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GAO-22-104431, COVID-19: Better USAID Documentation and More-Frequent Reporting Could Enhance Monitoring of Humanitarian Efforts

Issuer
Government Accountability Office
Document type
Report
Date
2022-01-26

Summary

GAO-22-104431, a U.S. Government Accountability Office report to congressional addressees dated January 26, 2022, on how the Department of State and USAID monitored humanitarian assistance funded by $908 million in fiscal year 2020 COVID-19 supplemental appropriations. GAO reports that both agencies shifted to remote monitoring, that State consistently documented oversight of two NGO awards reviewed, and that USAID did not consistently document field-level oversight of five NGO awards. It reports that USAID reverted from monthly to semiannual reporting for new awards in March 2021 without fully assessing the trade-offs. GAO recommends that USAID communicate expectations for documenting field-level oversight and assess the trade-offs of more-frequent reporting, and USAID concurred.

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Full text

                United States Government Accountability Office
                Report to Congressional Addressees




                COVID-19
January 2022




                Better USAID
                Documentation and
                More-Frequent
                Reporting Could
                Enhance Monitoring
                of Humanitarian
                Efforts




GAO-22-104431
                                             January 2022

                                             COVID-19
                                             Better USAID Documentation and More-Frequent
                                             Reporting Could Enhance Monitoring of Humanitarian
Highlights of GAO-22-104431, a report to
                                             Efforts
congressional addressees




Why GAO Did This Study                       What GAO Found
The COVID-19 pandemic has created            The Department of State (State) and the U.S. Agency for International
new humanitarian needs and                   Development (USAID) shifted to remote monitoring of their humanitarian
exacerbated existing vulnerabilities         assistance awards in response to COVID-19, but USAID documented field-level
around the world. In response to the         oversight inconsistently. State and USAID officials reported using technology,
pandemic, Congress appropriated and          such as video conferencing, to communicate with agency staff and with
State and USAID obligated $908               organizations implementing the awards but generally ceased in-person meetings
million in supplemental funding in fiscal    as well as site visits by headquarters-based staff. State used a standardized
year 2020 for international                  template to consistently document oversight of two nongovernmental
humanitarian assistance activities.
                                             organization (NGO) awards GAO reviewed. However, USAID did not consistently
The CARES Act includes a provision           document field-level oversight of five NGO awards GAO reviewed. USAID staff
for GAO to monitor the federal               were either unaware of the relevant guidance on field-level oversight or believed
government’s efforts to respond to the       it was no longer in effect. Communicating to staff the expectations for
COVID-19 pandemic. This report               documentation would help USAID preserve institutional knowledge and ensure
examines how State and USAID                 management has information needed to make programming decisions.
adapted their monitoring of
humanitarian assistance activities           USAID required implementers using fiscal year 2020 COVID-19 supplemental
supported by COVID-19 supplemental           funds to submit monthly reports, which contributed to lessons learned and
funding. This report also describes how      informed headquarters staff. In March 2021, USAID reverted to semiannual
implementing organizations adapted           reporting for new awards but did not fully assess the trade-offs of doing so. Such
their projects to the COVID-19 context       an assessment could help USAID weigh competing factors, such as increased
and the challenges they faced.               risks while monitoring remains curtailed by the pandemic versus the burden
GAO reviewed State and USAID
                                             placed on implementing organizations by more frequent reporting.
planning, funding, and guidance              Organizations implementing State and USAID humanitarian assistance awards
documents and interviewed officials;         adapted to COVID-19 chiefly through low-tech remote solutions and faced
obtained data on all humanitarian            implementation and monitoring challenges. These adaptations included (1)
assistance awards funded from                increased use of social distancing and personal protective equipment (see
COVID-19 fiscal year 2020                    figure), (2) teleconferences or video conferences instead of in-person meetings,
supplemental appropriations. GAO             and (3) increased use of remote tools, such as telephone surveys. Implementers
also reviewed relevant documents for a
                                             faced related procurement, technology, and logistics challenges, which delayed
nongeneralizable sample of 12 awards
                                             program implementation.
(seven to NGOs, five to public
international organizations), selected       Masked and Socially Distanced Humanitarian Assistance Training in Honduras
on the basis of factors such as
geographic representation and type of
implementer.

What GAO Recommends
GAO recommends USAID better
communicate expectations for
documentation of field-level oversight,
and assess the tradeoffs of more-
frequent reporting. USAID concurred
with the recommendations.



View GAO-22-104431. For more information,
contact Chelsa Kenney at (202) 512-2964 or
kenneyc@gao.gov.
                                                                                        United States Government Accountability Office
Contents


Letter                                                                                     1
               Background                                                                  4
               Agencies Shifted to Remote Monitoring, but USAID Documented
                 Oversight Inconsistently and Ended Beneficial Monthly
                 Reporting                                                                 8
               Implementers Adapted to COVID-19 Chiefly through Low-
                 Technology Remote Solutions and Faced Implementation and
                 Monitoring Challenges                                                   19
               Conclusions                                                               26
               Recommendations for Executive Action                                      27
               Agency Comments                                                           27

Appendix I     Objectives, Scope, and Methodology                                        31



Appendix II    Comments from the U.S. Agency for International Development               33



Appendix III   GAO Contact and Staff Acknowledgments                                     37


Tables
               Table 1: USAID Obligations of Supplemental International
                       Disaster Assistance Funding, by Programming Sector,
                       Fiscal Year 2020                                                    6
               Table 2: USAID Bureau for Humanitarian Assistance’s Mandatory
                       Indicators for COVID-19 Awards of International Disaster
                       Assistance Funding, by Activity                                   10

Figures
               Figure 1: Socially Distanced Cash Distribution in South Sudan             21
               Figure 2: Murals on COVID-19 Prevention in South Sudan                    22
               Figure 3: Volunteer Training in Honduras Using Personal
                        Protective Equipment and Social Distancing                       24
               Figure 4: Examples of Emergency Relief Supplies Provided by
                        USAID                                                            26




               Page i                         GAO-22-104431 CARES Act Humanitarian Assistance
Abbreviations

AOR                        agreement officer’s representative
ARPA                       American Rescue Plan Act of 2021
BHA                        Bureau for Humanitarian Assistance
COVID-19                   Coronavirus Disease 2019
FFP                        Office of Food for Peace
IDA                        International Disaster Assistance
MPR                        monitoring plan and report
NGO                        nongovernmental organization
OFDA                       Office of U.S. Foreign Disaster Assistance
OIG                        Office of Inspector General
PIO                        public international organization
PPE                        personal protective equipment
PRM                        Bureau of Population, Refugees, and Migration
State                      Department of State
UN                         United Nations
USAID                      U.S. Agency for International Development
WASH                       Water, Sanitation, and Hygiene




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Page ii                                GAO-22-104431 CARES Act Humanitarian Assistance
                       Letter




441 G St. N.W.
Washington, DC 20548




                       January 26, 2022

                       Congressional Addressees

                       The Coronavirus Disease 2019 (COVID-19) pandemic has created new
                       humanitarian needs and exacerbated existing vulnerabilities around the
                       world. The United Nations (UN) estimates that over 270 million people
                       worldwide suffered acute food insecurity by the end of 2020—an increase
                       from 149 million before the COVID-19 pandemic. The UN also estimated
                       there were more than 82 million forcibly displaced people as of the end of
                       2020, with those numbers expected to continue rising. Further, worldwide
                       economic contractions resulting from the pandemic brought about the first
                       increase in extreme poverty since 1998.

