Mid-Term Review: Building Resilience of Health Systems in Asian LDCs to Climate Change (PIMS 5400)

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Title Mid-Term Review: Building Resilience of Health Systems in Asian LDCs to Climate Change (PIMS 5400)
Atlas Project Number: 00105394
Evaluation Plan: 2018-2021, Bureau for Policy and Programme Support
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 10/2021
Planned End Date: 10/2021
Management Response: Yes
Focus Area:
  • 1. Resilience
  • 2. Others
Corporate Outcome and Output (UNDP Strategic Plan 2018-2021)
  • 1. Output 2.3.1 Data and risk-informed development policies, plans, systems and financing incorporate integrated and gender-responsive solutions to reduce disaster risks, enable climate change adaptation and mitigation, and prevent risk of conflict
SDG Goal
  • Goal 13. Take urgent action to combat climate change and its impacts
SDG Target
  • 13.2 Integrate climate change measures into national policies, strategies and planning
Evaluation Budget(US $): 18,250
Source of Funding: LDCF
Evaluation Expenditure(US $): 18,250
Joint Programme: No
Joint Evaluation: Yes
  • Joint with UN Agencies
  • Joint with WHO
Evaluation Team members:
Name Title Nationality
Kristie Ebie
Christopher Boyer
GEF Evaluation: Yes
GEF Project Title: Building Resilience of Health Systems in Asian LDCs to Climate Change
Evaluation Type: Mid-term Review
Focal Area: Climate Change
Project Type: FSP
GEF Phase: GEF-6
GEF Project ID: 6984
PIMS Number: 5400
Key Stakeholders:
Countries: GLOBAL
Lessons
Findings
Recommendations
1

No-cost extension. As expected, COVID-19 profoundly impacted project implementation. Ministries of Health were over-burdened with dealing with the COVID-19 preparedness and response, requiring the full efforts of all health professionals. Either health professionals were re-purposed as members of the COVID-19 response team or were asked to add responsibilities formerly managed by member of the COVID-19 response team. The priority had to be to save lives and initiate vaccination programs in the midst of the pandemic. Further, there were COVID-19 related impacts on field-based activities due to restrictions on movement, face-to-face meetings, and gatherings. Although considerable progress was made in each country, in part by re-aligning activities to the reality of COVID-19, additional time is necessary for countries to complete their outcomes and outputs, to achieve the project goals. 18 months would be appropriate given the ongoing uncertainties in how the COVID-19 pandemic will unfold over the next year. This should be led by WHO ROs and HQ, in close collaboration with country teams.

2

Encourage further adaptive management approaches to implementation. Given uncertainties with how the pandemic will unfold over the next year or so, particularly new variants and rate of vaccination, encouraging flexibility could help countries address unforeseen challenges and mitigate emerging risks, within GEF/LDCF rules and procedures. Proactively identifying emerging risks would reduce their impact on project implementation. Changes in implementation plans should be discussed and agreed between the country and the WHO and UNDP partners. This should be led by WHO ROs and HQ, in close collaboration with country teams. UNDP should provide support as appropriate based on experience with other projects.

3

Consider clarification of management arrangements, particularly channels and procedures for grievances. The Project management arrangements are complex with multiple country, regional, and HQ offices engaged with the Project. Most countries are clear on the management structure but revisiting and clearly identifying the mechanisms in place to report an issue with the Project or other sensitive matters, would be beneficial. This should be led by WHO ROs and HQ, with support from UNDP.

1. Recommendation:

No-cost extension. As expected, COVID-19 profoundly impacted project implementation. Ministries of Health were over-burdened with dealing with the COVID-19 preparedness and response, requiring the full efforts of all health professionals. Either health professionals were re-purposed as members of the COVID-19 response team or were asked to add responsibilities formerly managed by member of the COVID-19 response team. The priority had to be to save lives and initiate vaccination programs in the midst of the pandemic. Further, there were COVID-19 related impacts on field-based activities due to restrictions on movement, face-to-face meetings, and gatherings. Although considerable progress was made in each country, in part by re-aligning activities to the reality of COVID-19, additional time is necessary for countries to complete their outcomes and outputs, to achieve the project goals. 18 months would be appropriate given the ongoing uncertainties in how the COVID-19 pandemic will unfold over the next year. This should be led by WHO ROs and HQ, in close collaboration with country teams.

Management Response: [Added: 2022/06/23]

A no-cost extension of 18 months is fully supported by WHO. A no-cost extension request was submitted to UNDP in August 2020 with signed letters from all International Project Board members and WHO. As the findings of the MTR demonstrate, the request for a no-cost extension remains valid It is recommended to use the NCE already submitted by WHO.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
1.1 A no-cost extension
[Added: 2022/06/23] [Last Updated: 2022/11/21]
UNDP 2022/08 Completed The extension request was approved on 2-Nov-2022. History
2. Recommendation:

Encourage further adaptive management approaches to implementation. Given uncertainties with how the pandemic will unfold over the next year or so, particularly new variants and rate of vaccination, encouraging flexibility could help countries address unforeseen challenges and mitigate emerging risks, within GEF/LDCF rules and procedures. Proactively identifying emerging risks would reduce their impact on project implementation. Changes in implementation plans should be discussed and agreed between the country and the WHO and UNDP partners. This should be led by WHO ROs and HQ, in close collaboration with country teams. UNDP should provide support as appropriate based on experience with other projects.

Management Response: [Added: 2022/06/23]

Management response: WHO agrees with this recommendation in principle to the extent that it can be implemented within the project design and GEF rules. Adaptive management has been demonstrated by several countries, particularly in Outcome 3, as a response to COVID-19. For example, WASH and health care facility activities were adjusted to address the COVID-19 pandemic along with climate resilience. Adaptive management will continue to be supported by WHO.

As neither the project executing nor the project implementing agencies can unilaterally grant greater flexibility on budget allocation across outcomes or radically alter the project design, we would encourage the GEF secretariat to consider this proposal for future projects.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
2.1 Identify emerging risks and adjust implementation plans
[Added: 2022/06/23]
WHO COs, ROs, and HQ and UNDP 2023/08 Initiated
3. Recommendation:

Consider clarification of management arrangements, particularly channels and procedures for grievances. The Project management arrangements are complex with multiple country, regional, and HQ offices engaged with the Project. Most countries are clear on the management structure but revisiting and clearly identifying the mechanisms in place to report an issue with the Project or other sensitive matters, would be beneficial. This should be led by WHO ROs and HQ, with support from UNDP.

Management Response: [Added: 2022/06/23]

It is noted that “most countries are clear on the management structure”, however, that channels and procedures may not be as clear. Clear, simple guidance will developed and distributed to all project countries outlining these procedures.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Management arrangements to be discussed and clarified during the meeting.
[Added: 2022/06/23]
WHO HQ and ROs, UNDP 2021/10 Completed

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