MERG Meeting Geneva - Cambodia GFATM M&E; October 2004 1 Cambodia Experiences in Relation to M&E for PR/MoH-GFATM Presented by Dr. Or Vandine, PN, MD,

MERG Meeting Geneva - Cambodia GFATM M&E;MERG Meeting Geneva - Cambodia GFATM M&E; October 2004 October 2004

11

Cambodia Cambodia Experiences in Experiences in

Relation to M&E Relation to M&E for PR/MoH-GFATM for PR/MoH-GFATM

Presented by Presented by Dr. Or Vandine, PN, MD, MPHDr. Or Vandine, PN, MD, MPHDeputy-Director, CDC DepartmentDeputy-Director, CDC Department

Manager, PR/MoH-GFATMManager, PR/MoH-GFATM

The Eighth MERG Meeting, Geneva, SwitzerlandThe Eighth MERG Meeting, Geneva, Switzerland25 - 26 October, 200425 - 26 October, 2004

Th

e Globa l Fund to Fight AI DS , T

B and

Mal

ari a

kmµviF

ImUlniF

is k l s Mrab;Rby uT§nwgCMgWeGds _ rebg nigRKuncaj;

The G lob a l FundM inistry o f Hea lth

Rk s Ygs uxaPi) al mUl niF is k l

Th

e Globa l Fund to Fight AI DS , T

B a

nd M

alar

i a

kmµviF

ImUlniF

is k l s Mrab;Rby uT§nwgCMgWeGds _ rebg nigRKuncaj;

The G lob a l FundM inistry o f Hea lth

Rk s Ygs uxaPi) al mUl niF is k l

MERG Meeting Geneva - Cambodia GFATM M&E; October 2004MERG Meeting Geneva - Cambodia GFATM M&E; October 2004 22

PGA Round PGA Round 1 (Jan 2003)1 (Jan 2003)

PGA Round 2 PGA Round 2 (Oct 2003)(Oct 2003)

PGA Round 4 PGA Round 4 * *

(Not signed (Not signed yet)yet)

1 PGA:1 PGA:

1) HIV/AIDS1) HIV/AIDS 3 PGAs:3 PGAs: 1) HIV/AIDS 1) HIV/AIDS (42%)(42%)

2) Malaria (39%)2) Malaria (39%)

3) TB (19%)3) TB (19%)

2 PGAs: 2 PGAs: 1) HIV/AIDS 1) HIV/AIDS (63%)(63%)

2) Malaria (37%)2) Malaria (37%)

Total: Total: USD USD 11.2 million11.2 million

for 2 for 2 yrsyrs

Total: Total: USD 12.9 USD 12.9 millionmillion

for 2yrsfor 2yrs

Total: Total: USD 14.02 USD 14.02 millionmillion ? ?

for 2yrsfor 2yrs

I. Background Information:I. Background Information:

* : In September 2004, the TRP of GF approved the clarification provided by the CCC in August 2004.


I. Background Information I. Background Information (Cont...):(Cont...):

Multiple Sub-Recipients (SRs)Multiple Sub-Recipients (SRs)ComponeCompone

ntntRound 1 Round 1

((11 SRs11 SRs))Round 2 Round 2

((10 SRs10 SRs))Round 4 Round 4

((13 SRs13 SRs))

HIV/AIDS HIV/AIDS

(R1: 11 (R1: 11 SRs)SRs)

(R2: 5 SRs)(R2: 5 SRs)

(R4: 9 SRs)(R4: 9 SRs)

CRC, YCC, CRC, YCC, MoND, MoND, MoSALVY, MoSALVY, KHANA, MDM, KHANA, MDM, DSF, SHCH, DSF, SHCH, NCHADS, PSF, NCHADS, PSF, PSIPSI

SHCH, SHCH, NCHADS, NCHADS, PSF, RHAC, PSF, RHAC, FRCFRC

CARE, CPNCARE, CPN++, , DSF, MDM, DSF, MDM, NCHADS, NCHADS, NMCHC, NMCHC, NPH/WVI, PSF, NPH/WVI, PSF, SHCHSHCH

MalariaMalaria

(R2: 4 SRs)(R2: 4 SRs)

(R4: 4 SRs)(R4: 4 SRs)

n/an/a CNM, PFD, CNM, PFD, HU, PSIHU, PSI

CNM, PFD, HU, CNM, PFD, HU, PSIPSI

TBTB

(R2: 1 SR)(R2: 1 SR)n/an/a CENATCENAT n/an/a


II. Roles & Responsibility of PR in Relation to II. Roles & Responsibility of PR in Relation to M&EM&E

Prepare all plans, reports and requests to be sent to the GF Prepare all plans, reports and requests to be sent to the GF including the preparation of quarterly progress reports including the preparation of quarterly progress reports (financial/implementation);(financial/implementation);

Assist SRs with their reports and/or M&E plans (as needed);Assist SRs with their reports and/or M&E plans (as needed);

Organize PRTRT meetings to review plans/reports;Organize PRTRT meetings to review plans/reports;

Monitor SRs’ program activities on quarterly basis and/or as Monitor SRs’ program activities on quarterly basis and/or as frequent as needed during the course of implementation;frequent as needed during the course of implementation;

Participate in national efforts to strengthen national M&E Participate in national efforts to strengthen national M&E processes/systems;processes/systems;

Facilitate the LFA’s assessment process.Facilitate the LFA’s assessment process.


