 1,230 district participants were trained IDSR and EBS. The Terms of Reference for International Health Regulations for National Focal Persons were finalized. 10. To ensure COVID 19 situation monitoring a KAP survey study manuscript was drafted and submitted to journals for publishing. The Mental health in Covid-19: The Experience of Frontline Health Workers working in COVID Treatment Centres in Lilongwe and Blantyre study data was analysed and study report was drafted. The Clinical, Laboratory and Epidemiological Characterization of COVID-19 Patients in Malawian Setting: A Cross-Sectional Retrospective and Prospective Analysis data entry and analysis were conducted and a final report was compiled and 3 manuscripts were written. The study of Determining the Hesitancy of Malawians to receive COVD-19 Vaccine was conducted and a report was compiled and a manuscript has been drafted. I1. To ensure that project activities are socially and environmentally responsible and promote human wellbeing, 56 Ombudsmen, and social welfare officers were trained and refreshed on timely, effective and satisfactory resolution of grievances, 148 HSAs were trained in grievance redress processes and GBV prevention, 4,874 community leaders were engaged on COVID-19 & vaccines, GRM, cholera and GBV. DESC Members from 21 districts managed to conduct district-based safeguard supervision. Six (6) MoH staff against a target of 5 were trained in Environmental and social safeguards to improve awareness and capacity and this led to development of ToRs for the engagement of consultants to develop safeguards tools. 12. To support the implementation of the cholera response plan the project supported an integrated supportive supervision in Mulanje, Thyolo, Mulanje, Mwanza, Nsanje and Chikwawa. Investigation for pink eye in Karonga and Nkhotakota, and supervision for Rubella vaccination campaign in Neno to support the Rubella response in the district was done. 1512 district and health facility officers were supported with airtime for National and district coordination activities. To ensure cholera surveillance, 20 districts were supported with fuel and four out of five data management review meetings were conducted in four zones excluding the South West to improve quality data management and ensure action review of the cholera response. Airtime was provided to laboratory staff at national and district level to improve data reporting and coordination. To improve case management medical supplies worth US$ 9 million were procured. 30% of the required items were received and distributed to health facilities. To ensure risk communication and community engagement meetings with Community Health Structures to participate in Cholera response (CHAGs, VHCs, VDC, ADCs) were conducted in Blantyre, Nsanje and Rumphi, Nkhatabay, Ntchisi and Mangochi. 2450 Community Health Volunteers 7 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO, D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 were oriented on cholera and covid-19 response and vaccine. To ensure good health care management practices 207 bins and 150000 bin liners were procured and distributed to the districts for waste storage at the incinerator points. The implementation of these activities has led to the achievement and surpassing of targets for four of the five project development outcomes in relation to percentage of designated laboratories with staff trained to conduct COVID-19 diagnosis, percentage of designated health facilities ready to treat COVIDI9, percentage of targeted population fully vaccinated based on the targets defined in national plan and percentage of females fully vaccinated. Thirteen (13) of the 26 (50%) intermediate indicators have their targets surpassed. It is hoped that the remaining 13 intermediate indicator targets will be reached in the fiscal year. In conclusion, the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project has made significant progress in achieving its objectives, despite some challenges. The project has strengthened the country's capacity to detect, prevent, and respond to COVID-19, and has improved the overall health system's preparedness for future pandemics. Key achievements include the procurement and distribution of critical medical supplies, training of health workers, and enhancement of laboratory management systems, among others. While some areas require further improvement, the project's progress demonstrates the effectiveness of coordinated efforts in responding to public health emergencies. As the project continues, it is essential to build on these achievements, address remaining challenges, and ensure sustainable