End of Program Evaluation of GFATM Tuberculosis - Grant Round 2

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Evaluation Plan:
2009-2012, South Sudan
Evaluation Type:
Project
Planned End Date:
09/2009
Completion Date:
03/2010
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
60,000

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Title End of Program Evaluation of GFATM Tuberculosis - Grant Round 2
Atlas Project Number:
Evaluation Plan: 2009-2012, South Sudan
Evaluation Type: Project
Status: Completed
Completion Date: 03/2010
Planned End Date: 09/2009
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
Ally Ahmed Ramadha Lasu Team Leader
GEF Evaluation: No
Key Stakeholders:
Countries: SOUTH SUDAN
Lessons
Findings
Recommendations
1 Supply the reagents in powder form so that the end user constitute in ratios they deem appropriate.
2 The PR should link up with M&E department, under the Directorate for planning and research and work out the modalities of harmonizing the M&E systems of the two entities.
3 Technically competent bodies such as (WHO, UNICEF, UNAIDS) should be involved at the planning and implementation phase of all GFATM programs for quality assurance and technical standards
4 PR should strengthen its collaboration with TB stakeholders and offer capacity building support SRs
5 PR and the SR should adhere to the signed PCAs and always refer to it to avoid misunderstanding during program implementation.
6 The PR and MOH, GOSS needs to Strengthen the capacity of NTP to manage the program at SMoH and County Level as a long term strategy
7 CCM should have a technically competent committee that will review all country proposals to identify any artificially calculated indicator, offer a platform for discussion with all stakeholders and map out the strategy to inform the GF secretariat.
8 The CCM and PR should dovetail some of the R2 activities to R4 and R7
9 PR should recruit sufficiently experienced staff with medical background for disease specific positions (HIV/AIDS, TB and Malaria) within the UNDP to manage the programs effectively.
10 CCM should select a specific number of indicators per GF program for validation and verification every quarter such that at the end of the year it can independently forecast each grant performance. As a routine, the CCM should design and liase with the PR to fund grant oversight and M&E system training for CCM members to improve on the performance of their oversight role.
11 Since TB and HIV are closely related diseases, TB/HIV initiatives should be introduced in all TB treatment sites to increase TB detection and optimize treatment outcomes.
12 The PR needs to foster and support the integration of TB component together with supply management indicators into the national M&E system and HMIS in preparation for when all TB units will be integrated into the PHC system.
13 The PR and CCM needs to avail current SRs some ?bridging? funds to help in the transition period to offer the basic TB services as patients are informed about the changes.
14 The CCM, through the NTP should take the lead in creating awareness about alternative TB service units using the media (local radios, newspapers, TV, market announcements and posters) for the residents where TB sites that may close down.
15 Engagement of TB treatment success clients to advocate for TB prevention and suspect follow up at the community.
16 Recruitment and training of more laboratory personnel.
17 Provision of transport facilitation for TB suspects
18 CHD should be supported to supervise TB and other vertically run programs effectively. They need to clearly understand their role in the sustainability of these programs.
1. Recommendation: Supply the reagents in powder form so that the end user constitute in ratios they deem appropriate.
Management Response: [Added: 2011/12/15]

Key Actions:

2. Recommendation: The PR should link up with M&E department, under the Directorate for planning and research and work out the modalities of harmonizing the M&E systems of the two entities.
Management Response: [Added: 2011/12/15]

The PR Office is already working closely with the Directorate of Planning and Research. As a matter of fact, the M&E team of the GFATM UNDP is stationed within the Directorate to provide technical assistance to the MoH. PR Office works with MoH in development of M&E tools, TA in the Technical Working Group, assistance in proposal development, organizing trainings, and rolling out National M&E framework.

Key Actions:

3. Recommendation: Technically competent bodies such as (WHO, UNICEF, UNAIDS) should be involved at the planning and implementation phase of all GFATM programs for quality assurance and technical standards
Management Response: [Added: 2011/12/15]

WHO is one of our main SRs in planning and implementation of GF TB grants in the Southern Sudan. WHO provides technical support from proposal development, work planning and budget, and ensure quality implementation of the TB activities through direct support to MoH- National TB Programme. At the moment WHO is SR under TB R7 and is providing technical support to NTP to plan and implement the programme in all 10 states of Southern Sudan.

Key Actions:

4. Recommendation: PR should strengthen its collaboration with TB stakeholders and offer capacity building support SRs
Management Response: [Added: 2011/12/15]

This is part of our grant management strategy and overall support to the partners. The PR has recruited a team of M&E specialists to support among others capacity building of SR in data collection, reporting and data management. Additionally, the PR has recruited an international capacity building specialist to support the grants implementation in terms of capacity building. The PR has also recruited 4 international UNVs whom are working directly with TB and HIV/AIDS stakeholders at GOSS and state levels, as part of implementation of the capacity building and management strategy of the GF grants in the country. Additionally, through TB R7 grant the PR has recruited 14 professional staffs that are working with NTP at GOSS and state levels. The PR is always supporting the SRs in terms of human resource recruitment, salaries, training, equipments and infrastructures.

