Terminal Evaluation of the UNDP Support to Health Sector in Limpopo Programme: Phase III

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Evaluation Plan:
2013-2019, South Africa
Evaluation Type:
Final Project
Planned End Date:
03/2016
Completion Date:
12/2016
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
14,100

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Download document Terms of Reference Project Evaluation- Final July 2015.pdf tor English 491.13 KB Posted 291
Download document Phase III Final Evaluation 2015.docx.pdf report English 1385.24 KB Posted 324
Title Terminal Evaluation of the UNDP Support to Health Sector in Limpopo Programme: Phase III
Atlas Project Number: 58382
Evaluation Plan: 2013-2019, South Africa
Evaluation Type: Final Project
Status: Completed
Completion Date: 12/2016
Planned End Date: 03/2016
Management Response: Yes
Focus Area:
  • 1. Poverty and MDG
  • 2. Democratic Governance
  • 3. Others
Corporate Outcome and Output (UNDP Strategic Plan 2014-2017)
  • 1. Output 3.2. Functions, financing and capacity of sub-national level institutions enabled to deliver improved basic services and respond to priorities voiced by the public
Evaluation Budget(US $): 14,100
Source of Funding: Cost-sharing
Joint Programme: No
Mandatory Evaluation: No
Joint Evaluation: Yes
  • Joint with UNDP, Limopo Department of Health
Evaluation Team members:
Name Title Email Nationality
Andires Mr andriesmangokwana@yahoo.com
GEF Evaluation: No
Key Stakeholders: UNV, Health Professions Council of South Africa,
Countries: SOUTH AFRICA
Comments:

The evaluation will assess the overall contribution of the programme to the Government of Limpopo efforts in improving health service delivery as set out in the programme document, in particular, strengthening the capacity of the Department of Health on strategic planning, monitoring and evaluation, promoting advocacy for volunteerism, MDGs domestication, human rights, and gender equality

Lessons
1.

Programme Design and Implementation Approach: The design of the programme needs to ensure that problems are diagnosed and that proposed interventions respond to the needs of the Department and, most importantly, to the programme beneficiaries. Establishing proper institutional arrangements is key to an effective and efficient programme.


2.

Communication is an essential ingredient of a successful programme. Both stakeholders and in particular hosting health facilities should be properly briefed about the objectives of the programme and its requirements.

 

3. Sustainability: The lesson emerging from the programme is that sustainability should be seen in its wider context, not only in terms of finances. Transfer of skills and mentoring is a key component of sustaining the efforts and achievements made in the programme.

 

4. Target setting should not be done in isolation of the complex regulatory environment that the programme operates under. It is important to take into account what has been achieved in the previous phases of the Programme and understand the regulatory processes that could impact on the achievement of the target.


Findings
1.

Programme design and implementation approach: The Programme responds to a critical shortage of medical doctors, particularly in rural areas. It is therefore responsive to the needs of Limpopo Province and is aligned with government priorities at both national and provincial level. The outputs, targets, activities and tentative indicators have clearly been spelt out. Within this context, the programme will remain relevant for some time to come.

Country ownership/drivers: The programme has been designed and is led by the DOH. The involvement of stakeholders through the Project Steering Committee with clear Terms of Reference and comprising key decision-makers across different units within the DOH could be strengthened.

Achievement of objectives: Three sub-programmes, namely health planning, knowledge management and leadership development, and monitoring and evaluation, could not be achieved, mainly because of financial constraints. The recruitment and placement of UNVs was to a large extent achieved, although the target of 120 was not.

This has contributed to improving the provision of health care services, including the reduction of the TB cure rate, a reduction in the patient waiting time, and the establishment of diabetic clinics in Polokwane and Mankweng.

Sustainability: One of the main pillars of the sub-programme dealing with transfer of skills and mentoring could be strengthened to ensure it happens in a more structured manner.

Replication Approach: This programme could easily be replicated in other provinces, provided essential elements are in place, such as functional institutional arrangements and governance structures, a focal person to drive the programme, adequate funding, and a conducive environment for UNVs to perform their work.

Cost effectiveness and cost sharing: The sub-programme has undoubtedly proved that it involves value for money, and this could be strengthened by ensuring that the PMU is located within the Department. This will ensure easy access of PMU staff to senior management within the DOH and so improve coordination and communication and expedite decision-making processes. The biggest challenge with regard to efficiency has been the financial constraints which made it difficult to continue to recruit and place doctors, and expand the programme in general. In addition, it caused a lot of anxiety among the UNVs and could have affected their productivity levels.


Recommendations
1

There is a need to re-establish a Programme Steering Committee with very clear terms of reference. The terms of reference should deal with challenges that have been identified such as composition of the committee, quorums, decision making by members and feedback mechanisms and frequency of meetings.