health systems strengthening to protect the health and well-being of the Malawian people. DR. SAMSON MNDOLO SECRETARY FOR HEALTH MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 STATEMENT OF MANAGEMENT RESPONSIBILITIES The Project Appraisal Document of the International Development Association (IDA) Grant agreement of 141h April, 2020 and the Public Finance Management Act, 2022 requires management to prepare financial statements for each financial period which give a true and fair view of the state of affairs of the Project as at the end of the said time and of the operating results for that period. The Project Appraisal Document and the Act, also require management to ensure the Project keeps proper accounting records which disclose with reasonable accuracy at any time the financial position of the Project and enable them to ensure that the financial statements comply with applicable statutes. In preparing the financial statements, management accepts responsibility for the following; * Maintenance of proper accounting records; * Selection of suitable accounting policies and consistent application thereof; * Making judgments and estimates that are reasonable and consistently applied; * Compliance with applicable accounting standards when preparing financial statements * Preparation of financial statements on a going concern basis unless it is inappropriate to presume that the Project will continue in business in the foreseeable future. Management also accepts responsibility for taking reasonable steps to safeguard the assets of the Project and to maintain adequate systems of internal control to prevent and detect fraud and other irregularities. The financial statements have been approved on.............................by the Ministry of Health and Population are signed on its behalf by: SECRETARY FOR HEALTH PROJECT COORDINATOR- (Team Lead) 9 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 Telephone: + 265 1 770 700 In reply please quote No ......... Email: info a nao.zov.mw NATIONAL AUDITOFFICE Website: uNw.no.go1.mni P-O. BOX 30045 All Communications should be addressed to: CAPITAL CITY National Audit Office LILONGWE 3 MALAWI AUDITOR GENERAL AUDITOR GENERAL'S REPORT TO THE SECRETARY FOR HEALTH ON THE FINANCIAL STATEMENTS OF MALAWI COVID-19 EMERGENCY RESPONSE AND HEATH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW, IDA GRANT NO. D8870-MW, IDA GRANT E0980-MW AND CREDIT 7177 MW FOR THE YEAR ENDED 31 MARCH 2024 Opinion I have audited the financial statements comprising, Statement of Receipts and Payments and Designated Account Activity Statement of the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project IDA GRANT NO. D6200-MW, IDA GRANT NO. D8870-MW, IDA GRANT E0980-MW AND IDA CREDIT No 7177-MW for the year ending 3Is' March, 2024 and related notes as set out on pages 14 to 19. In my opinion, the financial statements present fairly, in all material respects, the financial position of the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project for the period ending 31" March, 2024 in accordance with the International Public Sector Accounting Standards (IPSAS). Basis for Opinion I conducted my audit in accordance with International Standards of Supreme Audit Institutions (ISSAls). My responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statements section of my report. I am independent of the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project and the Ministry of Health in accordance with the International Standards of Supreme Audit Institutions - Code of ethics (ISSAI 130) as promulgated by the International Organisation of Supreme Audit Institutions (INTOSAI), and I have fulfilled my other ethical responsibilities in accordance with these requirements. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. 10 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW, FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 Key Audit Matters Key audit matters are those matters that, in my professional judgment, were of most significance in my audit of the financial statements of the current period. These matters were addressed in the context of my audit of the financial statements as a whole, and in forming my opinion thereon, and I do not provide a separate opinion on these matters. I have determined that there is no need to communicate key audit matters in my report due the nature of the project. Responsibilities of Management for the Financial Statements Management of the Malawi COVID-19 Emergency Response and Health Systems Preparedness Project is responsible for the preparation and fair presentation of the financial statements in accordance with