Health System Strengthening

Report Cover Image
Evaluation Plan:
2017-2021, Mozambique
Evaluation Type:
Final Project
Planned End Date:
07/2021
Completion Date:
11/2021
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
28,000

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Title Health System Strengthening
Atlas Project Number: 00114992
Evaluation Plan: 2017-2021, Mozambique
Evaluation Type: Final Project
Status: Completed
Completion Date: 11/2021
Planned End Date: 07/2021
Management Response: Yes
UNDP Signature Solution:
  • 1. Governance
Corporate Outcome and Output (UNDP Strategic Plan 2018-2021)
  • 1. Output 1.2.1 Capacities at national and sub-national levels strengthened to promote inclusive local economic development and deliver basic services including HIV and related services
SDG Goal
  • Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels
  • Goal 3. Ensure healthy lives and promote well-being for all at all ages
  • Goal 5. Achieve gender equality and empower all women and girls
SDG Target
  • 16.3 Promote the rule of law at the national and international levels and ensure equal access to justice for all
  • 16.6 Develop effective, accountable and transparent institutions at all levels
  • 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
  • 5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation
Evaluation Budget(US $): 28,000
Source of Funding:
Evaluation Expenditure(US $): 11,000
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
Amjad Mohammed Idries Evaluation Consultant amjadwedaa@gmail.com
GEF Evaluation: No
Key Stakeholders:
Countries: MOZAMBIQUE
Lessons
1.

•    Adopting reasonable assumptions at the design and inception stage: a key lesson learned was the importance of incorporating reasonable assumptions about the conditions and external requirements for such a project before committing a timeline with the beneficiary.
•    Role of M&E systems: M&E practices were important in the management of project scope, time, cost, project quality, human resources, communication, and risk. There is a need to strengthen and empower the M&E Unit within UNDP CO in a project setting to help enforce M&E practices that lead to a successful project.
•    Partnership: close collaboration with MoH and jointly monitoring and decision-making ensured timely problem-solving in a particularly difficult year and achieved planned results as per donor expectations. The UNDP partnership with the Government would benefit from a more comprehensive approach in setting a funding package for support to the implementation of the logistical plan that ensures robust and sustained capacity (both as infrastructure and institutional skills to develop and manage these infrastructures).
•    Donor programmatic and financial coordination: In collaboration with the National Logistics Working Group, through the Gavi, additional interventions and opportunities for value-for-money could be identified and achieved. UNDP planned with the MoH-CMAM, with funding from GF, a full Rehabilitation Project for the Administrative building, including Demolition and Construction with Expansion up to more than 5200 pallet capacity for Medical warehouses Beira city, Sofala province
–    that is also to have cold rooms for vaccines. In addition, is also planned in the same context to install a second incinerator in Nampula to serve North Region, and for which the toolkit and materials that are planned to be prepared under Gavi TCA will be adopted, as UNDP is standardizing the equipment and complementing the necessary National guidelines in line with existing policies homologated by Government for appropriation and sustainability.
•    Integrated approach: While space and equipment are important, having well-trained people with the appropriate supervision and accountability is the essential factor in determining whether a medical warehouse is productive and successful or not. In addition, hiring people and finding the correct mix is critical, particularly when there are unpredictable highs and lows in the workload. The medical warehouse planner’s single most important activity is determining the type and number of people needed to operate the warehouse. The continued alignment of UNDP with sector partners namely through Health Partners Group (HPG) is important and can contribute to reinforce advocacy in this key aspect to ensure holistic approaches for transformative interventions.


Findings
1.

1-The project is relevant and consistent with the Government, donor, and UNDP’s priorities as described below. The stakeholders rate the project as either highly relevant or relevant. 

2- The evaluation concluded that the effectiveness represents one of the project's key strengths judging through the existing set of performance indicators and targets: finalisation of wareahouse infrastractures, capacity building)

3- The evaluation assessed project outputs measures – qualitative and quantitative – and indicates favorable outcomes and progress compared to suitable benchmarks and standards. The evaluation findings showed that the material and financial resources invested in the project (human resources, thematic capacity strengthening interventions) are adequate and mostly sufficiently for reaching the initially planned results.