2

The three stakeholders, UNDP/UNV Office, UNV Bonn and DOH and PMU should explore writing up a recruitment process that specifies roles and responsibilities and related time frames for the deliverables. This will go a long way to managing the different expectations of all involved and lay the foundation to expedite the recruitment and placement processes. Furthermore, the introduction and acceptance of doctors showing direct interest in the programme needs to be clarified. Those who have applied, it is important that their applications should be followed up by UNV Bonn.

3

The Department od Health should revive the annual meeting/workshop with all UNVs. This plays a crucial role in knowledge and information sharing and serves as a support mechanism for UNVs.

4

Robust induction and awareness-raising about the programme among hospital management and personnel is required. The induction should expose all stakeholders to the programme in its entirety. In addition, there must be a one-on-one session with hospital management not only to prepare them for the arrival of new UNVs but also for the hospital to share their limitations in terms of logistics, infrastructure and medical equipment.

5

One of the critical aspects of sustainability is transfer of knowledge and skills from UNVs to locals and vice versa. Mentoring is a critical vehicle to ensure that this take places, and thus it should be more carefully structured. Different models of mentoring should be explored, including one-to-one mentoring, group mentoring, and cross-hospital mentorship (staff of different hospitals mentored together.

1. Recommendation:

There is a need to re-establish a Programme Steering Committee with very clear terms of reference. The terms of reference should deal with challenges that have been identified such as composition of the committee, quorums, decision making by members and feedback mechanisms and frequency of meetings.

Management Response: [Added: 2016/04/19] [Last Updated: 2016/04/19]

Yes, the Department of Health endorsed the resuscitation of the Programme Steering Committee to provide oversight for programme implementation

Key Actions:

Key Action Responsible DueDate Status Comments Documents
ToR for the Steering Committee to be developed and endorsed by the Committee
[Added: 2016/04/19] [Last Updated: 2016/10/26]
UNDP Project Coordinator, and Department of Health Focal Point 2016/04 Completed The final ToR to be shared with members of the Project Steering Committee in April 2016to be endorsed at the next PSC seating
2. Recommendation:

The three stakeholders, UNDP/UNV Office, UNV Bonn and DOH and PMU should explore writing up a recruitment process that specifies roles and responsibilities and related time frames for the deliverables. This will go a long way to managing the different expectations of all involved and lay the foundation to expedite the recruitment and placement processes. Furthermore, the introduction and acceptance of doctors showing direct interest in the programme needs to be clarified. Those who have applied, it is important that their applications should be followed up by UNV Bonn.

Management Response: [Added: 2016/04/19] [Last Updated: 2016/04/20]

A clear recruitment process with roles and responsibilities already exist within policies of responsible stakeholders but need to be clearly documented.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
PMU to write/document the recruitment process and also make follow ups with applicants and responsible professional councils.
[Added: 2016/04/20] [Last Updated: 2016/10/26]
PMU, the document process to be endorse by the PSC 2016/06 Completed The recruitment process has been outlined.
3. Recommendation:

The Department od Health should revive the annual meeting/workshop with all UNVs. This plays a crucial role in knowledge and information sharing and serves as a support mechanism for UNVs.

Management Response: [Added: 2016/04/20]

Yes, the Department endorsed the annual events with all UNV doctors

Key Actions:

Key Action Responsible DueDate Status Comments Documents
PMU in consultation with the Department of Health (DOH) will organise annual events for information sharing and learning
[Added: 2016/04/20]
PMU. DOH No due date Initiated Annual events will be continuously organised on annual basis
4. Recommendation:

Robust induction and awareness-raising about the programme among hospital management and personnel is required. The induction should expose all stakeholders to the programme in its entirety. In addition, there must be a one-on-one session with hospital management not only to prepare them for the arrival of new UNVs but also for the hospital to share their limitations in terms of logistics, infrastructure and medical equipment.

Management Response: [Added: 2016/04/20] [Last Updated: 2016/04/20]

The Human Resource Development Unit in the Department has an induction programme for newly appointed staff, UNVs will also go through this induction programme and any other training programmes organised by the Department.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
UNVs like any newly recruited staff will go through the induction programme of DOH
[Added: 2016/04/20]
DOH No due date Initiated The induction will be done regularly as and when new recruitment is done.
5. Recommendation:

One of the critical aspects of sustainability is transfer of knowledge and skills from UNVs to locals and vice versa. Mentoring is a critical vehicle to ensure that this take places, and thus it should be more carefully structured. Different models of mentoring should be explored, including one-to-one mentoring, group mentoring, and cross-hospital mentorship (staff of different hospitals mentored together.

Management Response: [Added: 2016/04/20]

The Department will issue a Circular regarding the training of all staff, including UNV doctors.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
DOH to circulate the training Circular to all staff including UNVs
[Added: 2016/04/20]
The Human Resource Development Unit in the Department, PMU to ensure that the circular is received by all UNVs. No due date Initiated Circulars are published on regular basis and sharing with UNV doctors will be an ongoing process

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