International Public Sector Accounting Standards (IPSAS) Financial Reporting under the historical cost convention and for such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. This responsibility includes designing, implementing and maintaining internal controls relevant to the preparation of the financial statements that are free from material misstatements, whether due to fraud or error. Auditor's Responsibilities for the Financial Statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with International Standards of Supreme Audit Institutions (ISSAls) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. As part of an audit in accordance with ISSAls, I exercise professional judgment and maintain professional scepticism throughout the audit. I also: Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for my opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. 11 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 * Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the internal control. * Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management. * Evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation. I communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that I identify during my audit. I also provide those charged with governance with a statement that I have complied with relevant ethical requirements regarding independence, and to communicate with them all relationships and other matters that may reasonably be thought to bear on my independence, and where applicable, related safeguards. From the matters communicated with those charged with governance, I determine those matters that were of most significance in the audit of the financial statements of the current period and are therefore the key audit matters. I describe these matters in my auditor's report unless law or regulation precludes public disclosure about the matter or when, in extremely rare circumstances, I determine that a matter should not be communicated in my report because the adverse consequences of doing so would reasonably be expected to outweigh the public interest benefits of such communication. 12 MINISTRY OF IlEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 The engagement audit resulting in this independent Auditor's report is: Signature... ...... .... .. THOMAS K. . A NATIONAL AUDI LILONGWE MALAWI Date...k a4 pdi......... 13 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 STATEMENT OF RECEIPTS AND PAYMENTS BY CATEGORY Notes Year Ended Year Ended 31 Mar 2024 31 Mar 2023 MWK'000 USD'000 MWK'000 USD'000 Balance brought forward 3.047.155 2.779 1.774.337 2.014 FINANCING IDA Grant D6200-MW 359,446 349 IDA Grant D8870-MW 3 3890,739 2.290 2.881.981 2.798 IT GrantTF8917-MW 3 5.164,479 3.039 1.586.984 1.541 IDA Grant 1:00980-MW 3 6.353.623 3.739 6.830,187 6,341 Direct Payments 4 24.821.154 14.607 43,277,150 26,454 13,432,936 13.042 PAYMENTS Imergency COVID- 19 Response 5 18.882.963 I1.435 9.371.117 9.274 Supporting National and Sub- 2 national. Prevention and Preparedness 6 1.543.866 934 231.529 226 3 Implementation Management and Monitoring and Evaluation 7 1.902.074 1.151 783.133 763 4 Cholera Contingent Emergency Response Component 8 16.242.560 9.829 TOTAL PAYMENTS 38,571,463 23348 10,385,779 1026 BALANCE AS31 MARCH 2024 4,705,687 3,105 3,047,157 2,779 PRESENTED BY Bank and Cash Balances 9 RBM Designated Account 1.215.091 1.195 65,403 65 RBM Holding Account 5.243.853 2.699 3.114.917 2.844 First Capital Operating Account (1,753.258) (789) (133.163) (130) CLOSING BALANCE AS AT 31 MARCH 2024 4,705,687 3,105 3,047,157 2,779 14 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 STATEMENT OF RECEIPTS AND PAYMENTS BY COMPONENT (IN DETAILS) Notes Year Ended Year Ended 3/31/2024 3/31/2023 MWK'000 USD'000 MWK'000 USD'000 Balance brought forward 3,047,155 2,779 1,774,337 2,014 FINANCING IDA Grant D6200-MW 359,446 349 IDA Grant D8870-MW 3 3,890,739 2,290 2,881,980 2,797 TF Grant TF8917-MW 3 5,164,479 3,039 1,586,984 1,541 IDA Grant E00980-MW 3 6,353,623 3,739 6,830,187 6,341 Direct Payments 4 24,821,154 14,607 43,277,150 26,454 13,432,936 13,042,002 PAYMENTS Expenditure by Component I. Emergency Covid-19 Response 1.1. Case Detection, Confirmation, Contact Tracing, Recording, Reporting 2,153,893 1,304 3,182,502 3,148 1.2. Health System Strengthening 4,747,398 2,874 1.828,468 1,808 1.3. Vaccination Procurement and Deployment - 4,360,146 4,313 1.4 Maintaining Essential Health Services 11,981,629 7,116 - - Subtotal 18,882,919 11,294 9,371,117 9,270 2. Supporting National and Sub-national, Prevention and Preparedness 2.1. Infectious disease capacity strengthening - 81,618 80 15 MINISTRY