4- project’s benefits are likely to continue after the handover of the project to MoH.

5- The evaluation sought evidence on (a) tangible and observed reduction of stockouts or supplies disruption of key commodities, (b) positive perceptions of stakeholders on the project role as a facilitating factor to enhance overall health outcomes, (c) absence of significant or unacceptable negative effects. 


Recommendations
1

Continue to build the partnership between the UNDP and MoH to support the health system's decentralization agenda and enhance equity outcomes.

2

Align the governance and coordination of similar future projects with existing structures

3

Work in advance to address and overcome the anticipated bottlenecks.

4

Align health-related development prioritization according to government prioritization.

5

Develop an integrated approach for technical assistance and capacity building, if funded by donors in future interventions.Develop an integrated approach for technical assistance and capacity building, if funded by donors in future interventions.

6

Document lessons learned on the design of the intermediary medical warehouses before the expansion of the model.

7

MOH to focus the capacity-building interventions on priority areas and based on robust need assessment.

8

Diversify and differentiate the approach and business model for the technical assistance beyond construction activities to include other initiatives and innovations.

9

Identify opportunities for achieving efficiencies in scale and high value-for-money.

10

Establish and integrate robust M&E systems as part of projects management of similar construction projects.

11

Conduct a technical evaluation to assess the performance of the medical warehouse, if funded by donors in future interventions.

12

Conduct follow-up evaluation activities to complement the findings of this evaluation, if funded by donors in future interventions.

13

Ensure the Government maintains sustainable budgetary support for the operational costs associated with the new projects.

Management Response Documents
1. Recommendation:

Continue to build the partnership between the UNDP and MoH to support the health system's decentralization agenda and enhance equity outcomes.

Management Response: [Added: 2021/12/11]

. Reccommendation accepted. UNDP and other stakeholders will continue to provide targeted support to the Government to advance the Decentralization agenda in a meaningful manner and ensure the achievement of equity outcomes associated with similar kinds of projects.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Collaborate with the local authorities by building and strengthening their capacity in strategic planning and budgeting, management and leadership – using existing platforms.
[Added: 2021/12/11]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
2. Recommendation:

Align the governance and coordination of similar future projects with existing structures

Management Response: [Added: 2021/12/11]

Reccommendation accepted. We will increase efficiency and strengthen the capacities in the mid-long term by building on exiting coordination and engagement platforms.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Maintain active membership in National Logistics working group; and reporting as per ongoing system cleared in the ProDoc.
[Added: 2021/12/11]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
3. Recommendation:

Work in advance to address and overcome the anticipated bottlenecks.

Management Response: [Added: 2021/12/11]

Reccommendation accepted. We will consolidate MoH partnership; seek (even) informal sharing among individual local private sector companies at a large scale.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Promote the practice of engaging support from MoH dedicated focal persons to coordinate with local authorities – and continue transparent discussion in technical forums, minute and communicated as necessary in Project Board and High-level specific sector groups, for increased appropriation through joint decision making and risks sharing.
[Added: 2021/12/11]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
4. Recommendation:

Align health-related development prioritization according to government prioritization.

Management Response: [Added: 2021/12/11]

Reccommendation accepted. We will continue align its development priority actions on HSS in close collaboration with the government and agree on prioritization of the different zones depending on the actual needs.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Joint development of programme during grant making and further amendments to financing agreements.
[Added: 2021/12/11]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
5. Recommendation:

Develop an integrated approach for technical assistance and capacity building, if funded by donors in future interventions.Develop an integrated approach for technical assistance and capacity building, if funded by donors in future interventions.

Management Response: [Added: 2021/12/12] [Last Updated: 2021/12/13]

Reccommendation accepted. We will design a capacity building specific component if approved to be funded by donor. However, no due date can be entered as this key action will be implemented in case donor approves to fund.