Key Actions:

5. Recommendation: PR and the SR should adhere to the signed PCAs and always refer to it to avoid misunderstanding during program implementation.
Management Response: [Added: 2011/12/15]

The PR has taken necessary steps, to ensure that, all PCA are clearly understood by the SRs and are in line with PR and GF programme implementation framework. These include meeting the SRs, organizing training sessions for SRs and giving continuous feedback on project implementation.

Key Actions:

6. Recommendation: The PR and MOH, GOSS needs to Strengthen the capacity of NTP to manage the program at SMoH and County Level as a long term strategy
Management Response: [Added: 2011/12/15]

This is one of key interventions in R7 TB grant. Under this grant, the PR is supporting a number of initiatives (mentioned below in the key management actions) to strengthen the capacity of NTP to manage the programme at SMoH and county level.

Key Actions:

7. Recommendation: CCM should have a technically competent committee that will review all country proposals to identify any artificially calculated indicator, offer a platform for discussion with all stakeholders and map out the strategy to inform the GF secretariat.
Management Response: [Added: 2011/12/15]

There is already a technical working group for each of the three diseases. Each group develops the disease specific proposal and prepares documents for phase II application, including revision of artificially calculated indicators.

Key Actions:

8. Recommendation: The CCM and PR should dovetail some of the R2 activities to R4 and R7
Management Response: [Added: 2011/12/15]

The activities of R2 were continued through R7. Round 7 took all support being rendered to the 36 facilities that were supported by Round 2.

Key Actions:

9. Recommendation: PR should recruit sufficiently experienced staff with medical background for disease specific positions (HIV/AIDS, TB and Malaria) within the UNDP to manage the programs effectively.
Management Response: [Added: 2011/12/15]

Following the recommendation, the PR has recruited a medical doctor for the position of TB Project Manager.

Key Actions:

10. Recommendation: CCM should select a specific number of indicators per GF program for validation and verification every quarter such that at the end of the year it can independently forecast each grant performance. As a routine, the CCM should design and liase with the PR to fund grant oversight and M&E system training for CCM members to improve on the performance of their oversight role.
Management Response: [Added: 2011/12/15]

Starting 2010, the PR has started collaborative field visits with CCM. In addition, the CCM organizes independent field visits and prepare reports of their findings to dicsuss with the PR. The Grant Management Solutions (GMS), assigned by the Global Fund, conducted a training for the CCM members to strengthen CCM?s oversight role.

Key Actions:

11. Recommendation: Since TB and HIV are closely related diseases, TB/HIV initiatives should be introduced in all TB treatment sites to increase TB detection and optimize treatment outcomes.
Management Response: [Added: 2011/12/15]

Under Round 5, TB/HIV initiatives are already been introduced in all TB treatment sites to increase TB detection and optimize treatment outcomes.

Key Actions:

12. Recommendation: The PR needs to foster and support the integration of TB component together with supply management indicators into the national M&E system and HMIS in preparation for when all TB units will be integrated into the PHC system.
Management Response: [Added: 2011/12/15]

The M&E team is working closely with the M&E Directorate, MoH to rollout the national M&E framework with one data flow channel. A number of steps will be taken under Round 9 to strengthen this initiative.

Key Actions:

13. Recommendation: The PR and CCM needs to avail current SRs some ?bridging? funds to help in the transition period to offer the basic TB services as patients are informed about the changes.
Management Response: [Added: 2011/12/15]

Round 7 grant has already been used to bridge the gap.

Key Actions:

14. Recommendation: The CCM, through the NTP should take the lead in creating awareness about alternative TB service units using the media (local radios, newspapers, TV, market announcements and posters) for the residents where TB sites that may close down.
Management Response: [Added: 2011/12/15]

The TB sites under R2 were shifted to R7. Therefore, no sites were closed down. IEC activities have been organized under Round 5 TB/HIV grant.

Key Actions:

15. Recommendation: Engagement of TB treatment success clients to advocate for TB prevention and suspect follow up at the community.
Management Response: [Added: 2011/12/15]

This is one of the key strategies being used by our SR e.g. AAA, in community mobilization and awareness rising, where by the people who are successful cured from TB diseases are used to advocate for the services; ?? TB is curable and the treatment is free and available in local health facilities??

Key Actions:

16. Recommendation: Recruitment and training of more laboratory personnel.
Management Response: [Added: 2011/12/15]

In Round 7, more laboratory personnel are being recruited and trained.

Key Actions:

17. Recommendation: Provision of transport facilitation for TB suspects
Management Response: [Added: 2011/12/15]

The PR provides support to SRs to conduct outreach activities in the communities, so that the community members can easily access the services. Some of the support provided to SRs includes, vehicles, bicycles, motorbikes, and additional microscopes for outreach activities ? to allow the medical teams to carry out the tests in the field so as to avoid the suspected patients to walk long distances to reach the TB units for microscopic testing. The PR, WHO and MOH- NTP are working together to open more TB units, so that the community members can access the health care services at their neighborhood. At the moment a total of 45 TB units have been established and are operation under support from TB R7.

Key Actions:

18. Recommendation: CHD should be supported to supervise TB and other vertically run programs effectively. They need to clearly understand their role in the sustainability of these programs.
Management Response: [Added: 2011/12/15]

With the establishment of the State TB coordination offices, the CHD will automatically receive appropriate guidelines and support. This function is included in the TOR of the state TB coordinator.

Key Actions:

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