OF HEALTH . MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 2.2. EOC Capacity 48,286 29 24,950 25 2.3 Disease Surveillance 161,383 98 in Affected Districts 2.4 Supporting National and Sub-National, Prevention and Preparedness 1,334,213 807 124,961 124 Subtotal 1,543,883 934,23 231,529 229 3.1implementation Management and Monitoring and Evaluation 3.1. Implementation management and 1,522,004 921 coordination 293,807 291 3.2. Monitoring and Evaluation 162,576 98 74,999 50 3.3. Safeguards 217,514 131 414,326 423 Subtotal 1,902,095 1,151 783,133 764 4. Cholera Contingent Emergency Response Component 4.1 To Provide Effective Coordinated Leadership 118,052 71 Cholera Prevention and Control Activities at local district and national levels 4.2 To enhance surveillance system that is accurate reliable timely 49,346 30 and useful 4.3 To ensure provision of laboratory support for the 316,298 191 accurate and timely diagnosis of cholera 4.4 To Provide timely accessible and high quality clinical care for all 14,999,510 9,076 cholera patients 16 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO, D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 4.5 To implement social and behaviour change interventions for cholera 449,917 272 prevention and control that are evidence based 4.6 To Provide water sanitation and hygiene interventions that effectively control the 179,460 109 spread of cholera during outbreaks 4.7 Project Management, 130,160 79 M&E and Safeguards Subtotal 16,242,742 9,829 - - 38,571,463 23,348 10,385,779 10,263 4,705,687 3,105 3,047,157 2,779 PRESENTED BY Bank and Cash Balances MK USD MK iSD RBM Designated Account 1,215,091 1,195 65,402 65 RBM Holding Account 5,243,853 2,699 3,114,917 2,843 First Capital Operating Account (1,753,258) (789) (133,163) (129) Closing Balances 4,705,687 3,105 3,047,156 2,779 1-7 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 BUDGET VS ACTUAL EXPENDITURE BY CATEGORY FOR THE YEAR ENDED 31 MARCH 2024 BI DGET ACTIAL VARIANCE % Bl'DGET A(T'L VARIANCE % USD '000 USD '000 1 SD 1000 SDI '000 IS) '000 UsD '000 CATEGORY Emergency COVI D- 19 Response 4 38.213 11.435 26.779 300/ 21.871 9,274 12.598 4I% Supporting National and Sub-national, Prevention and Preparedness 4 2,044 934 1.110 d@% 249 226 3 91% Implementation Management and Monitoring and Evaluation 4 1.606 1.151 455 72% 796 '63 33 90% Cholera Contingent Emergency Response Component 4 2.529 9.829 (7.300) TOTAL EXPENDITURES 44,393 23,348 21,044 22.916 10.263 12,654 is MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 Designated Account Activity Statement - IDA D6200;D8870; 71770; E0980; TFB8717 For the Period Ending: March, 2024 Deposit Bank Reserve Bank of Malawi IDA Grant No. D6200- MW; D8870; IDA71770; E0980; TF8717Currency of Designated Account-US Dollars Account No '00130016000103 Part I Total Grant Cumulative advances to end of current reporting I period $ 15,181,037 15,181,037 Cumulative expenditures to end of last reporting 2 period $ 12,463,100 12,463,100 Outstanding advance to be accounted fior(line I 3 Minus lines 2) $ 2,717,937 2,717,937 Part II Part II Opening DA Balance at beginning of reporting period (as of beginning of quarter) I January, 4 2024 Account DA 8,736 8,736 Account Holding RBM 2,635,055 2,635,055 Account Operating- FCB (947,572) (947,572) 1,696,219 1,696,219 5 Add/ Subtract: Cumulative Adjustments (if any) - 6 Advances from World Bank during period (1) S 4,351,284 4,351,284 7 lines 5 and 6 5 4,351,284 4,351,284 Outstanding balances to be accounted for (add lines 8 4 and 7) 5 6,047,503 6,047,503 Closing DA balance at end of current reporting 9 period- March., 2024 Account DA 1,195,297 1,195,297 Account Holding -RBM 2,699,205 2,699,205 Account Operating- FMB (789,047) (789,047) $ 3,105,455 3,105,455 10 Add -Subtract : Cumulative adjustments (2) - 19 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 Expenditures for current reporting I I pcriod(Excluding direct payments) 5 3,329,567 3,329,567 12 12. Add lines 10 and II S 3,329,567 3,329,567 13 13. Add lines 9 and 12 S 6,435,023 6,435,023 14 14. Dilference (ifany) (line 8 less line 13) (Note 1) $ (387,519) (387,519) Part Ill Total forecasted amount to be paid hy World 15 Bank S 5,605,455 5,605,455.37 16 1 ess: Closing DA balance aller adjustments S 3,105,455 3,105,455 17 Direct Payments-Specials Commitments - - 18 Add lines 16 and 17 S 3,105,455 3,105,455 Cash requirement from World Bank for next two 19 reporting period (line 15 less line 18) S 2,500,000 2,500,000 NOTE The exchange rate used as at March, 2024 is MWKI,7331US$1 The Iorecast is based on the below listed payments I Fees for consultants 35.000 2 office