                       Congress appropriated $908 million in supplemental funding in fiscal year
                       2020 for international humanitarian assistance activities. 1 Specifically, the
                       Coronavirus Preparedness and Response Supplemental Appropriations
                       Act and the CARES Act provided $350 million for Migration and Refugee
                       Assistance programming, managed by the Department of State’s (State)
                       Bureau of Population, Refugees, and Migration (PRM). The acts also
                       provided $558 million for International Disaster Assistance (IDA)
                       programming, which is managed by the U.S. Agency for International
                       Development’s (USAID) Bureau for Humanitarian Assistance (BHA). 2

                       The CARES Act includes a provision for us to monitor and oversee the
                       federal government’s efforts to prepare for, respond to, and recover from




                       1The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020,
                       and the CARES Act appropriated about $2.3 billion for diplomatic and foreign assistance
                       programming administered by State and USAID, to respond to COVID-19 abroad. This
                       supplemental funding included $908 million appropriated to the International Disaster
                       Assistance account and the Migration and Refugee Assistance account. See Pub. L. No.
                       116-123, tit. IV, 134 Stat. at 153; Pub. L. No. 116-136, div. B, tit. XI, 134 Stat. at 590.
                       2In March 2021, the American Rescue Plan Act of 2021 (ARPA) appropriated funds for
                       global response and humanitarian response. See Pub. L. No. 117-2, tit. X, §§ 10003-04,
                       135 Stat. at 239. According to State officials, all $500 million appropriated for humanitarian
                       response went to the Migration and Refugee Assistance account. According to USAID
                       officials, BHA was allocated $1.3 billion of the $3.09 billion that the ARPA appropriated for
                       global response. Discussion of funding in this report does not include the funds
                       appropriated by the ARPA.




                       Page 1                                  GAO-22-104431 CARES Act Humanitarian Assistance
COVID-19. 3 This report (1) examines how State and USAID adapted
program monitoring for humanitarian assistance activities supported by
supplemental funding in response to the COVID-19 pandemic and (2)
describes efforts that organizations implementing this funding made to
adapt their projects to conditions during the pandemic as well as the
challenges these implementers faced.

To address both of these objectives, we obtained information from
agency planning, funding, and guidance documents and interviewed
officials at State and USAID. 4 We obtained financial data on all
humanitarian assistance awards funded from the Coronavirus
Preparedness and Response Supplemental Appropriations Act and the
CARES Act. 5 From this universe of 209 awards, we selected a
nongeneralizable sample of 12 awards to nongovernmental organizations
(NGO) and public international organizations (PIO)—three awards
provided by State (two NGO awards and one PIO award) and nine
awards provided by USAID (five NGO awards and four PIO awards). 6

In selecting these awards, we used a mixture of random and judgmental
sampling to maximize coverage of features such as geographic
representation, implementation by NGOs and PIOs, permissive and
nonpermissive environments before the pandemic’s onset, obligation




3Pub. L. No. 116-136, div. B, § 19010. We regularly issue government-wide reports on the
federal response to COVID-19. For the latest report, see GAO, COVID-19: Additional
Actions Needed to Improve Accountability and Program Effectiveness of Federal
Response, GAO-22-105051 (Washington, D.C.: Oct. 27, 2021).
4We evaluated each agency according to its own policies and requirements.

5We obtained these data from State’s State Assistance Management System and
USAID’s Phoenix database. To assess the data’s reliability, we reviewed agency
responses to questions about data reliability, noting the specific tagging required for
COVID-19-supplemental funding. We also compared the data we received with the data
State and USAID reported to Congress and with original approval documentation. We
found that the data we received were sufficiently reliable for describing obligation and
programming information for COVID-19 supplemental funding.
6In total, State obligated funding through 21 awards and USAID obligated funding through
188 awards.




Page 2                                 GAO-22-104431 CARES Act Humanitarian Assistance
amounts, and program sectors. 7 We selected more NGO awards than
PIO awards because State and USAID generally impose fewer
programmatic monitoring requirements on PIOs than on NGOs. 8
Accordingly, we focused on NGO awards when evaluating agency
monitoring practices. For implementer adaptations to COVID-19, we
looked at both NGO and PIO awards.

For each award, we examined relevant award file documents, including
implementer reporting and agency oversight documentation. We
compared this documentation with agency policies and standards. We
determined that standards for internal control related to identifying,
analyzing, and responding to significant changes that could affect the
internal control system were relevant to our audit objectives. 9 We also
interviewed field-level USAID and implementer officials for three of the
awards. As part of this work, we reported in March 2021 on State’s and
USAID’s obligations of COVID-19 supplemental funding, including policy
changes that delayed USAID’s obligations. 10 For a more detailed
description of our scope and methodology, see appendix I.

We conducted this performance audit from July 2020 to January 2022 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




7USAID defines nonpermissive environments as contexts, at the national or subnational
level, in which uncertainty, instability, inaccessibility, or insecurity constrains USAID's
ability to operate safely and effectively. According to USAID, the vast majority of the
countries in which USAID provides humanitarian assistance have experienced some
degree of nonpermissiveness over the last 20 years, with backsliding, dramatic
downturns, and disruptive shocks not uncommon.
8According to Automated Directives System (ADS) 308.3.1, as a result of their
intergovernmental composition, PIOs are not generally subject to U.S. laws or business
standards.
9GAO, Standards for Internal Control in the Federal Government, GAO-14-704G
(Washington, D.C.: September 2014).
10GAO, COVID-19: Sustained Federal Action Is Crucial as Pandemic Enters Its Second
Year, GAO-21-387 (Washington, D.C.: Mar. 31, 2021).




Page 3                                   GAO-22-104431 CARES Act Humanitarian Assistance
Background
Humanitarian Impact of     The COVID-19 pandemic dramatically increased the need for
COVID-19                   humanitarian assistance throughout the world. Humanitarian assistance—
                           including the provision of food, water, shelter, emergency health care,
                           support for sanitation and hygiene, and critical nutrition services—is
                           directed to the world’s vulnerable populations. These populations—
                           including refugees, conflict victims, internally displaced persons, stateless
                           populations, and vulnerable migrants—can be highly vulnerable to
                           COVID-19 because of their reduced access to health care and, often,
                           their location in congested areas such as refugee camps.

                           The UN estimated that 235 million people worldwide—one in 33 people
                           globally—would require humanitarian assistance and protection in 2021.
                           This represents an increase from the estimate for 2020—one in 45 people
                           globally—which was the highest in decades. Additionally, the global
                           recession that resulted from the pandemic deepened humanitarian needs
                           across the globe. The UN reported, “For the first time since the 1990s,
                           extreme poverty will increase. Life expectancy will fall. The annual death
                           toll from HIV, tuberculosis and malaria is set to double. We fear a near
                           doubling in the number of people facing starvation.” 11

State and USAID            Within State, PRM manages humanitarian assistance funds in the
Humanitarian Response to   Migration and Refugee Assistance account, to address the needs of
                           refugees and internally displaced persons. Within USAID, BHA manages
COVID-19
                           humanitarian assistance funds in the IDA account, to provide relief and
                           rehabilitation to victims of human-induced and natural disasters. 12 State
                           and USAID provide humanitarian assistance through funding awards to
                           implementers, including NGOs and PIOs such as UN organizations.

                           In March 2021, we reported that State and USAID had fully obligated the
                           fiscal year 2020 supplemental funding allocated to the Migration and
                           Refugee Assistance and IDA accounts, respectively, by August 2020. 13



                           11United Nations, Office for the Coordination of Humanitarian Affairs, Global Humanitarian
                           Overview, 2021 (Geneva: Dec. 10, 2020).
                           12USAID established BHA in 2020, consolidating the former Office of U.S. Foreign
                           Disaster Assistance and Office of Food for Peace.
                           13GAO-21-387.




                           Page 4                                 GAO-22-104431 CARES Act Humanitarian Assistance
State funding and activities. According to State data, State obligated
the $350 million in supplemental Migration and Refugee Assistance
funding through 21 awards for programs in 68 countries. State data show
that the vast majority of PRM’s supplemental funding (about $339 million,
or 97 percent) were voluntary contributions to PIOs. 14 According to PRM,
the remaining funding (about $11 million, or 3 percent) went primarily to
NGOs with which PRM had preexisting programs.

Because voluntary contributions to PIOs support multisectoral activities
and are designed to provide flexibility to the organizations, PRM officials
said it is not possible to itemize the humanitarian assistance obligations
by programming sector. However, according to PRM, its awards
supported humanitarian partners as they pivoted to undertake COVID-19
prevention, mitigation, and response measures on behalf of PRM’s
populations of concern—refugees, conflict victims, internally displaced
persons, stateless populations, and vulnerable migrants. PRM funding
also supported broader community and national public health systems’
pandemic responses.

