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Capacity Development in Health Sector Program
Commissioning Unit: Malawi
Evaluation Plan: 2012-2018
Evaluation Type: Project
Completion Date: 10/2012
Unit Responsible for providing Management Response: Malawi
Documents Related to overall Management Response:
 
1. Recommendation: There is need to address problems which result in the steering board meeting less regularly. The current governance structure of the project should be improved. Board membership should include effectively delegated mid-career professionals with less hectic schedules who can devote more time to the project. An alternative would be to cast the net wider and include experienced members from civil society.
Management Response: [Added: 2012/11/02] [Last Updated: 2012/11/02]

The Human Resource Technical Working Group (TWG) in the Ministry of Health shall act as the Project Board (PB) for the project. Issues for discussion by the TWG shall be presented by MoH and UNDP. Increasing the composition of the PB would, therefore, not be feasible at this point in time. Management therefore accepts this recommendation but with the above arrangement.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
1.1 The Ministry of Health is to make the necessary arrangements to inform the HR-TWG of this additional role
[Added: 2012/11/02] [Last Updated: 2014/10/28]
CD Cluster, Programme Analyst 2012/12 No Longer Applicable
2. Recommendation: The project should incorporate reflective workshops in order to develop realistic annual implementation plans and budgets. The project should also package current relevant components into a specific monitoring and evaluation results framework or project log frame. Annual work plans should also be supported by detailed activity schedules. Finally, given the success and impact of the project, targets should be reviewed annually, and funds permitting, new higher targets should be set.
Management Response: [Added: 2012/11/02]

UNDP agrees with this recommendation. The New Program Development process shall consider incorporating new implementation strategies that will involve key stakeholders in the health sector and government departments.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
2.1 Hold a biannual review meeting with stakeholders review progress
[Added: 2012/11/02] [Last Updated: 2013/02/27]
UNDP and Ministry of Health (MOH) 2012/12 No Longer Applicable
2.2 Carry out a revision of the 2012 AWP with a revised monitoring and evaluation and logical framework
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNDP, MOH 2012/12 Completed
3. Recommendation: The CDH project should shift focus and concentrate on recruiting specialist doctors. With a general consensus emerging that Malawi is producing enough undergraduate doctors, the focus of the project should be changed. It should concentrate on recruiting specialists rather than general doctors. Currently the College of Medicine is graduating around forty doctors every year and these are going a long way in covering the gap of general practitioners in Malawi hospitals.
Management Response: [Added: 2012/11/02]

The UNDP shall take the advice of the MoH on this issue and follow a phased out approach to recruiting more specialists as opposed to GPs as need be. However, the demand for GPs is still high both at Central and district levels.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
3.1 Develop ToRs for all existing vacant positions at central hospitals
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNDP 2012/06 No Longer Applicable A decision has been made to close the project by mid 2015
3.2 Review/take stock of the existing number of specialists and their distribution in central hospitals in the country
[Added: 2012/11/02]
UNDP, MOH 2012/07 Completed
3.3 Incorporate UNV specialist doctors requirements into MoH Human Resource Development Plan for 2012 -2016
[Added: 2012/11/02] [Last Updated: 2014/10/28]
MOH 2012/12 No Longer Applicable Project due to close by mid-2015
4. Recommendation: The UN volunteer unit (Malawi) should improve on financial reporting activities to ensure that reporting is in line with donors? expectations. The project should improve a great deal on fulfilling current donor financial reporting requirements. They have been concerns regarding the frequency and level of reporting from the donor?s perspective. Regular and detailed financial reports need to be submitted to donors. Since funding for the project comes from two separate channels of the global fund, the reports should clearly distinguish usage of money from the two sources.
Management Response: [Added: 2012/11/02]

This recommendation is well accepted for it hinges on good operating standards and accountability. The UNDP shall produce the required quarterly financial reports and submit them to the responsible parties. The UNV Unit shall be required to provide any administrative information as needed.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
UNDP to produce quarterly financial expenditure reports for submission to Ministry of Health for sharing with donors management.
[Added: 2012/11/02]
UNDP 2012/06 Completed This will be an ongoing activity
5. Recommendation: The current recruitment period of 6 to 9 months is long and ways must be found to shorten the process and make it more efficient. The process should be streamlined with due consideration to the quality of output required: High caliber individuals meeting recruitment requirements who will help the project achieve its goals and objectives. This requires collaborated efforts by the MoH, UNDP Malawi, and the UN volunteer Bonn office.
Management Response: [Added: 2012/11/02]

