Mid-Term Evaluation of GFATM HIV/AIDS Prevention & Care Grant Round 4

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Evaluation Plan:
2009-2012, South Sudan
Evaluation Type:
Project
Planned End Date:
08/2009
Completion Date:
03/2010
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
60,000

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Title Mid-Term Evaluation of GFATM HIV/AIDS Prevention & Care Grant Round 4
Atlas Project Number:
Evaluation Plan: 2009-2012, South Sudan
Evaluation Type: Project
Status: Completed
Completion Date: 03/2010
Planned End Date: 08/2009
Management Response: Yes
Focus Area:
  • 1. Poverty and MDG
Corporate Outcome and Output (UNDP Strategic Plan 2014-2017)
Evaluation Budget(US $): 60,000
Source of Funding:
Joint Programme: No
Joint Evaluation: Yes
  • Joint with Global Fund, UNICEF, UNAIDS
Evaluation Team members:
Name Title Email Nationality
Ayo Adene Team Leader
GEF Evaluation: No
Key Stakeholders:
Countries: SOUTH SUDAN
Lessons
Findings
Recommendations
1 GFATM may need to revise some targets based on the fact that not all our programs are fully functional. For example, our PMTCT outcome indicator continues to suffer low scores. That is because the PMTCT programs in Malakal , Wau and Yei and other sites all started in 2009. By the end of 2010 therefore, those targets would have been met. A note can also be done to the Global Fund asking to reset some targets, and when these are reset, they can be met by the end of the grant.
2 To build a country wide M&E system at every level, there should be an M&E officer at every county level AIDS Commission (CAC), and at the State level AIDS Commission. The county level Departments of Health and the State Ministries of Health also need to be strengthened with one officer. Every State Ministry of Health should have a fully staffed Directorate of HIV with an M&E department.
3 Strengthening M&E involves committing resources to staff training, computer systems, filing systems, transportation and seeking technical assistance. These needs should be planned in a budget.
4 For national health information system. The PR needs to plan this, and provide resources for the backup infrastructure such as electricity, standby generators, computers and the internet.
5 Conduct a review of the contract agreement with the supply chain management agency
6 A review of the supply chain management agency?s work plan to see if it is capable of addressing the issues raised in the mid-term evaluation, and if not, to develop it.
7 Identify focal persons in the counties, who may be a staff of UNICEF or WHO (Sub Recipients), to regularly follow up on supplies when they are delivered, as long as they have been informed.
8 Conduct field visits. Strengthen monitoring and evaluation (logistics) capacity of the supply chain management agency
9 Setting of minimal standards and storage conditions for drugs and supplies in the field, at service delivery points. This may be a long process.
10 A functional Logistic Management Information System (LMIS) should be created to connect the states and counties with the central store.
11 Strengthen the HIV/AIDS/STIs Directorate at every state level to supervise the running of HIV programs in every VCT, ART and PMTCT center. This is beginning to work in Wau for instance, where an acting Director of Health has just been appointed.
12 Let payment of incentives for government staff be included in workplans and proposals.
1. Recommendation: GFATM may need to revise some targets based on the fact that not all our programs are fully functional. For example, our PMTCT outcome indicator continues to suffer low scores. That is because the PMTCT programs in Malakal , Wau and Yei and other sites all started in 2009. By the end of 2010 therefore, those targets would have been met. A note can also be done to the Global Fund asking to reset some targets, and when these are reset, they can be met by the end of the grant.
Management Response: [Added: 2011/12/17]

PMTCT targets have been overstated due to lack of baseline data at the time of proposal writing. The Global Fund supported the MOH GOSS in completing the ANC Surveillance in 2009 and the results were released in August 2010. The results of the ANC surveillance indicate that the average prevalence rate amongst ANC attendees is 3%, with some of the sites reporting very low figures.

Key Actions:

2. Recommendation: To build a country wide M&E system at every level, there should be an M&E officer at every county level AIDS Commission (CAC), and at the State level AIDS Commission. The county level Departments of Health and the State Ministries of Health also need to be strengthened with one officer. Every State Ministry of Health should have a fully staffed Directorate of HIV with an M&E department.
Management Response: [Added: 2011/12/17]

The M&E systems at the MoH and SMoH have a long way to go in Southern Sudan. To strengthen M&E at state level, the PR office in collaboration with the MoH organized a training on M&E which was attended by M&E Officers from all states. In addition, UNDP has recruited and put in place four international UN volunteers in four different states who specialize in monitoring and evaluation. These specialists are based at the SMoH Offices.

Key Actions:

3. Recommendation: Strengthening M&E involves committing resources to staff training, computer systems, filing systems, transportation and seeking technical assistance. These needs should be planned in a budget.
Management Response: [Added: 2011/12/17]

A costed M&E plan has been developed and approved by the Global Fund based on the OSDV 2009 findings.