USAID funding and activities. According to USAID data, USAID
obligated the $558 million in supplemental IDA funding through 188
awards in 43 countries. USAID data show that PIOs received the majority
of BHA’s supplemental funding (about $339 million, or 61 percent) and
NGOs received the remaining funding (about $219 million, or 39 percent).

According to USAID data and officials, initial programming primarily
focused on augmenting ongoing health interventions and providing water,
sanitation, and hygiene support to mitigate widespread transmission of
COVID-19, address public health consequences, and maintain essential
health services for crisis-affected populations. Subsequent programming
aimed to address the pandemic’s longer-term food-security and economic
impacts in humanitarian settings to prevent a further deterioration of
preexisting crises, according to USAID data and officials.



14According to State guidance, voluntary contributions are discretionary financial
assistance provided to public international organizations, among other institutions, which
are meant to directly support the activities of the organization or to sustain its general
budget and operations. While the funds may be used to advance specific activities and
goals of the U.S. government, the central purpose of the funds is to enable the recipient to
carry out its activities. According to State officials, this means that generally U.S. voluntary
contributions cannot be traced to specific activities within a given country, since the
funding is pooled with resources from other donor countries.




Page 5                                   GAO-22-104431 CARES Act Humanitarian Assistance
                       Table 1 shows USAID’s total obligations of fiscal year 2020 supplemental
                       funding for humanitarian assistance, by programming sector.

                       Table 1: USAID Obligations of Supplemental International Disaster Assistance
                       Funding, by Programming Sector, Fiscal Year 2020

                                                                                                                         Total obligated,
                        Sector                                                                                                 in dollars
                        Nutrition and Food Assistance                                                                       189,342,490
                        Health                                                                                              136,890,850
                        Water, Sanitation, and Hygiene                                                                      115,270,666
                        Logistics                                                                                             59,863,966
                        Protectiona                                                                                           23,568,653
                        Multipurpose Cash Assistance                                                                          13,734,813
                        Humanitarian Coordination and Information Management                                                   8,719,255
                        Agriculture and Food Security                                                                          5,218,735
                        Humanitarian Policy, Studies, Analysis, or Applications                                                1,644,836
                        Shelter and Settlements                                                                                1,564,664
                        Economic Recovery and Market Systems                                                                   1,490,034
                        Risk Management Policy and Practice                                                                      691,038
                        Total                                                                                               558,000,000
                       Source: GAO analysis of U.S. Agency for International Development (USAID) data. | GAO-22-104431
                       a
                        USAID defines protection programming as activities that support the needs of vulnerable populations
                       such as women, children, persons with disabilities, and elderly-headed households.




State and USAID        Monitoring—the ongoing and systematic tracking of data and information
Monitoring Practices   relevant to policies, strategies, programs, projects, or activities—is used
                       to determine whether desired results are occurring as expected during
                       program, project, or activity implementation. Monitoring often relies on
                       indicators—that is, quantifiable measures of a characteristic or condition
                       of people, institutions, systems, or processes that may change over time.
                       Data collected through monitoring can be used to make programmatic
                       adaptations, support program evaluations, and contribute to the
                       development of lessons learned.

                       State and USAID both designate agency personnel to be responsible for
                       monitoring their respective awards. For State PRM awards, a
                       Washington, D.C.–based program officer conducts oversight in concert
                       with field-based refugee coordinators, acting as the grant officer’s
                       representative for the awards. Similarly, for USAID BHA awards, a
                       Washington, D.C.–based agreement officer’s representative (AOR) is


                       Page 6                                                GAO-22-104431 CARES Act Humanitarian Assistance
responsible for providing programmatic and administrative oversight.
AOR duties include conducting site visits and communicating with
implementing partners as well as reviewing reports and monitoring
compliance with reporting requirements. Activity managers based in
Washington or the field can provide support to the AOR in performing
monitoring functions—for example, collaborating with the AOR to conduct
site visits, verify monitoring data, conduct data-quality assessments, and
upload required documentation to the official award file.

State and USAID incorporate monitoring requirements into their awards.
For NGO awards, both PRM and BHA typically require quarterly financial
reports as well as periodic progress reports. In general, while PRM and
BHA apply reporting requirements to their PIO awards, they do not
require the same level or frequency of programmatic reporting from PIOs
as they do from NGOs. PRM monitors PIO awards differently than NGO
awards because its PIO awards are voluntary contributions (i.e., awards
of discretionary financial assistance). Because U.S. voluntary
contributions to PIOs are often combined with contributions from other
donors for very large global or regional projects, they generally cannot be
traced to specific activities in a given country, according to State officials.
Similarly, although PIOs that receive BHA awards are required to provide
quarterly and final financial reports and biannual program performance
reports, BHA does not require the same level or frequency of
programmatic reporting from PIOs as it does from NGOs.

For PIO oversight more broadly, both PRM and BHA engage with these
organizations at multiple levels. For example, PRM and BHA officials
participate in PIOs’ executive boards and engage frequently with
humanitarian organizations’ governing bodies and headquarters staff at
U.S. missions in Geneva, New York, and Rome as well as with European
Union counterparts in Brussels.

The COVID-19 pandemic substantially affected U.S. agencies’ and their
implementing partners’ ability to conduct project monitoring. According to
the USAID Office of Inspector General (OIG), by October 2020, over 90
percent of USAID missions reported that their capability to monitor foreign
assistance programs was reduced or significantly restricted because of
the impacts of COVID-19. 15 In recent analyses, USAID has also noted
that the operational adjustments that it and its implementing partners

15U.S. Agency for International Development, Office of Inspector General, USAID Adapted
to Continue Program Monitoring during COVID-19, but the Effectiveness of These Efforts
Is Still to Be Determined, Audit Report 9-000-21-007-P (Washington, D.C.: May 21, 2021).




Page 7                                GAO-22-104431 CARES Act Humanitarian Assistance
                           have made in response to the pandemic have limited their ability to
                           monitor programs as they normally would and have increased program
                           risks.


Agencies Shifted to
Remote Monitoring,
but USAID
Documented
Oversight
Inconsistently and
Ended Beneficial
Monthly Reporting
State Relied on Existing   State relied on preexisting processes and requirements to program and
Requirements, while        implement COVID-19 supplemental funding, while USAID issued new,
                           COVID-19-specific requirements to NGO implementers.
USAID Issued New
Pandemic-Specific          State’s process and requirements for COVID-19 supplemental
Requirements to            funding. State programmed supplemental Migration and Refugee
Implementers               Assistance funding through PRM’s Policy and Program Review
                           Committee process—a preexisting, PRM-specific process that seeks to
                           engage bureau-level stakeholders in strategy and funding decisions.
                           According to PRM, the process includes specific procedures for
                           emergency response. For COVID-19 supplemental funding, the
                           committee approved 11 funding memorandums, each detailing proposed
                           implementers, programming, and monitoring approaches, including how
                           the implementer’s program would respond to COVID-19. PRM did not
                           issue new guidance or requirements to its PIO or NGO implementers for
                           adapting to COVID-19 and instead relied on its preexisting internal
                           controls, such as required risk assessments, to identify and address
                           COVID-19-related risks.

                           USAID’s process and requirements for COVID-19 supplemental
                           funding. USAID programmed COVID-19 supplemental funding through a
                           new, centralized process unique to this funding. Concurrently, BHA
                           issued new risk assessment and reporting requirements to its NGO




                           Page 8                        GAO-22-104431 CARES Act Humanitarian Assistance
implementers. 16 BHA required NGOs receiving fiscal year 2020 COVID-
19 supplemental funding to include risk-mitigation measures for the
pandemic in their award applications’ safety and security plans. These
plans were to describe in detail how emergency medical care and
evacuation would be executed from all of the proposed activity locations
in light of border closures and limitations in air travel and local medical
care capacity and capability. BHA also recommended that applications
include monitoring practices appropriately adapted for staff and
beneficiary safety, including data collection safety and security protocols.