The recruitment process will be improved by having four sessions of interviews in a year. Efforts have also been made before to request the Bonn office to specifically consider recruiting doctors for Malawi only.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Conduct quarterly interviews
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNV/UNDP/MOH 2013/06 Completed Recruitment was intensified during first half of 2014. Beyond this, this is no longer necessary as project is due to close.
6. Recommendation: Consideration should be given to extension of UN volunteer doctors contracts from the current one year. This will greatly simplify planning from both the doctors and host institution perspectives. Currently UN volunteer doctors are given one year service contracts which are subject to extension. The existing one year contracts make planning difficult for the doctors and their host institutions. The current and proposed specialist training programmes being spearheaded by UN volunteer doctors would also benefit significantly from a planning perspective. Long term contract will maximize their impact on the delivery of health services.
Management Response: [Added: 2012/11/02]

Extension of initial contracts from one to two years has been agreed in principle to concurrently run together with the project funding cycle. If long term funding can be assured and that the MoH includes UNV doctor budget in its planning, this recommendation is well accepted

Key Actions:

Key Action Responsible DueDate Status Comments Documents
6.1 MoH to incorporate the UNV doctors budget in its annual planning for 2012 and beyond
[Added: 2012/11/02] [Last Updated: 2014/10/28]
MOH 2012/12 No Longer Applicable
6.2 MoH to communicate to UNDP budget commitment/transfer funds for 2 years to facilitate 2 years contracts extensions
[Added: 2012/11/02] [Last Updated: 2014/10/28]
MOH 2012/12 No Longer Applicable This did not materialize and now no longer applicable as project is due to close first half of 2015
7. Recommendation: The project has experienced problems in retaining and attracting specialist doctors. This is largely due to the discrepancy between the current UN volunteer doctor?s package and what specialists earn elsewhere. There is need to push up the allowance in order to attract more specialists. The project is currently facing problems in attracting highly experienced doctors who would maximize impact. With the suggested shift in project focus towards recruitment and placing of specialist doctors, this issue takes an even more strategic importance. Whilst acknowledgement has to be made that volunteerism is the central theme when recruiting UN volunteers, the allowances of UN volunteer specialist doctors should be meaningfully increased in order to attract more qualified and experienced doctors. Notwithstanding the volunteerism element on which recruitment of UN volunteers is premised, the existing gap between the current UN volunteer package and what specialists earn elsewhere should be a guiding tool in this.
Management Response: [Added: 2012/11/02]

The living allowances for UN Volunteers are set up by the UN and is based on the cost of living at the country office level. Any adjustment would, therefore, have to be done by the UN Headquarters office.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The UNV Unit will be undertaking periodic cost of living assessments and analyses and keep management informed of any new developments with regards to Volunteer rd to review of living allowances
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNV/UNDP 2012/12 No Longer Applicable Project is due to close by mid-2015
8. Recommendation: Lack of basic equipment is a rampant problem in Malawi?s public health facilities and UN volunteer doctors cannot deliver services effectively if they lack basic equipment to work with. A basic equipment grant to UN volunteer doctor?s host institutions would go a long way in enhancing the doctors? work conditions. Lack of basic medical equipment has been highlighted as an obstacle hindering the work of UN volunteer doctors in various hospitals in the country. The Government of Malawi and the CDH project should ensure that basic medical equipment is available to medical doctors. The doctors are failing to provide some services because of lack medical equipment. The project should consider introducing ?Basic Equipment Grant? to all health facilities where the doctors are working.
Management Response: [Added: 2012/11/02]

This is a true reflection of the real situation in the hospitals. The CDH Program budget would not support the heavy and highly specialized type of medical equipment that most central hospitals require. The UNDP would like to accept this recommendation and support procurement of modest equipment for UNV doctors wherever and whenever approved by the MoH.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
9.1 In the next phase of the program (New Project Development 2012 -2016) elements of basic equipment will be included to complement volunteer living allowances in the budget.
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNDP 2012/12 Completed Support provided by NRE in 2014 included provision for equipment
9.2 Separate donors for equipment to be identified to assist provide specialized medical equipment
[Added: 2012/11/02] [Last Updated: 2014/10/28]
UNDP, MOH 2012/12 Completed Initiated as part of the new project

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