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Follow-Up Audit of the STD/AIDS Prevention Program in the Department of Health

Report No. 96-14


The Office of the Auditor conducted a follow-up audit of the Department of Health's STD/AIDS prevention program for the period from January 1994 to June 1996. The audit examined the extent to which the department has addressed findings and recommendations contained in our Audit of the STD/AIDS Prevention Program in the Department of Health, Report No. 93-29.

In our follow-up, we found some progress since our previous audit. For example, the department has filled the position of chief of the STD/AIDS Prevention Branch and has upgraded the administration of contracts for STD/AIDS services.

We also found that further improvements are needed. The STD/AIDS Prevention Branch needs strategic planning and better coordination. The lack of strategic planning limits the branch's ability to be proactive in the face of changing circumstances and to fully justify its $8 million funding level. The branch also has had mixed results in coordinating its activities. Efforts to improve communications have begun, but some attempts to obtain feedback from staff have faltered. The State AIDS Plan is not yet complete, the branch still lacks a policies and procedures manual, and its organizational structure is not completely clear.

We also found that management of the Community Health Outreach Work (CHOW) Project by the department and the branch should be tightened. In particular, the outreach project is unable to fully account for the total number of needles in use by the needle exchange program and assure one-for-one exchanges as required by state law. The project was not aware of or able to account for a l6,422 difference in needle counts over a nine-month period in 1995. A substitute staffing arrangement for the project was also placing the department at risk, and fiscal monitoring over project expenditures was insufficient.

The STD/AIDS Prevention Branch administers 39 contracts with private providers, accounting for nearly one-half of the branch's total allocations. We found that the department has made some progress in its administration of contracts. However, monitoring and evaluation could still be improved. The department has not developed a complete manual to guide contract monitoring and evaluation, monitoring forms are limited, and follow-up on monitoring reports is needed. Although annual site visits have contributed much to the monitoring process, the branch has just begun to evaluate the quality of provider services. A realistic approach to contracting is needed in which the branch clearly shows how many contracts and what types are essential to achieving its mission, assures that no duplication exists, and assesses its overall management approach to contracts in light of available resources and the State's fiscal climate.

Finally, we found that an artificial arrangement to increase the compensation of a top administrator in the Department of Health has undermined the STD/AIDS Prevention Branch. Funds from five federal grants to the department were used to create a faculty position at the University of Hawaii simply to supplement the salary of the chief of the department's Communicable Disease Division.

Recommendations and Response

Our report makes a number of recommendations for improvement in planning, coordination, oversight of the Community Health Outreach Work Project, and contract administration. We also recommend that the department terminate the compensation arrangement described above.

In its response, the department agrees with parts of our report, disagrees with others, and provides additional information on its activities.

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