Further, BHA established a monthly reporting requirement for NGO
implementers receiving fiscal year 2020 COVID-19 IDA supplemental
funding. Specifically, the additional reporting required implementers to
provide updates of applicable COVID-19 mandatory indicators through
USAID’s online reporting tools. These mandatory indicators included
several new indicators as well as preexisting standard indicators required
by the Office of U.S. Foreign Disaster Assistance (OFDA) and the Office
of Food for Peace (FFP)—predecessors to BHA. 17 While NGOs were
required to update these indicators monthly, their monitoring and
evaluation plans that we examined also included various other indicators
to be addressed in semiannual and final reports. 18 Table 2 lists BHA’s
mandatory COVID-19 indicators for NGOs.




16U.S. Agency for International Development, USAID/Bureau for Humanitarian Assistance
Interim Guidance for Applicants Engaging in COVID-19 Humanitarian Response (June 11,
2020).
17In June 2020, USAID created BHA by consolidating OFDA and FFP into a single
bureau.
18According to BHA documentation, PIOs were requested, but not required, to report
monthly on the COVID-19 mandatory indicators for NGOs.




Page 9                               GAO-22-104431 CARES Act Humanitarian Assistance
Table 2: USAID Bureau for Humanitarian Assistance’s Mandatory Indicators for COVID-19 Awards of International Disaster
Assistance Funding, by Activity

 Category                                                          Indicator                                                  New or preexisting
 Non-food assistance
 Health, Public Health Emergency of                                Number of outpatient health facilities supported           New
 International Concern
 Health, Public Health Emergency of                                Number of inpatient health facilities supported            New
 International Concern
 Health, Public Health Emergency of                                Number of hospitalizations                                 New
 International Concern
 Health, Public Health Emergency of                                Number of individuals screened or triaged for COVID-19 New
 International Concern                                             at supported health facilities
 Health, Public Health Emergency of                                Number of people reached through risk communication        New
 International Concern                                             activities by channel
 Health, Public Health Emergency of                                Number of health care staff trained                        Preexisting
 International Concern
 Protection, Psychosocial Support Services                         Number of individuals participating in psychosocial        Preexisting
                                                                   support services
 Protection, Child Protection                                      Number of individuals participating in child protection    Preexisting
                                                                   services
 Protection, Gender-Based Violence                                 Number of individuals accessing gender-based violence Preexisting
                                                                   response services
 Protection, coordination, advocacy, and                           Number of individuals trained in protection                Preexisting
 information
 Water, Sanitation, and Hygiene (WASH) Non- Total number of people receiving WASH non-food items Preexisting
 Food Items                                 through all modalities.
 Food assistance
 Food assistancea                                                  Number of individuals participating in U.S. food security Preexisting
                                                                   programs
 Local, Regional, and International                                Quantity distributed (metric tons), by commodity           Preexisting
 Procurement Commodity
 Local, Regional, and International                                Number of unique participants receiving in-kind food       Preexisting
 Procurement Commodity
 Cash Transfers and Food Vouchers                                  Total amount distributed (US$), by modality (cash and      Preexisting
                                                                   voucher)
 Cash Transfers and Food Vouchers                                  Number of unique participants receiving support, per       Preexisting
                                                                   modality (cash and voucher)
 WASH Non-Food Items                                               Total number of people receiving WASH non-food items Preexisting
                                                                   through all modalities
Source: U.S. Agency for International Development (USAID). | GAO-22-104431
                                                               a
                                                                The USAID/Bureau for Humanitarian Assistance Interim Guidance for Applicants Engaging in
                                                               COVID-19 Humanitarian Response, June 11, 2020, named this category “E1”. According to BHA, this
                                                               label was from a legacy indicator list. For clarity, we have named it food assistance.




                                                               Page 10                                   GAO-22-104431 CARES Act Humanitarian Assistance
                          In addition, BHA required NGO implementers to submit monthly, two-
                          page maximum narrative summaries of any recent challenges or
                          successes as well as activities the implementer planned to prioritize for
                          the next month. 19

                          USAID issued guidance to implementers that addressed various
                          considerations and potential tools for remote monitoring. 20 For example,
                          in areas with sufficient mobile coverage and phone ownership,
                          implementers could consider gathering data through text messaging,
                          phone surveys, or computer-assisted phone interviewing. Similarly, the
                          guidance suggested web surveys and mobile apps could be used in
                          areas with sufficient internet connectivity. In addition, the guidance
                          discussed potential application of geospatial tools, such as satellite
                          imagery, in contexts where changes in the physical landscape at the
                          location of USAID activities were particularly relevant.

State and USAID Shifted   After the pandemic began, PRM and BHA shifted to remote monitoring of
to Remote Monitoring of   awards implemented by partners. To facilitate this transition, both PRM
                          and BHA issued guidance to their staff on potential adjustments to
Implementer Activities    operations during the COVID-19 pandemic. 21 This guidance included
                          recommendations for adjusting monitoring of implementers. For example,
                          the BHA guidance stated that a “do no harm” approach should be
                          prioritized, and the PRM guidance reminded staff to keep the “do no
                          harm” principle in mind in their monitoring. 22 Both sets of guidance
                          recommended alternative oversight activities for agency staff as well as
                          potential adaptations to implementers’ data collection tools. The agencies’
                          guidance also recommended against any activities that could endanger
                          the health of implementers’ staff or program beneficiaries.




                          19According to BHA documentation, although PIO partners were exempt from these
                          requirements, they were encouraged to submit monthly updates.
                          20U.S. Agency for International Development, Guide for Adopting Remote Monitoring
                          Approaches during COVID-19 (May 2020).
                          21Department of State, PRM Program Monitoring during COVID; U.S. Agency for
                          International Development, Adaptations to Partner M&E for Humanitarian Assistance
                          Activities due to COVID-19—Guidance to AORs and Program Staff for OFDA/FFP
                          Partners.
                          22“Do no harm” is a general principle whereby actors endeavor not to cause further
                          damage and suffering as a result of their actions.




                          Page 11                               GAO-22-104431 CARES Act Humanitarian Assistance
                          In practice, PRM and BHA officials’ remote monitoring generally involved
                          greater use of video conference software as well as continued use of
                          phone and email communications, according to officials we contacted.
                          The officials told us that because of agency restrictions on travel due to
                          the COVID-19 pandemic, in-person meetings generally ceased and site
                          visits by AORs and other headquarters staff were put on hold.
                          Headquarters staff stated that because most monitoring interaction with
                          implementers occurs in the field, remote monitoring did not significantly
                          change their level of contact with field staff and implementers, apart from
                          the cancellation of in-country site visits. 23

                          Field-level oversight of implementing partners initially shifted largely to
                          remote monitoring, particularly in countries where either the host
                          government or the U.S. embassy restricted movement. In the interim, field
                          staff continued reviewing progress reports and holding conference calls
                          with implementing partners. Some field-level site visits by agency staff
                          resumed later where local context allowed. However, both PRM and BHA
                          officials stated that conducting such site visits remained challenging. In-
                          person site visits by BHA-funded third-party monitoring firms were also
                          initially suspended.

State Consistently        PRM consistently documented field-level oversight activities for its NGO
Documented Field-Level    awards that we reviewed, but BHA did not. To examine agency
                          monitoring practices during the pandemic, we examined award file
Oversight of NGO Awards
                          documentation for two PRM and five BHA awards to NGO
We Reviewed, but          implementers. 24 We focused our analysis on oversight activities
USAID’s Documentation     conducted by agency personnel in the field, because according to agency
Was Inconsistent          officials, primary oversight takes place in the field, particularly during the
                          pandemic when travel from headquarters to the field was curtailed. Both
                          agencies’ award files consistently documented award modifications, such
                          as the granting of a no-cost extension, and generally included required
                          reports from implementing partners.



                          23According to BHA, AORs may be unable to monitor activities in person in complex
                          operating environments where there are security and access constraints. Officials said
                          these constraints to in-person monitoring are not exclusively a result of the pandemic. To
                          mitigate constraints in conducting field-based oversight activities, BHA may utilize third-
                          party monitoring mechanisms to assist AORs in fulfilling field-based oversight activities.
                          24We also reviewed one PRM award and four BHA awards to PIOs. However, we did not
                          include them in our analysis of agency monitoring practices during the pandemic because
                          the oversight context differs for PIO awards and because State and USAID place fewer
                          programmatic monitoring requirements on PIO awards.




