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Evaluation of Primary Health Care Initiative Project
Commissioning Unit:Trinidad and Tobago
Evaluation Plan:2017-2021
Evaluation Type: Project
Completion Date:05/2017
Unit Responsible for providing Management Response: Trinidad and Tobago
1. Recommendation:

Recommendation 1: A comprehensive assessment of the Primary care health system including the critical gaps in capacity should be the basis of any further UNDP/UNV intervention.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/23]

In future phases of the Primary Health Care Initiative project gap analysis using secondary sources of information will be reviewed. This will be supported by interviews with senior management in the Ministry of Health of Trinidad and Tobago and the Regional Health Authorities (RHAs).

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. A gap analysis for this new project has been recommended.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP Country Office in collaboration with the Ministry of Health 2017/12 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. The decision to redirect the project was made with the agreement of senior management in the Ministry of Health of Trinidad and Tobago and the Regional Health Authorities (RHAs).
2. Recommendation:

Recommendation 2: Any future iteration of the UNDP/UN Volunteer programme in health, particularly one involving the assignment of Doctors and Nurses must take into account several critical success factors as well as recognize the limitations of interventions in the health system.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/23]

Management has determined that any future iteration of the projects need to take into account the following:
a) The need to involve registration or regulatory agencies during project development. Specifically, the Medical Board and the Nursing council. This will facilitate discussion of issues that may hinder implementation including licensing non-nationals to practice in the primary health system. If the issue is related to the supervision of non-nationals, a Senior Medical Professional could be assigned to perform this function.
b) The selection and recruitment process should include at a minimum, criteria related to the MBTT guidelines for full registration status;
c) Involvement of the RHAs at the project development stage and the identification of focal points to support project administration and performance monitoring;

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. Currently the UNDP/UNV CO has only engaged the Ministry of Health (MoH). However a request from UNDP/UNV to MoH asking for an introductory meeting with other relevant stakeholders has been made.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV Country Office 2017/12 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. The decision to redirect the project was made with the agreement of senior management in the Ministry of Health of Trinidad and Tobago and the Regional Health Authorities (RHAs).
3. Recommendation:

Recommendation 3: A more rigorous results matrix should be developed.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/23]

Management agrees with the above-mentioned recommendation and has decided that with any future iteration of the project a detailed logframe will be developed in collaboration with the counterpart. This will include baselines and realistic indicators and measurable targets.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. UNDP/UNV to develop an improved logframe for the new project.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV Country Office 2018/02 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. A new and improved logframe was developed for this new phase of the project which has been agreed to by senior management of MoH.
4. Recommendation:

Recommendation 4: Need to ensure that key stakeholders, particularly the executing agency and its personnel understand the overall project design, how elements are linked and the required sequence.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/23]

UNDP/UNV to continue working with the MInstry of Health, while ensuring that such key stakeholders as the regulatory bodies and Regional Health Authorities are informed. UNDP/UNV would also seek to ensure that relevant project information is shared among all the key stakeholders as the project progresses.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. Currently the UNDP/UNV CO has only engaged the Ministry of Health (MoH). However a request from UNDP/UNV to MoH asking for an introductory meeting with other relevant stakeholders has been made. UNDP will ensure that the stakeholders invited to the project board will be representative of all key stakeholders.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV country office 2017/12 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. The decision to redirect the project was made with the agreement of key stakeholders including senior management in the Ministry of Health of Trinidad and Tobago and the Regional Health Authorities (RHAs).
5. Recommendation:

Recommendation 5: Proposals such as this need to ensure that complementary interventions are critical to achieving stated programme outcome.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

As stated in the management response to Recommendation 3, UNDP/UNV would ensure that key stakeholders are involved and/or consulted in the design phase of the project, specifically seeking clarification on how the intended intervention complements the outputs and outcomes of ongoing programmes/projects in the Ministry of Health. Therefore indicators and outcomes developed for the project would benefit the long term objectives of the Ministry beyond the project itself.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. At the project design stage the engagement of key personnel at the Ministry of Health and other key stakeholders would be sought to identify connections between the proposed project and wider objectives of the Government.The engagement and the participation of these key stakeholders at the project board would be utilized to gain insight into the wider objectives of the Ministry.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV country office in collaboration with all key stakeholders 2018/02 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. To date three (3) project board meeting have been held at which consensus regarding the new direction of the project was reached.
6. Recommendation:

Recommendation 6: Clearly articulated roles and responsibilities need to be documented in any project agreement, including expectations of performance.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

The UNDP/UNV country office does not agree with this recommendation as stated. The Primary Health Care Initiative project document did elaborate on the roles and responsibilities of each project partner. However, the UNDP/UNV country office is unable to enforce any systems of accountability within the Ministry of Health to ensure that these roles, which were agreed to, upon the signing of the project document, are carried out.