operating costs 365,000 3 Various activity programs 1.450.000 4 Procurements 650.000 2,500,000 20 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 NOTES TO THE FINANCIAL STATEMENTS 1. Nature of Business (a) Malawi COVID-19 Emergency Response and Health Systems Preparedness Project is an IDA funded but implemented by the Ministry of Health and Population. The project has a five-year life span and the total project investment is USD 96.9 million comprising original grant of USD 7 million and additional financing grant of USD 30 million and then a further additional financing of combination of grant and loan totaling USD59.9. The major activities of the project are providing immediate support to Malawi to prevent the spread of COVID-19 through surveillance and containment strategies, Case detection, confirmation, contact tracing, recording, and reporting. Strengthening the capacity of the public health, project management and coordination, monitoring & evaluation (M&E), operational reviews to assess implementation progress and logistical support and also supports the grievance redress mechanism (GRM) and other activities in the Environmental and Social Commitment Plan (ESCP). In the period under review, some resources were redirected to respond to the cholera outbreak. This was planned for 6 months' implementation with a total budget of $12.1 million and planned to end July 2024. However due to some factors, the implementation period has been adjusted to September, 2024. 2. Significant Accounting Policies 2.1 Basis of preparation The financial statements have been prepared on cash basis in accordance with the International Public Sector Accounting Standards. The financial statements of the Project are expressed in both, US Dollars and Malawi Kwacha, which are the reporting and functional currencies respectively of the Project. 2.2 Foreign currency transactions Local currency receipts and expenditures are translated into United States Dollars using the exchange rates that Reserve Bank of Malawi used to convert the proceeds from the special account. Where part of the expenditures has to be met from the proceeds of subsequent drawdowns from special to local account, this is done on First in First out (FIFO) basis. All local expenditures paid from the local accounts/currency are translated back to the USD at the actual rate used for the transfer from special to local account. Cash balances held in foreign currency at close of reporting period are reported using the ruling rate at such times. Gains or losses on foreign currency transactions/balances are normally dealt with in within the Statement of Special Account, however the project decided that such recognition should be done at close of the project so that the operation 21 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 is simplified. However, the effects of gains/losses are witnessed from the results being achieved with the same budgeted funds. 2.3 Receipts Receipts are recognised when they are credited in the projects designated account held at Reserve Bank of Malawi. The project receipts comprised, funding from the donor, including direct payments made to the suppliers. Other receipts are those made from sales of tender documents, and refunds from tax authorities NOTES TO THE FINANCIAL STATEMENTS (CONTINUED) 3. Replenishment to the Special Account These are amounts of withdrawal applications received during the period under review, as follows: Financial Withdrawal Application Date Agreement Number USD'000 MK'000 26-Apr-2023 DA0980 WA AF2-036 COVID- 19 1,320 2,242,983 08-Aug-2023 DA0980 WA AF-027 COVID-19 1,100 1,870,045 20-Jan-2024 DA0980 WA AF2-035 COVID-19 862 1,464,090 21-Jan-2024 DA0980 WA AF2-037 COVID-19 457 776,504 3,739 6,353,622 19-Jan-2024 DTF 8917 WA AF2-005 COVID-19 1,000 1,699,295 28-Feb-2024 DTF 8917 WA AF2-038 COVID-19 1,000 1,699,288 26-Apr-2024 DTF 8917 WA AF2-039 COVID-19 936 1,591,208 21-Jan-2024 DTF 8917 WA AFTF-039 COVID-19 103 174,688 3,039 5,164,479 08-Aug-2023 DA8870 WA AF-028 COVID-19 215 365,325 17-Oct-2023 DA8870 WA AF-029 COVID 19 1,250 2,123,407 19-Jan-2024 DA8870 WA AF-035 COVID-19 231 392,447 20-Jan-2024 DA8870 WA AFT-036 COVID-19 594 1,009,560 2,290 3,890,739 Total 9,068 15,408,840 22 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 4. Direct Payments I)O000 %IK'00 IDA 71770 JIDA) components Description invoice-iwii2023/001-I'ssentiaI Medicines and 03-Oct-2023 4 Medical Supplies 9.000 15,293.651 12-Jun-2024 I Essential Medical Supplies 204 345.888 wire switch. 30 Tablests. 30 phones (survaille tablets) I 14-Jun-2023 I server. 5 desktops. 