                          Page 12                                 GAO-22-104431 CARES Act Humanitarian Assistance
Both of the PRM NGO award files we examined contained a monitoring
plan and report (MPR), which PRM uses to document its oversight for all
PRM NGO awards. The MPR is a standard template that lays out basic
expectations of the grants officer’s representative regarding monitoring
and is to be filled in by PRM staff as they complete oversight activities.
For example, the MPR contains specific sections for documenting receipt
and review of quarterly project and financial reports, notation of site visits,
and monitoring observations by headquarters and field staff. The template
also contains guidance on timelines, suggested content, and supporting
documentation. According to PRM officials, the MPR serves as a “one
stop shop” summarizing all required monitoring of an NGO award and is
part of the official award file.

Both PRM NGO award files we examined contained documentation of
field-level oversight activities, such as PRM monitoring plans,
implementer meeting notes, email correspondence, and notation of site
visits in the MPR. For example, one award’s MPR noted two site visits
conducted by a PRM-funded third-party monitor; the MPR also included
meeting notes and email exchanges with the implementer that addressed
implementation delays and the need for a no-cost extension. The other
award’s MPR explicitly ruled out site visits for the award because of
movement restrictions related to insecurity and the pandemic. That MPR
also contained updates from the refugee coordinator in the country as
well as progress evaluations from the program officer.

Our review of BHA documentation of field-level oversight activities
identified inconsistency in the documentation for NGO awards.
Specifically:

•   The official award files for two of the five USAID NGO awards we
    reviewed contained no documentation of field-level oversight.
•   The contents of the other three files ranged from two email updates
    from the field to extensive field-level materials, including field-based
    implementer presentations and meeting or call notes.
•   None of the five awards’ official files contained documentation of any
    field-level site visits. 25



25Because all site visits by Washington-based BHA staff were put on hold, none of the
award files for the five NGO awards we reviewed contained records of AOR site visits.




Page 13                               GAO-22-104431 CARES Act Humanitarian Assistance
When we asked about field-level oversight, BHA staff in the field
subsequently confirmed that they had conducted site visits for three
awards and provided relevant documentation from informal files. 26
However, this documentation was also inconsistent. For one award, BHA
field staff documented their site visit with a full trip report. For another
award, the site visits were described in a larger email update. For the
third award, field staff noted that instead of recording site visit notes, they
orally informed Washington-based staff of the site visit through a phone
call. The staff provided us with related email correspondence with the
implementer regarding logistics and follow-up from the site visit.

Further, nearly all BHA AORs and field staff we spoke with were unaware
of—and therefore did not follow—applicable legacy guidance issued by
BHA’s predecessors, OFDA and FFP, relating to field-level site visit
documentation. The USAID OIG had previously identified similar issues.
Specifically, in December 2015, a USAID OIG review of the agency’s
response to Ebola in Liberia identified weaknesses in documentation of
local site visits. 27 The OIG recommended that OFDA implement standard
operating procedures for sharing program information, including
documenting site visits and other efforts to verify program activities.
OFDA and FFP subsequently developed standardized guidance for field-
level site visits that included documentation standards. 28 Notably, this
legacy guidance includes documentation expectations. The legacy
guidance states, among other things, that “it is important to clearly and
systematically document” site visits and “it is also very important to file the
information in official files” to ensure successor staff have access to site
visit information.

However, when we initially inquired about BHA standards for
documentation of field-level oversight, BHA headquarters officials
responded that no such guidance existed and that they planned to

26BHA confirmed there were no site visits for one of the remaining two NGO awards. For
the other award, BHA clarified that a third-party monitor visited some sites as part of
oversight for a non-COVID BHA award. Furthermore, BHA determined that visiting other
sites would have been invasive and unsafe to both implementing partner and third-party
monitoring staff.
27U.S. Agency for International Development, Office of Inspector General, Audit of
Selected Ebola-Response Activities Managed by USAID’s Office of U.S. Foreign Disaster
Assistance In Liberia, Audit Report 7-669-16-002-P (Dakar, Senegal: Dec. 4, 2015).
28U.S. Agency for International Development, Monitoring, Evaluation, Accountability, and
Learning Policy, Guidance, and Tools; Annex 5: OFDA/FFP Site Visit Guidance
(November 2019).




Page 14                               GAO-22-104431 CARES Act Humanitarian Assistance
develop such guidance in the future. In the interim, according to these
officials, BHA was identifying lessons learned from its first year of
operating as a consolidated bureau. Officials also said that, given the
effects of the COVID-19 pandemic on the bureau’s already complex
operating environments, BHA had prioritized the development of
guidance for implementing partners, such as the recommendations for
conducting remote monitoring, rather than in-person site visit guidance for
BHA staff.

Subsequently, one BHA field staff member informed us about the OFDA–
FFP legacy guidance, stating that it had once—but no longer—governed
field-level oversight. When we asked BHA headquarters officials about
the legacy guidance, they stated that all legacy guidance remains in effect
until BHA is able to develop new, updated tools and guidance. Further,
they stated that this legacy site-visit guidance represents best practices
and, although it is not considered an official requirement, staff should
follow it until it is superseded by updated BHA guidance.

However, BHA AORs and field staff we spoke with were not aware that
they were expected to follow this guidance. None of the BHA staff we
interviewed who were responsible for oversight of the awards we
reviewed identified the legacy guidance as current operating procedure.
In one case, BHA staff explicitly told us they believed the guidance was
defunct.

As a result, site visits for the awards we reviewed were not consistently
documented in accordance with the best practices outlined in the legacy
guidance. For example, one award lacked any site visit documentation,
and BHA field staff stated that they had provided only an oral report to the
headquarters-based AOR. In addition, although the legacy guidance
emphasizes the importance of saving these field-level site visit
documents in official files, none of the field-level site visits for the BHA
awards we reviewed were documented in the official award file. Because
they were unaware of this guidance, some AORs we interviewed said
that, absent clear expectations, documentation included in the official
award file depended primarily on the professional judgement of the AOR.
Both BHA’s standard AOR designation letter and the legacy OFDA–FFP
site-visit guidance emphasize the importance of documentation to ensure
that successor staff with field or headquarters oversight responsibilities
have full information about USAID’s oversight activities.

Ensuring that all staff are aware of their responsibilities to document field-
level oversight activities in official award files would help USAID preserve


Page 15                          GAO-22-104431 CARES Act Humanitarian Assistance
                            institutional knowledge of actions taken to assure accountability, and
                            standardize the collection and documentation of field-oversight monitoring
                            reports. In addition, such documentation would ensure BHA management
                            has the information needed to assess program progress toward goals,
                            and make decisions about program direction and operation. This
                            information is especially significant in an emergency context such as the
                            COVID-19 pandemic, where programmatic responses must often be
                            rapidly adapted to unforeseen and changing circumstances. Furthermore,
                            in a context where normal oversight activities are curtailed—particularly
                            when AORs cannot conduct their own site visits—clear and consistent
                            documentation of field-level site visits and other oversight activities is
                            essential to ensure accountability for award funding.

Monthly Reporting           We found that BHA’s monthly reporting requirement for NGOs
Enhanced Lessons-           implementing awards of fiscal year 2020 COVID-19 IDA supplemental
                            funding produced several benefits. However, in March 2021 BHA decided
Learned Activities and
                            not to apply this requirement to awards of new COVID-19 relief funds.
Informed Staff, but USAID
Did Not Require It for      The monthly indicator updates and narrative summaries enabled BHA to
Later Awards                produce a series of summary and lessons-learned documents. According
                            to BHA, over time its monitoring and evaluation staff produced seven
                            overviews of COVID-19 award progress based on 8 months of NGO
                            reporting. These overviews generally summarized monthly indicator data
                            from all NGO awards and some PIO awards funded with fiscal year 2020
                            COVID-19 IDA supplemental funding. The intent of these monthly
                            overviews was to provide a comprehensive view of BHA’s COVID-19
                            response to date and of award implementation status. The overviews
                            generally contained monthly and cumulative BHA-wide indicator values
                            for targets related to all awards of fiscal year 2020 COVID-19 IDA
                            supplemental funding and included disaggregated data by activity and
                            geographic region. The overviews also contained more-detailed progress
                            information for several individual indicators, monthly reporting compliance
                            tables, and data quality updates.

