Nearly a year and a half after the US Department of Health and Human Services (HHS) launched an investigation into the Marshall Islands' use of nearly $1 million in health-related grants and put a hold on new grant money, the funds remain blocked and mental health programs that have relied on the US funding for many years are languishing.

It appears likely because the Ministry of Finance and its sub-grantee the Marshall Islands Single State Agency (SSA) have been unable to produce documents justifying the use of nearly $1 million spent in 2016 and 2017, that the Marshall Islands government will have to reimburse this funding to HHS.

The amount in question is over $950,000, and the Marshall Islands government reportedly has been unable to produce documents justifying the spending requested by HHS investigators.

Audits by Deloitte of the Marshall Islands SSA and its grants to a non-profit organization known as Kumit for the 2016 and 2017 period generated numerous "findings" of possible misuse and questioned the spending of hundreds of thousands of dollars of the US funding.

The Marshall Islands Ministry of Health and Human Services, which is headquartered at Majuro hospital (pictured), has seen most of its mental health and substance abuse prevention US grants locked due to unresolved audit issues between the Ministry of Finance and the US government. Photo: Marshall Islands Journal.

Deloitte auditors also recommended further investigation by the Marshall Islands and United States authorities.

The US investigation was launched in January 2021. At that time, HHS' Substance Abuse and Mental Health Services Administration (SAMHSA) initiated its investigation into the many audit findings of US grant funds spent by Kumit through an agreement with the SSA, which received the US funds via the Ministry of Finance. When Marshall Islands authorities didn't reply by a February deadline last year, SAMHSA responded by blocking close to half a million dollars in one new grant until the audit issues were resolved.

Some communication between US and Marshall Islands authorities did occur in 2021, according to local officials, but this did not resolve matters outstanding from the 2016 and 2017 audits.

This past December, SAMHSA released only $34,152 of a $210,419 grant for Mental Health - one of the several streams of funding under SAMHSA for the Marshall Islands. The rest of the grant was "locked."

"Due to the systemic nature of the (audit) concerns which could affect all awards, the Payment Management System accounts related to all SAMHSA awards remain locked," said the award to the Ministry of Health and Human Services issued this past December in documents obtained by the Marshall Islands Journal.

The "lock" on funds remains in place, hurting delivery of Ministry of Health programs.

SAMHSA's grant advised Marshall Islands authorities that SAMHSA "is prioritizing its review and will officially respond to your organization's last submission after which time your organization must make all necessary corrections to the long outstanding audit concerns. Otherwise, SAMHSA will move to suspend and/or terminate the award as appropriate and in accordance with HHS regulations."

In early March, the SAMHSA official handling the investigation acknowledged receipt of a March 1 reply to SAMHSA's January 21 audit letter. Marshall Islands authorities told SAMHSA that the Ministry of Finance would be responding to outline new standard operating procedures for managing future grant funds and related corrective actions to ensure the problems with the use of US federal funds did not happen again. In this March 12 communication, SAMHSA indicated it wanted to resolve all outstanding audit concerns as quickly as possible.

Dr Holden Nena, who is the clinical director of the Human Services at the Ministry of Health and Human Services, said late last week that nearly $1 million in available funding is still on hold. "It's all blocked," he said.

One grant on hold is over $200,000 for mental health programs, while another Covid-related mental health grant of $700,000 is also held up because of the audit problems with the SSA grant use.

"I've been trying to negotiate for the release of funds," he said. Nena has been talking with the US Public Health Services Region IX administrator in San Francisco in an attempt to find a way to release funds. "She told me that SAMHSA is waiting on a response from the Ministry of Finance," Nena said.

Only $129,000 from one funding stream known as the Substance Abuse and Prevention Treatment program is currently available under the HHS SAMHSA program for MOHHS programs. Normally the annual SAHMSA grant, which has several different streams of focus in the mental health and substance abuse intervention areas, includes funding levels over $1.5 million.

"The good news," said Nena, "is that the new (human services) building is finished." Nena was referencing a new facility completed earlier this year that will allow for the expansion of services for people with mental health-related needs. It was built with Asian Development Bank and US government Covid-related funding.

Late last month, the Ministry of Health broke ground for the first mental health facility to be constructed in Majuro. Dr. Holden Nena, the head of Human Services, center, was joined by numerous government and health officials for the ground breaking. Photo: Marshall Islands Journal

The bad news is that with the SAMHSA holding up on all mental health-related funding, there is no money for equipment, supplies, and staff to operate the new building.

"The Marshall Islands has wanted this building since 1986," he said. "It will provide a lot of services for Marshallese."

His struggle now is to find funding to get basic equipment and supplies so the Ministry of Health and Human Services can begin operating the newly built facility, as well as to get a resumption of regular SAMHSA funding for ongoing and essential mental health services for the country.