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Emergency Funding for Ebola Response: Some USAID Reimbursements Did Not Comply with Legislative Requirements and Need to Be Reversed

GAO-17-35 Published: Nov 02, 2016. Publicly Released: Nov 02, 2016.
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Fast Facts

West Africa experienced the largest Ebola outbreak in the history of the virus, resulting in more than 11,000 deaths as of June 2016.

In response to the outbreak, the U.S. Agency for International Development began funding a range of activities to control the virus's spread and strengthen global health security. Congress later provided billions of dollars to support and reimburse these efforts, and we found that USAID's management of more than $60 million of the reimbursed funds did not comply with the law.

We recommended ways for USAID to better manage these funds and ensure compliance with the law.

Total Allocations, Obligations, and Disbursements from the Appropriation for Ebola Activities, as of July 1, 2016

Bar chart: $2.5 billion allocations, $1.5 billion total obligations, and $875 million disbursements.

Bar chart: $2.5 billion allocations, $1.5 billion total obligations, and $875 million disbursements.

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Highlights

What GAO Found

As of July 1, 2016, the U.S. Agency for International Development (USAID) and the Department of State (State) had obligated 58 percent and disbursed more than one-third of the $2.5 billion appropriated for Ebola activities. In the early stages of the U.S. response in West Africa, USAID obligated $883 million to control the outbreak, and State obligated $34 million for medical evacuations, among other activities. Subsequently, the United States shifted focus to mitigating second-order impacts, such as the deterioration of health services and food insecurity, and strengthening global health security. Accordingly, USAID obligated $251 million to restore health services, among other activities, and $183 million for activities such as strengthening disease surveillance, while State obligated $5 million for biosecurity activities.

Of 271 reimbursements that USAID made for obligations incurred prior to the enactment of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015 (the Act), USAID made 21 reimbursements, totaling over $60 million, that were not in accordance with the Act. These 21 reimbursements represent roughly 15 percent of the $401 million that USAID obligated for reimbursements, of the almost $1.5 billion that had been obligated as of July 1, 2016 (see fig.). For these 21 reimbursements, USAID did not reimburse the same appropriation accounts as the accounts from which it originally obligated the funds, and therefore it did not have legal authority to make these reimbursements. In addition, four reimbursements were for obligations that USAID did not document were for Ebola activities. In reviewing the reimbursements, GAO found that USAID does not have written policies or procedures for staff to follow in making and documenting reimbursements. As a result, USAID does not have a process that could provide reasonable assurance that it complies with reimbursement provisions of applicable appropriations laws, such as the reimbursement provisions in the Act.

Total Allocations, Obligations, and Disbursements from the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015, as of July 1, 2016

Total Allocations, Obligations, and Disbursements from the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015, as of July 1, 2016

Why GAO Did This Study

In March 2014, the World Health Organization reported an Ebola outbreak in West Africa and, as of June 2016, reported that the outbreak had resulted in more than 11,000 deaths in Guinea, Liberia, and Sierra Leone. USAID and State initially funded Ebola activities using funds already appropriated. In December 2014, Congress appropriated approximately $2.5 billion to USAID and State, in part, for international efforts to prevent, prepare for, and respond to an Ebola outbreak and mandated that the agencies report periodically on their use of the funds. Congress also allowed the agencies to reimburse accounts for obligations incurred for Ebola activities prior to the fiscal year 2015 appropriation.

The Act also included a provision for GAO to conduct oversight of USAID and State activities to prevent, prepare for, and respond to the Ebola outbreak. This report examines (1) USAID's and State's obligations and disbursements for Ebola activities and (2) the extent to which USAID made reimbursements in accordance with the fiscal year 2015 appropriations act. GAO analyzed USAID and State funding, reviewed documents on Ebola activities, and interviewed agency officials.

Recommendations

GAO is making four recommendations, including that USAID should reverse reimbursements not made in accordance with the Act and develop written policies and procedures for its reimbursement process. USAID concurred with GAO's recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
U.S. Agency for International Development To ensure that USAID reimburses funds in accordance with section 9002 of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015, the Administrator of USAID should reverse reimbursements that were not made to the same appropriation account as the account from which USAID obligated the funds.
Closed – Implemented
USAID agreed with GAO's findings and recommendation. In August 2017, USAID reversed approximately $31.4 million in IDA account funds from the Act that it had used to reimburse for the Title II obligations that the Office of Food for Peace incurred prior to enactment of the Act. In addition, in August 2017, USAID reversed approximately $29.7 million of ESF account funds from the fiscal year 2015 appropriation that USAID had used to reimburse for the obligations of GHP and Development Assistance account funds that the Bureau for Global Health and the missions had incurred prior to enactment of the Act.
U.S. Agency for International Development To ensure that USAID reimburses funds in accordance with section 9002 of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015, the Administrator of USAID should reverse reimbursements for which there is no documentary evidence that the obligation was incurred to prevent, prepare for, and respond to the Ebola outbreak.
Closed – Implemented
USAID agreed with GAO's findings and recommendation. In August 2017, USAID reversed each of these 4 reimbursements. USAID does not intend to use funds from the Act to reimburse these 4 obligations that it incurred prior to enactment of the Act, according to USAID officials.
U.S. Agency for International Development To ensure that USAID reimburses funds in accordance with section 9002 of the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015, the Administrator of USAID should determine whether reversing any of these reimbursements results in the obligation of funds in excess of appropriations in violation of the Antideficiency Act and, if so, report any violations in accordance with law.
Closed – Implemented
USAID concurred with the recommendation. In August 2017, USAID reversed the improper reimbursements, and the agency's Chief Financial Officer determined that reversing the reimbursements did not result in the obligation of funds in excess of appropriations in violation of the Antideficiency Act.
U.S. Agency for International Development To help ensure that USAID complies with reimbursement provisions that may arise in future appropriations laws, the Administrator of USAID should develop written policies and procedures for the agency's reimbursement process.
Closed – Implemented
USAID concurred with GAO's findings and recommendation. In September 2017, USAID developed its Supplemental Appropriation Transfer Guide and disseminated the guide on the agency's Automated Directives System. The guide provides written policies and procedures that clarify the roles and responsibilities of USAID offices and bureaus when an appropriation authorizes a transfer of budget authority from one appropriation account to another, including reimbursing accounts for obligations incurred prior to the enactment of a supplemental appropriation.

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Topics

Global healthAppropriation accountsPolicies and proceduresDisease surveillanceHealth care servicesInternal controlsPublic health emergenciesEpidemicsAppropriation actsBudget authorityDisease controlEmergency medical response plansEmergency preparednessEmergency response fundsEmerging infectious diseasesHealth services administrationReimbursementsDisbursement proceduresComplianceLegislation