                            In addition, the monthly reporting directly informed a lessons-learned
                            analysis of BHA Water, Sanitation, and Hygiene (WASH) programming
                            stemming from the COVID-19 IDA supplemental funding. This analysis
                            found that 42 percent of BHA’s implementing partners had not begun
                            distributing non-food items—essentially, hygiene kits—5 months after
                            their awards’ start dates. In addition, the analysis determined that,
                            because of the time required for internal BHA processing, even with
                            accelerated technical reviews, WASH kits may not have reached most
                            beneficiaries until 6 or more months after the need for emergency


                            Page 16                         GAO-22-104431 CARES Act Humanitarian Assistance
assistance began. According to USAID, this delay was of particular
concern because generally in a rapid-onset response, material support
becomes less relevant for affected populations as more time passes.
According to BHA officials, the bureau incorporated these and other
lessons learned into subsequent programming of American Rescue Plan
Act of 2021 (ARPA) supplemental funding for the COVID-19 response.

Monthly reporting also increased BHA headquarters staff’s access to
information about award implementation. BHA AORs and Washington-
based staff assigned to oversee the three NGO awards for which we
conducted interviews stated that the monthly reports had provided useful
information. For example, Washington-based oversight staff assigned to
the Honduras award stated that although they normally would not
interface often with implementers absent a formal request (e.g., a request
for a no-cost extension), the monthly reports provided more real-time
visibility on implementation. For example, the monthly narratives
essentially telegraphed ahead of time the need for an upcoming no-cost
extension and for program adaptation due to hurricanes Eta and Iota.

According to BHA, the monthly reporting requirement was designed to
align with USAID’s monthly financial reporting requirements outlined in
the CARES Act. 29 When BHA adopted the requirement in spring 2020, it
anticipated the COVID-19 pandemic response to be acute and short-term,
and it intended to obligate COVID-19 supplemental funding through 6-
month awards to rapidly respond. BHA typically requires NGO
implementing partners to submit standard semiannual and final reports on
program progress and to also submit quarterly financial reports. 30 Monthly
reporting provided BHA information on implementation progress before
these 6-month awards ended. According to BHA, given the potential need
for more-frequent reporting, the absence of USAID Task Force or agency

29The CARES Act states that “[o]n a monthly basis until September 30, 2021, each
agency shall report to the Director of the Office of Management and Budget, the Bureau of
Fiscal Service in the Department of the Treasury, the Committee, and the appropriate
congressional committees on any obligation or expenditure of large covered funds,
including loans and awards.” Pub. L. No. 116-136, § 15011 (b)(1)(A).
30For example, in BHA NGO awards we examined, semiannual reports were due no later
than 30 days after the end of each of two 6-month, semi-annual reporting periods
(October 1–March 31 and April 1–September 30). The recipients had to provide a report
for the reporting period in which the award began, unless the performance start date was
within 60 days of the end of the reporting period. Results from the final period were to be
included in the final program results report no later than 90 days after the estimated
completion date.




Page 17                                 GAO-22-104431 CARES Act Humanitarian Assistance
guidance on exact reporting frequency, and the need for rapid obligation
of emergency funding, BHA decided to require monthly reporting for
selected mandatory COVID-19 indicators in key programming areas. BHA
reported that this increased the information available about the COVID-19
NGO awards while also aligning with USAID’s CARES Act monthly
financial reporting requirements.

Conversely, BHA did not require monthly reporting for NGOs
implementing awards of COVID-19 relief funding provided by the ARPA,
which was enacted in March 2021. 31 BHA officials cited several reasons
for reverting to standard reporting requirements for ARPA-funded awards.
First, according to the officials, the ARPA, unlike the CARES Act, did not
include a monthly financial reporting requirement for USAID. Second, the
officials said BHA was concerned that the monthly reporting requirement
might have been burdensome to implementers and affected populations.
Finally, according to BHA, USAID has also made commitments through
international donor coordination initiatives to harmonize and simplify
reporting requirements. 32

The implementer representatives we interviewed described varied
experiences with the monthly reporting requirement. One implementer
representative stated that the monthly reporting was not particularly
onerous, as the implementer typically prepared to report monthly to BHA
field staff regardless of the requirement. Representatives of the other two
implementers stated that the reporting itself was not necessarily onerous
but that unclear guidance from BHA made it more challenging. For
example, according to one representative, the implementer did not fully
understand the nature of the information needed in the monthly
narratives, the format required, or the purpose for which the information
would be used. BHA continues to require NGO implementing partners to
submit standard semiannual and final reports about program progress as
well as quarterly financial reports.

Before choosing not to apply monthly reporting requirements to ARPA-
funded awards, BHA officials did not fully assess the costs or benefits of
enhanced reporting given the limits to USAID’s monitoring capabilities
31Pub. L. No. 117-2, 135 Stat. 4.

32According to BHA officials, USAID has made commitments through international donor
coordination initiatives, including the Grand Bargain and the Good Humanitarian
Donorship Initiative, to improve the effectiveness and efficiency of humanitarian action—
specifically with respect to harmonizing and simplifying reporting requirements.




Page 18                                GAO-22-104431 CARES Act Humanitarian Assistance
                       during COVID-19, which have continued well into 2021. According to
                       standards for internal control in the federal government, agency
                       management should identify, analyze, and respond to significant changes
                       that could affect the internal control system. 33 Such analysis includes
                       assessing whether existing controls are sufficient or additional controls
                       are needed in response to external changes, such as during the COVID-
                       19 pandemic. These standards also state that weighing both costs and
                       benefits can help management design and implement an effective internal
                       control system.

                       Thoroughly assessing the tradeoffs of requiring more-frequent NGO
                       reporting—particularly in a pandemic where normal monitoring, such as
                       site visits, is curtailed—could help BHA ensure it receives timely updates
                       on program implementation that would allow for rapid adaptation and real-
                       time analysis of lessons learned. USAID could use such an assessment
                       to weigh multiple factors—including the increased monitoring risks while
                       the COVID-19 pandemic persists as well as international donor
                       coordination initiatives to reduce reporting burdens—to determine the
                       most appropriate frequency of reporting. For example, USAID might
                       consider whether quarterly reporting would provide sufficient benefits to
                       balance the administrative burden placed on NGOs. Furthermore, such
                       an assessment could help determine whether specific program activities
                       or award types (e.g., 6-month awards) would particularly benefit from
                       more-frequent reporting than the semiannual reporting BHA currently
                       requires.


Implementers
Adapted to COVID-19
Chiefly through Low-
Technology Remote
Solutions and Faced
Implementation and
Monitoring
Challenges


                       33GAO-14-704G.




                       Page 19                         GAO-22-104431 CARES Act Humanitarian Assistance
Implementer Adaptations    Implementers for the 12 awards we reviewed largely relied on low-tech
to the COVID-19            remote solutions to adapt programming and monitoring in light of COVID-
                           19. Implementers we interviewed stated that such adaptations did not
Environment Largely Used
                           differ significantly from their typical programming and monitoring
Low-Technology Remote      practices.
Solutions
                           Implementer adaptations for the awards we reviewed included (1)
                           increased use of social distancing and personal protective equipment
                           (PPE); (2) teleconferences or video conferences instead of in-person
                           gatherings; and (3) increased use of remote tools, such as telephone
                           surveys.

                           Social distancing and PPE. Almost all of the 12 implementers for the
                           awards we reviewed reported they had some COVID-19 protocols in
                           place for monitoring and implementation. The protocols that the
                           implementers used varied, but most incorporated social distancing or the
                           use of PPE into program implementation and monitoring. For example,
                           one implementer continued in-person household surveys but used masks,
                           gloves, and social distancing. Other implementers integrated social
                           distancing and handwashing into their distribution efforts. For a USAID
                           award in Honduras, implementer officials stated that instead of physically
                           inspecting handwashing stations in homes that received WASH kits,
                           monitoring staff stood outside the homes and asked residents to self-
                           report.