36 laptops, and 4print 354 602.386 40% of478661.12-cholera lab. Diagnostic sequencing i5-Nov-2023 1 reagents- Final the other cost will go to 1402 191 325.354 40% of 339247- Chlone testing kit Final other cost w ilI 25-Oct-2023 I go to 4602 136 230.592 4 Ambulances( toyota landeruser ambulance. 4.2 litre 02-Aug-2023 I diesel engine-) 207 352.315 28-Jul-2023 I Qty 29Toyota Ililux double cab 2.4 turbo diesel Rid 1.034 1.756.984 21-Apr-23 I Vaccines 1.134 1.926.225 1216 out 3040 bicycles delivered and 40% of 28-Sep-2023 1 532,405.58 invoice cost 215 365.283 1780 out 3040 bicycles delivered and 60% of 18-Jan-24 I 532.405.58 invoice cost 322 547.928 12-Jun-2024 I CT SCANNER Part of 1,471.370.67-30% depxsit 287 488,032 STATIC DIGITAL X-RAY MAClIiNES- Part or 26-Mar-2024 I I,471,370.67-30% deposit 463 786,777 MOBILE DIGITAL X-RAY MACIINES Part of 26-Mar-2024 1 1.471.370.67-30% deposit 721 1.224.807 Samsung galaxy A7 litc Tablets-1370 ofeach-tablets 26-Mar-2024 I cover and protector 338 574.933 Sub Total 14,607 24,821,154 5. Emergency COVID-19 Response L.L Case Detection, Confirmation, Contact Tracing, Recording, Reporting MWK'000 USD'OOO 1.2. Health System Strengthening 2,153.893 1,304 1.3. Vaccination Procurement and Deployment 4,747,398 2,874 1.4 Maintaining Essential Health Services - 11,981,629 7,116 Total 18,882,919 11,294 23 MINISTRY OF HEALTH . MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 6. Supporting National and Sub-national, Prevention and Preparedness MWK'000 USD'000 2.1. Infectious disease capacity strengthening - 2.2. EOC Capacity 48,286 29 2.3 Disease Surveillance in Affected Districts 161,383 98 2.4 Supporting National and Sub-National, Prevention and Preparedness 1,334,214 807 Total 1,543,884 934.23 7. Implementation Management and Monitoring and Evaluation MWK'000 USD'000 3.1. Implementation management and coordination 1,522,004 921 3.2. Monitoring and Evaluation 162,576 98 3.3. Safeguards 217,514 131 Total 1,902,095 1,151 8. Cholera Contingent Emergency Response Component MWK'000 USD'000 4.1 To Provide Effective Coordinated Leadership Cholera Prevention and Control Actvities at local district and national levels 118,052 71 4.2 To enhance surveillance system that is accurate reliable timely and useful 49,346 30 4.3 To ensure provision of laboratory support for the accurate and timely diagnosis of cholera 316,298 191 4.4 To Provide timely accessible and high quality clinical care for all cholera patients 14,999,510 0076 4.5 To implement social and behavior change interventions for cholera prevention and control that are evidence based 449,917 272 4.6 To Provide water sanitation and hygiene interventions that effectively control the spread of cholera during outbreaks 179,460 109 47 Project Management, M&E and Safeguards 130,160 79 Total 16,242,742 9,829 9. Closing Balances 24 MINISTRY OF HEALTH , MALAWI COVID-l9 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 Bank and Cash Balances MK USD MWK'000 USD'O00 RBM Designated Account 1,215,091 1,195 RBM Holding Account 5,243,853 2,699 First Capital Operating Account (1,753,256) (648) Closing Balances as at 31st March 2024 4,705,688 3,246 10. Non-Current Assets Capital expenditure is expensed in the year of purchase and no provision for depreciation is made on all non-current assets. This schedule includes all assets acquired since the project inception and are stated at cost. Details Amount (USD) (MWK) Opening Balance Ist 1,995 1,716,796 April,2023 Additions 2023/24 2,300 3,908,421 Disposals - - Closing Balance 4,295 5,625,217 11. IDA Loan/Grant Disbursements The loan and grant funds are accessed through initial submission of a six months forecast to IDA who in turn disburses funds as an advance to the Project Designated Account. The Interim Financial Reports are then used to document the utilization of funds on a quarterly basis through the Client Connection Portal. In terms of procurements for above the threshold, suppliers are paid directly to their bank accounts from The Bank in Washington. 12. Disbursement Method The project is using Report Based method of disbursement. The Interim Financial Reports (IFRs) coupled with Statements of expenditure as proof of utilization are used for replenishment to the Designated Account. 25 MINISTRY OF HEALTH MALAWI COVID-19 EMERGENCY RESPONSE AND HEALTH SYSTEMS PREPAREDNESS PROJECT- IDA GRANT NO. D6200-MW AND GRANT NO. D8870-MW, GRANT E0980-MW AND IDA CREDIT No 7177-MW. FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 13. Economic Factors Economic factors relevant to the project's performance are set out below; Economic trends as at 3 1s' March 2023 were as follows; Kwacha/Rand 59,8668 Kwacha/Dollar 1,053.4299 Inflation 27.5% 26