Key Actions:

7. Recommendation:

Recommendation 7: The Ministry of Health needs to conduct a performance assessment of the primary health care system to identify obstacles to improved waiting times and integrated health care, among other things.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

In future projects the UNDP/UNV country office would insist upon a needs assessment. This needs assessment will be used to develop baselines and indicators for future projects. Mid-term and final evaluations would also highlight the status of the respective indicators (e.g. reduced waiting times).

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. A needs assessment will be conducted by the UNDP/UNV country office in collaboration with the Ministry of Health and the Regional Health Authorities (RHAs).
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV country office 2018/02 Completed A formal needs assessment in the form of a desk review and consultations with key stakeholders were conducted to determine the needs on the Ministry of Health (MoH) and the Regional Health Authorities (RHAs). The objectives as determined were agreed upon by all key stakeholders.
8. Recommendation:

Recommendation: 8: The UNDP/UNV needs to develop indicators related to the organization’s mandate including the promotion of volunteerism.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

The UNDP/UNV country office is not in agreement with this recommendation. Volunteers are encouraged to participate in voluntary activities. However, this is optional. As such the UNDP/UNV believe that this should be tracked via their individual performance assessment conducted by the volunteer and their respective supervisors and not be part of the project document.

Key Actions:

9. Recommendation:

Recommendation 9: Project Governance arrangements must be closely monitored to ensure the adequacy of oversight. The establishment of a Project Board or Steering Committee is vital to more effective project management

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/23]

The UNDP/UNV country office is in agreement with this recommendation. We would seek to ensure that in future projects working project boards with appropriate representation from key stakeholders are formed and that project board meetings are held regularly (i.e. at least once per quarter).

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. For this new project the UNDP/UNV country office would insist on the configuration and activation of the project board, through continued advocacy and information sharing on the benefits of the project board. Additionally the country office would liaise with key stakeholders to ensure that the project board meetings are held at least once per quarter.
[Added: 2017/10/23] [Last Updated: 2018/04/27]
UNDP/UNV country office 2018/04 Completed The UNDP CO and the Ministry of Health (MoH) have agreed upon a new phase for the Primary Health Care Initiative project. This phase seeks to achieve the following objectives: 1. Improvement of the governance capacity of the Boards of Regional Health Authorities (RHAs) to have a positive impact on healthcare service delivery. 2. Upgrading of the governance, compliance, advisory and communications skills of Corporate Secretaries of RHAs. 3. Enhancement of the leadership skills of Chief Executive Officers (CEOs) and Executive Management of RHAs to have an immediate impact on healthcare service delivery. 4. Strengthening of the capacity of RHAs and the MOH to implement the new procurement system. Due to the fact that a new phase of the project has been initiated the project board meets regularly to discuss its progress. To date three project board meetings have been held.
10. Recommendation:

Recommendation 10: The establishment of a National UN volunteer as project manager within the Ministry of Health may contribute to more effective and efficient project implementation

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

The UNDP/UNV country office is in full agreement with this recommendation and will incorporate a project manager for all large scale projects. In the event that the coountrepart does not agree to expend funds on hiring a project manager the recommendation to engage a national UN volunteer (NUNV) focal point will be recommendedin the design and development of the project. This NUNV, like the project manager would be placed in the office of the implementing partner.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. In this new project a project manager will be recruited who will sit at the Ministry of Health. Four national UN volunteers will be recruited and one will sit at each of the 4 Regional Health Authorities as project support officers.
[Added: 2017/10/23] [Last Updated: 2018/09/12]
UNDP/UNV in collaboration with the Ministry of Health 2018/06 Completed A project manager was recruited in July of 2018 for the next phase of the Primary Health Care Initiative project.
11. Recommendation:

Recommendation 11: Monitoring and Evaluation requirements must be adhered to in any future programmes.

Management Response: [Added: 2017/10/10] [Last Updated: 2017/10/24]

The UNDP/UNV country office agrees with this recommendation. Future projects would ensure that the monitoring and evaluation plan incorporated within the project document is expanded and more detailed, including but not limited to data collection methods, the responsibilities of the diffrent project partners, and identify the key objectives to be evaluated.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The existing project would be coming to an end in December of 2017. The country office is currently in negotiations with the Ministry of Health to develop a new initiative. The recommendations and management responses are being taken into consideration in the development of this new project. An expanded and detailed monitoring and evaluation plan would be developed for this new project.
[Added: 2017/10/23] [Last Updated: 2019/01/14]
UNDP/UNV country office 2019/03 Initiated The new phase of the project has been agreed upon. The new project results and resources framework (RRF) as well as a new and expanded monitoring and evaluation plan for the this phase of the project have been drafted and are awaiting ratification from the Project Board which is scheduled to take place prior to the end of the first quarter 2019.

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