                           Page 20                         GAO-22-104431 CARES Act Humanitarian Assistance
Figure 1: Socially Distanced Cash Distribution in South Sudan




                                         Teleconferences and videoconferences in lieu of in-person
                                         gatherings. Implementers used teleconferencing and videoconferencing
                                         for meetings and training sessions that would typically be held in person.
                                         Although implementer staff we interviewed said virtual training for
                                         beneficiaries was somewhat less effective than in-person training, they
                                         also reported benefits of virtual meetings and training sessions. For
                                         example, implementer staff said virtual meetings enabled participation by
                                         some beneficiaries who typically would not be able to attend in-person
                                         sessions.

                                         Remote tools. Implementers also shifted to using remote tools, such as
                                         phone surveys and text messaging, to communicate, gather information,
                                         and monitor projects. For example, for a State award in Afghanistan, the
                                         implementer reported that it had prioritized the use of phone interviews
                                         and substituted key informant interviews for focus groups. For a USAID
                                         award in the Pacific Islands, the implementer reported that it had not
                                         collected any in-person data for its baseline survey, in keeping with
                                         USAID’s “do no harm” principle. Instead, the implementer conducted
                                         remote interviews with key informants and leveraged a variety of
                                         secondary data sources, including data collected for other projects. For a
                                         USAID award in West Africa, the implementer reported that it had
                                         solicited and received feedback from community members via online
                                         platforms, national hotlines, and text messaging. Figure 2 shows another



                                         Page 21                         GAO-22-104431 CARES Act Humanitarian Assistance
                            type of remote tool used to communicate with local communities—murals
                            painted in South Sudan as part of one project’s community messaging
                            about how to prevent the spread of COVID-19.




Challenges Related to       Implementers reported that challenges related to procuring PPE,
PPE Procurement,            accessing technology, and moving staff and supplies within and between
                            countries during the COVID-19 pandemic delayed implementation and
Technology, and
                            made monitoring more difficult. Because of these types of challenges, the
Movement of Staff and       implementers of all but two of the 12 awards we reviewed requested and
Supplies Delayed            obtained no-cost extensions of their award agreements.
Implementation and Made
Monitoring More Difficult   Challenges related to PPE procurement. In March 2021, we reported
                            that a policy decision restricting the use of USAID funds for procuring




                            Page 22                        GAO-22-104431 CARES Act Humanitarian Assistance
PPE had delayed the obligation of BHA supplemental funding. 34 Our
review showed that this PPE-related prohibition also slowed project
implementation in some cases where implementers struggled to find PPE
manufacturers in the country or regionally. If there were no local or
regional manufacturers, implementers had to appeal to USAID to be
allowed to buy PPE for their beneficiaries.

For a USAID award in Syria, after attempting unsuccessfully to find PPE
in Syria or Turkey, the implementer purchased PPE on the international
market, where prices were higher, to avoid implementation delays. In
Honduras, project implementation was delayed while implementer staff
tried to identify local or regional sources of PPE for community volunteers
and beneficiaries. According to implementer documentation, when the
implementer was unable to identify local or regional PPE sources, it
requested a waiver from USAID’s PPE requirements. The implementer
reported that it received the waiver in October 2020, approximately 3
months after project implementation began. (Fig. 3 shows an example of
PPE in use on this project.)




34On March 20, 2020, the USAID COVID-19 Task Force notified BHA that no USAID
funds could be used to procure PPE. According to BHA officials, it was initially unclear
how to handle applications that had already been submitted with PPE components, which
constituted most applications. Specifically, the restriction notice did not specify which
types of PPE were covered or whether USAID would make exceptions for emergency
humanitarian programming. On June 9, 2020, the USAID COVID-19 Task Force approved
revised guidance on award language that loosened the restriction by allowing
procurement of PPE without prior USAID authorization under specified conditions. The
revised guidance allowed implementers to procure PPE from any source if it was to be
used by the implementers’ staff. However, any PPE intended for beneficiaries had to be
procured locally or not otherwise intended for the U.S. market.




Page 23                               GAO-22-104431 CARES Act Humanitarian Assistance
Figure 3: Volunteer Training in Honduras Using Personal Protective Equipment and
Social Distancing




Challenges related to technology. Implementers reported that greater
use of technology presented challenges, even while it became
increasingly critical for operating in a COVID-19 environment. For
example, although video conference technology allowed greater access
to beneficiaries in Ukraine who would otherwise have been unreachable,
implementer representatives reported that they were not always able to
successfully use such technology because of spotty reception or internet
access. Additionally, some beneficiaries were not conversant in the
technology, requiring implementer staff to schedule in-person visits to
deliver training or help with technological challenges.

Implementers noted that using the telephone provided some access to
beneficiaries but also presented challenges. For example, for a USAID
award in South Sudan, implementers said that conducting interviews over
the phone worked fairly well in an urban setting where cell phone
ownership was relatively high. However, they reported encountering
difficulties such as lack of connectivity, incorrect phone numbers, loss of
battery power during interviews, and, in some cases, language barriers.
In Sierra Leone, cash transfers via cell phones to recipients in remote
areas were delayed because of challenges related to the use of special
cell-phone SIM cards for the cash transfers. In particular, fewer recipients
than expected owned cell phones, and some recipients lost their SIM
cards, necessitating reissuance of the SIM cards.




Page 24                           GAO-22-104431 CARES Act Humanitarian Assistance
In general, implementers for the awards we reviewed did not use higher-
tech remote monitoring solutions such as virtual site visits or computer-
assisted surveys. Implementers we spoke with stated that many of these
options required reliable cell or high-speed internet service, which is often
not available in the places where disaster responses take place.

Challenges related to moving staff and supplies. Some
implementation challenges stemmed from in-country COVID-19
restrictions on movement of personnel. Because of these movement
restrictions, implementer staff were sometimes locked down in their office
or home locales, which hampered their ability to access project sites or
implement programs. In some instances, closed borders prevented
implementer personnel outside the country from entering. By contrast, the
implementer in Honduras reported it had acquired an emergency services
exemption from local government movement restrictions; otherwise,
programming would have been much more difficult, according to
implementer staff.

Supply chain issues also prevented implementers from procuring and
transporting materials. For example, implementer staff in Ukraine
reported being unable to import medical supplies because of supply chain
issues. Moreover, implementer staff reported that supply chain issues
significantly delayed the procurement and shipping of handwashing kits in
several locations for a USAID Pacific Islands project. (Fig. 4 shows
examples of emergency relief supplies provided by BHA.)




Page 25                          GAO-22-104431 CARES Act Humanitarian Assistance
              Figure 4: Examples of Emergency Relief Supplies Provided by USAID




              In addition to endangering lives, the COVID-19 pandemic has disrupted
Conclusions   economies as well as the availability of food and medical supplies
              worldwide. According to the UN, these and other secondary effects of the
              pandemic have exacerbated humanitarian crises on a global scale. As the
              global community attempts to address these needs, the pandemic also
              challenges the ability of donors and implementers to effectively monitor
              the assistance they are providing.

              State PRM, USAID BHA, and their implementing partners have taken
              steps to adapt their programming and monitoring during the pandemic.
              While those steps have allowed programming of emergency funding to
              continue, they have also brought significant challenges. The challenges to
              monitoring encountered by USAID and its implementers have not abated.
              The reliance of USAID staff in Washington, D.C., on field-based oversight
              for site visits and oversight of agency programming heightens the
              importance of documenting field-based oversight in a central location
              such as award files. Without clear guidance regarding field-level site visits
              and other oversight, USAID risks losing institutional knowledge about its
              programs and may lack timely information needed to assess program
              progress and make decisions about program direction and operation.




              Page 26                           GAO-22-104431 CARES Act Humanitarian Assistance
                      BHA mitigated some of the challenges associated with reduced
                      monitoring capabilities by requiring more-frequent reporting from
                      implementers, which also enabled the bureau to identify lessons learned
                      and incorporate them into subsequent programming. However, BHA
                      decided not to apply the requirement on more recent awards without fully
                      assessing the benefits and costs of enhanced reporting. Such an
                      assessment could allow BHA to potentially adapt what was beneficial and
                      mitigate any burdensome aspects. Doing so could help ensure that BHA
                      receives timely information that allows for rapid adaptation and real-time
                      analysis of lessons learned, which are particularly important in emergency
                      contexts where normal implementation and monitoring are curtailed.