Key Actions:

4. Recommendation: For national health information system. The PR needs to plan this, and provide resources for the backup infrastructure such as electricity, standby generators, computers and the internet.
Management Response: [Added: 2011/12/17]

As part of Round 9 activities which are starting in October 2010, Round 9

Key Actions:

5. Recommendation: Conduct a review of the contract agreement with the supply chain management agency
Management Response: [Added: 2011/12/17]

The contract was reviewed with the Euro Health and all the issues were addressed. In addition to this the present contract with EH is coming to an end on Oct. 30th 2010. The contract of the Supply Chain Management agent has clear deliverables and only requires strict enforcement and close follow-up and supervision. Problems with supply chain management mainly started during the hand over from PSF to Eurohealth, and also from former PSF/Eurohealth staff to new Eurohealth staff. Weekly meetings are being held with Eurohealth and actions are strictly being followed up.

Key Actions:

6. Recommendation: A review of the supply chain management agency?s work plan to see if it is capable of addressing the issues raised in the mid-term evaluation, and if not, to develop it.
Management Response: [Added: 2011/12/17]

Euro Health in collaboration with the GFATM Procurement team develops work plans and updated regularly, which becomes the part of quarterly PUDR. As noted earlier, the workplan of the Supply Chain Management Agent?s is capable of addressing all the issues raised in the mid-term evaluation, and only requires strict enforcement and close follow-up and supervision. Problems with supply chain management mainly started during the hand over from PSF to Eurohealth, and also from former PSF/Eurohealth staff to new Eurohealth staff. Weekly meetings are being held with Eurohealth and actions are strictly being followed up. Eurohealth?s performance is being closely monitored and documented through performance evaluations conducted when quarterly disbursements are released.

Key Actions:

7. Recommendation: Identify focal persons in the counties, who may be a staff of UNICEF or WHO (Sub Recipients), to regularly follow up on supplies when they are delivered, as long as they have been informed.
Management Response: [Added: 2011/12/17]

It is the role of SRs to regularly monitor health items stock at the service delivery points and report back to EH. WHO and UNICEF will be requested to provide the names of the focal points for various sites where possible.

Key Actions:

8. Recommendation: Conduct field visits. Strengthen monitoring and evaluation (logistics) capacity of the supply chain management agency
Management Response: [Added: 2011/12/17]

EH has hired a capacity building and M&E specialists who conducts field visits for hands on training of health facility staff as well as identifying challenges and addressing them. The reports of these trainings along with assessment are shared with the PR. The agent has also developed a tool to trigger when sites are expected to request new orders of drugs and other pharmaceuticals. Sites are reminded to submit their orders ahead of time to avoid stock outs. Two trainings were conducted on HIV and TB drug management, and as well as on general logistics.

Key Actions:

9. Recommendation: Setting of minimal standards and storage conditions for drugs and supplies in the field, at service delivery points. This may be a long process.
Management Response: [Added: 2011/12/17]

There is a minimal budget allocated to support this aspect of the programme, for example there is no budget for renovation of facilities to ensure they meet minimum standards to store drugs and other commodities. However, the PR has provided equipment such as refrigerators with freezers and generators to ensure appropriate storage of cold chain supplies, and as well as consistent electricity supply. Facilities are assisted to allocate the appropriate space for storage of drugs and other pharmaceuticals. The department of Quality Assurance, Directorate of Pharmaceuticals Services and Supplies, MOH GOSS has developed a QA policy which addresses this recommendation.

Key Actions:

10. Recommendation: A functional Logistic Management Information System (LMIS) should be created to connect the states and counties with the central store.
Management Response: [Added: 2011/12/17]

There is a minimal budget allocated to support this aspect of the programme, for example there is no budget to establish an electronic LMIS but there is a budget to equip all ART sites with desktops, printers, and small photocopiers. LMIS tools have been reviewed and simplified to ensure that facilities can easily download and send the tools to the Supply Chain Management agent when ordering health products. The tools have formulas to make to avoid any miscalculations of forecasted products. The recommendation has been taken up and the new SCM agent will be implementing the LMIS.

Key Actions:

11. Recommendation: Strengthen the HIV/AIDS/STIs Directorate at every state level to supervise the running of HIV programs in every VCT, ART and PMTCT center. This is beginning to work in Wau for instance, where an acting Director of Health has just been appointed.
Management Response: [Added: 2011/12/17]

The MOH GOSS is working on strengthening State HIV/AIDS/STIs Directorate within the State MOH Offices but the GFATM has no budget to support this function. Most of the State HIV/AIDS/STIs Directorates have Director-Generals but no programme management staff. SSAC is also being supported to strengthen their State offices. Most of the posts will be filed after the referendum because GOSS has temporarily suspended the creation of new posts until after the referendum. The GFATM programme is currently providing incentives to staff at ART sites, recruitment of three ART Zonal Focal Points to be based in three regional states (Juba, Wau and Malakal), and as well as the recruitment of programme management staff within the HIV/AIDS/STIs Directorate of the MOH GOSS. An International Clinical mentor has been appointed and I supporting various ART sites.

Key Actions:

12. Recommendation: Let payment of incentives for government staff be included in workplans and proposals.
Management Response: [Added: 2011/12/17]

Payment of incentives of Government staff is against government policy. Non-civil servant project staff can be appointed through the grant and paid However, payment of incentives to health workers at ART sites is allowed and is included in the workplans and budget for the current grants. ART sites are only receiving incentives because the ART programme is not part of primary health care and most sites are managed by NGOs. WHO is managing this activity and is in the process of effecting payment for all backdated incentives.

Key Actions:

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