Key Actions:

6. Recommendation:

Document lessons learned on the design of the intermediary medical warehouses before the expansion of the model.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. Ensure lessons learned re captured n final project handover to MoH.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Document lessons learned on the intermediary medical warehouse construction.
[Added: 2021/12/12]
UNDP Health Unit 2021/12 Completed Provided to MoH
7. Recommendation:

MOH to focus the capacity-building interventions on priority areas and based on robust need assessment.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. Support MoH to identify gaps and risks and devise, on that basis, an executable workforce plan, including interventions to address any over-or under-supply of staff and any skills gaps

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Advocate in sector specific forums for the resource mobilization to ensure: a. Training of supply chain managers in priority areas is a short-term solution to cover urgent gaps b. Capitalize on the existing capacities already available at the MoH or created because of the project in Manica c. Development a toolkit or hand booklet in order to capture the procedures and process of building the capacity of the government staff in the project’s area that could be used for future projects
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
8. Recommendation:

Diversify and differentiate the approach and business model for the technical assistance beyond construction activities to include other initiatives and innovations.

Management Response: [Added: 2021/12/12]

Reccommendation accepted.Extend support for the post construction stage to support the operationalization, as fund is made available.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Work closely with the MoH project management team at central levels to identify opportunities for operational improvements in order to maintain the positive UNDP’s partnership with the Government and ensure qualitative impact is retained and optimized.
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
9. Recommendation:

Identify opportunities for achieving efficiencies in scale and high value-for-money.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. Devote efforts to identify the sources of value for money and eliminate avoidable and unnecessary costs for any future projects.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Continue implementation based on UNDP procurement rules and regulations and reinforce quality assurance mechanisms based on lessons learned.
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
10. Recommendation:

Establish and integrate robust M&E systems as part of projects management of similar construction projects.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. Promote mechanisms to establish and integrate robust M&E systems as part of projects management of similar construction projects.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Advocate in CO to: a. Strength and assign an M&E staff to projects (focal points) setting to help enforce M&E practices that lead to a successful project implementation; and to establish the right M&E metrics and monitor the project progression continuously b. Establish quarterly meetings to evaluate and track M&E indicators and keep records of meeting notes, and progress recorded on Sharepoint
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Ongoing process through all project implementation cycle (NFM3).
11. Recommendation:

Conduct a technical evaluation to assess the performance of the medical warehouse, if funded by donors in future interventions.

Management Response: [Added: 2021/12/12]

Reccommendation accepted.CMAM to conduct the analysis after one year of effective use to gather technical information.  The performance evaluation methods to include benchmarking and any suitable analytical models.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Advocate with Principal Recipient the MoH to consider this action and attempt to mobilize resources to be able to implement.
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Highlight key recommendations from final evaluation report in Project Board meeting.
12. Recommendation:

Conduct follow-up evaluation activities to complement the findings of this evaluation, if funded by donors in future interventions.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. Advocate with Principal Recipient the MoH to consider this action and attempt to mobilize resources to be able to implement. Those can be: (i) Analyze the pre-design evaluation findings with a view to better understanding early design decisions ‘effect; (ii) conduct an impact evaluation three years after the warehouse becomes operating fully.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Advocate with Principal Recipient the MoH to consider this action and attempt to mobilize resources to be able to implement.
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Initiated Highlight key recommendations from final evaluation report in Project Board meeting.
Organize sessions with the MoH to explain the findings from the pre-design evaluation and their implications for how projects should be designed.
[Added: 2021/12/12]
UNDP Health Unit 2021/12 Completed Provided to MoH in different report tools.
13. Recommendation:

Ensure the Government maintains sustainable budgetary support for the operational costs associated with the new projects.

Management Response: [Added: 2021/12/12]

Reccommendation accepted. The planned and ongoing projects need to be completed and linked strategically to achieve the broader goals of the national strategic plan.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Advocate in sector specific forums for the donor programmatic and financial coordination towards support to MoH increase of domestic fund by reducing maintenance costs by using innovative solutions and efficient management models.
[Added: 2021/12/12]
UNDP Health Unit 2022/12 Not Initiated Ongoing process through all project implementation cycle (NFM3).

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