                      We are making the following two recommendations to USAID:
Recommendations for
Executive Action      The USAID Administrator should ensure that BHA clearly communicates
                      to staff the expectations for documentation of field-level oversight, such
                      as site visits, in each award file, such as by educating staff about legacy
                      guidance or issuing new BHA guidance. (Recommendation 1)

                      The USAID Administrator should ensure that BHA assesses the costs
                      and benefits of requiring more-frequent reporting from implementers in
                      contexts where normal operations and monitoring are curtailed.
                      (Recommendation 2)

                      We provided a draft of this report to State and USAID for comment.
Agency Comments       During the draft review period, and in consultation with USAID, we
                      modified our recommendations to address them to the USAID
                      Administrator.

                      USAID provided comments that we have reproduced in appendix II. In its
                      comments, USAID concurred with our recommendations and stated that it
                      will take actions to implement them. State and USAID also provided
                      technical comments that we incorporated as appropriate.

                      We are sending copies of this report to the appropriate congressional
                      committees, the Secretary of State, and the Administrator of USAID. In
                      addition, the report will be available at no charge on the GAO website at
                      http://www.gao.gov.




                      Page 27                          GAO-22-104431 CARES Act Humanitarian Assistance
If you or your staff have any questions about this report, please contact
me at (202) 512-2964 or at kenneyc@gao.gov. Contact points for our
Office of Congressional Relations and Office of Public Affairs can be
found on the last page of this report. GAO staff who made key
contributions to this report are listed in appendix III.




Chelsa Kenney
Director, International Affairs and Trade




Page 28                          GAO-22-104431 CARES Act Humanitarian Assistance
Congressional Addressees

The Honorable Patrick Leahy
Chairman
The Honorable Richard Shelby
Vice Chairman
Committee on Appropriations
United States Senate

The Honorable Ron Wyden
Chairman
The Honorable Mike Crapo
Ranking Member
Committee on Finance
United States Senate

The Honorable Robert Menendez
Chairman
Committee on Foreign Relations
United States Senate

The Honorable Patty Murray
Chair
The Honorable Richard Burr
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate

The Honorable Gary C. Peters
Chairman
The Honorable Rob Portman
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate

The Honorable Rosa L. DeLauro
Chair
The Honorable Kay Granger
Ranking Member
Committee on Appropriations
House of Representatives




Page 29                        GAO-22-104431 CARES Act Humanitarian Assistance
The Honorable Frank Pallone, Jr.
Chairman
The Honorable Cathy McMorris Rodgers
Republican Leader
Committee on Energy and Commerce
House of Representatives

The Honorable Gregory W. Meeks
Chairman
The Honorable Michael T. McCaul
Ranking Member
Committee on Foreign Affairs
House of Representatives

The Honorable Bennie G. Thompson
Chairman
The Honorable John Katko
Ranking Member
Committee on Homeland Security
House of Representatives

The Honorable Carolyn B. Maloney
Chairwoman
The Honorable James Comer
Ranking Member
Committee on Oversight and Reform
House of Representatives

The Honorable Richard E. Neal
Chairman
The Honorable Kevin Brady
Republican Leader
Committee on Ways and Means
House of Representatives




Page 30                     GAO-22-104431 CARES Act Humanitarian Assistance
Appendix I: Objectives, Scope, and
              Appendix I: Objectives, Scope, and
              Methodology


Methodology

              This report (1) examines how State and USAID adapted program
              monitoring for humanitarian assistance activities supported by
              supplemental funding in response to the COVID-19 pandemic and (2)
              describes efforts that organizations implementing this funding made to
              adapt their projects to conditions during the pandemic as well as the
              challenges these implementers faced.

              To address both of these objectives, we obtained information from
              agency planning, funding, and guidance documents and interviewed
              officials at State and USAID. 1 We obtained financial data on all
              humanitarian assistance awards funded from the Coronavirus
              Preparedness and Response Supplemental Appropriations Act and the
              CARES Act. 2 We obtained these data from State’s State Assistance
              Management System and USAID’s Phoenix database. To assess the
              data’s reliability, we reviewed agency responses to our questions about
              data reliability, noting the specific tagging required for COVID-19-
              supplemental funding. We also compared the data we received with the
              data State and USAID reported to Congress and with original approval
              documentation. We found that the data we received were sufficiently
              reliable for describing obligation and programming information for COVID-
              19 supplemental programming.

              From this universe of 209 awards, we selected a nongeneralizable
              sample of 12 awards. 3 In selecting these awards, we used a mixture of
              random and judgmental sampling to maximize coverage of features such
              as geographic representation; implementation by nongovernmental
              organizations (NGO) and public international organizations (PIO);
              permissive and nonpermissive environments 4 before the onset of the
              pandemic; obligation amounts; and program sectors. In general, we
              selected more NGO awards than PIO awards because State and USAID

              1We evaluated agency actions independently of one another and did not directly compare
              the agencies’ respective performance.
              2 See Pub. L. No. 116-123, tit. IV, 134 Stat. at 153; Pub. L. No. 116-136, div. B, tit. XI, 134
              Stat. at 590.
              3Specifically, State obligated funding to 21 awards and USAID obligated funding to 188
              awards.
              4USAID defines nonpermissive environments as contexts, at the national or subnational
              level, in which uncertainty, instability, inaccessibility or insecurity constrains USAID's
              ability to operate safely and effectively. According to USAID, the vast majority of the
              countries in which USAID provides humanitarian assistance have experienced some
              degree of nonpermissiveness over the last 20 years, with backsliding, dramatic downturns
              and disruptive shocks not uncommon.




              Page 31                                  GAO-22-104431 CARES Act Humanitarian Assistance
Appendix I: Objectives, Scope, and
Methodology




generally impose fewer programmatic monitoring requirements on PIOs
than on NGOs. We selected three State awards, including two NGO
awards (for projects in Kenya and Afghanistan) and one PIO award (for a
project covering multiple countries). We selected nine USAID awards,
including five NGO awards (for projects in Honduras, Pacific Islands,
South Sudan, Syria, and Ukraine) and four PIO awards (for projects in
Colombia, Philippines, Sierra Leone, and West Africa).

To examine these awards, we developed a data collection instrument to
identify adaptive measures for data collection and site visits as well as
challenges to implementation and monitoring. For each award, we
examined relevant award file documents, including risk assessments,
award modifications, implementer reporting, and agency oversight
documentation. We compared this documentation with agency policies
and standards. We determined that federal internal control standards
related to identifying, analyzing, and responding to significant changes
that could affect the internal control system were relevant to our audit
objectives. 5 To further explore variability in USAID monitoring
documentation, we selected three USAID NGO awards (for projects in
Honduras, South Sudan, and Ukraine) to conduct remote meetings with
agency oversight staff and implementer officials based in Washington,
D.C., and the field.

We conducted this performance audit from July 2020 to January 2022 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.




5GAO, Standards for Internal Control in the Federal Government, GAO-14-704G
(Washington, D.C.: September 2014).




Page 32                               GAO-22-104431 CARES Act Humanitarian Assistance
Appendix II: Comments from the U.S.
              Appendix II: Comments from the U.S. Agency
              for International Development


Agency for International Development




              Page 33                              GAO-22-104431 CARES Act Humanitarian Assistance
Appendix II: Comments from the U.S. Agency
for International Development




Page 34                              GAO-22-104431 CARES Act Humanitarian Assistance
Appendix II: Comments from the U.S. Agency
for International Development




Page 35                              GAO-22-104431 CARES Act Humanitarian Assistance
Appendix II: Comments from the U.S. Agency
for International Development




Page 36                              GAO-22-104431 CARES Act Humanitarian Assistance
Appendix III: GAO Contact and Staff
                  Appendix III: GAO Contact and Staff
                  Acknowledgments


Acknowledgments

                  Chelsa Kenney, (202) 512-2964 or kenneyc@gao.gov
GAO Contact
                  In addition to the contact named above, Kara Marshall (Assistant
Staff             Director), David Hancock (Analyst-in-Charge), Eugene Beye, Neil
Acknowledgments   Doherty, Justin Fisher, Reid Lowe, Jason Marshall, and Nicole Willems
                  made key contributions to this report.




(104431)
                  Page 37                               GAO-22-104431 CARES Act Humanitarian Assistance
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