III. PR’s Key M&E Activities in III. PR’s Key M&E Activities in 2004 :2004 :

Jan 2004Jan 2004 M&E Plans for Round 2 developed for 3 M&E Plans for Round 2 developed for 3 components: HIV/AIDS, Malaria, TB components: HIV/AIDS, Malaria, TB

Feb 2004Feb 2004 M&E training for SRs R1 & 2; Finalized M&E training for SRs R1 & 2; Finalized the the PR’s M&E assessment reports; Field visitsPR’s M&E assessment reports; Field visits

Mar 2004Mar 2004 Field Monitoring Visits to R1 SRs Field Monitoring Visits to R1 SRs

April 2004April 2004 Meeting with SRs and Quarterly Report Meeting with SRs and Quarterly Report preparation and hosted the Asia Regional preparation and hosted the Asia Regional Conference for GFATMConference for GFATM

May 2004 May 2004 Revisions of the field monitoring Revisions of the field monitoring approach; approach; activity-specific checklists & activity-specific checklists & issue-oriented issue-oriented reports;reports;


III. PR’s Key M&E Activities in 2004 III. PR’s Key M&E Activities in 2004 (Cont...) :(Cont...) :

June 2004 June 2004 Revisions of TB & Malaria M&E Plans; 2nd Revisions of TB & Malaria M&E Plans; 2nd Quarter Field Monitoring visits to SRs (R1 & R2)Quarter Field Monitoring visits to SRs (R1 & R2)

July 2004July 2004 Meeting with SRs and Quarterly Report Meeting with SRs and Quarterly Report preparation; Field visits; M&E preparation; Field visits; M&E

presentation at presentation at AIDS Conference in BKKAIDS Conference in BKK

Aug 2004Aug 2004 Finalized reports sent to the GF; Working draft Finalized reports sent to the GF; Working draft of of 22ndnd Edition M&E Guidelines developed; Edition M&E Guidelines developed;

Presentation to CCC Sub-CommitteePresentation to CCC Sub-Committee

Sept 2004Sept 2004 Round 4 M&E Orientation Meeting for SRs; Round 4 M&E Orientation Meeting for SRs; Presentation to CCC Sub-Com.; 3Presentation to CCC Sub-Com.; 3rdrd

Quarter Field Quarter Field monitoring visits to SRs (R 1 & R2)monitoring visits to SRs (R 1 & R2)

Oct 2004Oct 2004 Meeting with SRs and Quarterly Report Meeting with SRs and Quarterly Report preparation; Finalization of M&E preparation; Finalization of M&E

Guidelines 2Guidelines 2ndnd. . Edition; Finalization of M&E Plans Edition; Finalization of M&E Plans for Year 2 of for Year 2 of Round 1; Work on the M&E Plans Round 1; Work on the M&E Plans for Round 4; for Round 4; M&E Presentation to 8M&E Presentation to 8thth. MERG . MERG Meeting in Meeting in GenevaGeneva


IV. PR’s M&E Guidelines :IV. PR’s M&E Guidelines :

• Developed with WHO TA ; largely adapted from and Developed with WHO TA ; largely adapted from and drawn upon other GF, UNAIDS & USAID’s documents, drawn upon other GF, UNAIDS & USAID’s documents, MoH M&E Framework, and other relevant documents at MoH M&E Framework, and other relevant documents at national levelnational level

1.1. Introduce key M&E concepts and frameworkIntroduce key M&E concepts and framework

2.2. Provide guidance for development of SRs’ M&E plansProvide guidance for development of SRs’ M&E plans

3.3. Provide instructions on GF reporting forms and Provide instructions on GF reporting forms and requirementrequirement

4.4. Introduce GF’s performance-based disbursement Introduce GF’s performance-based disbursement conceptconcept


V. PR’s M&E PlansV. PR’s M&E Plans

1. Developed with WHO TA & key stakeholders at national 1. Developed with WHO TA & key stakeholders at national level engaged in an level engaged in an intensive participatoryintensive participatory & consultative & consultative processprocess

2. All M&E plans developed2. All M&E plans developed first by each SRs, next cumulative PR’s (GF formats)first by each SRs, next cumulative PR’s (GF formats) Indicators selected via consensus, ensuring consistency Indicators selected via consensus, ensuring consistency

with the approved proposal and the MOH M&E with the approved proposal and the MOH M&E frameworkframework

Existing data collection systems incorporated whenever Existing data collection systems incorporated whenever possiblepossible


VI. Quarterly Reports VI. Quarterly Reports Sequence :Sequence :

StepStepss

Specific ActionSpecific Action Timeline Timeline (after Q end)(after Q end)

11 SRs submit Quarterly Rpt to PRSRs submit Quarterly Rpt to PR 2 weeks2 weeks

22 PR combines all SR reports into 1 PR combines all SR reports into 1 PR report and sends to PRTRT PR report and sends to PRTRT members members

4 weeks 4 weeks

33 PR convenes PRTRT meeting to PR convenes PRTRT meeting to review reports and provide review reports and provide feedbackfeedback

5 weeks 5 weeks

44 PR submits finalized report to CCC PR submits finalized report to CCC 6 weeks 6 weeks

55 PR submits the report to LFA PR submits the report to LFA (KPMG)(KPMG)

45 days 45 days

66 KPMG reviews, drafts KPMG reviews, drafts recommendation to GF and submits recommendation to GF and submits report to GFreport to GF

??????

77 GF reviews, approves and grants GF reviews, approves and grants next disbursementnext disbursement

??????


VII. Issues and Challenges :VII. Issues and Challenges :

1. Complexity of GF structure in Cambodia1. Complexity of GF structure in Cambodia• Multiple players interdependent (SSRs, SRs, PR, CCC, Multiple players interdependent (SSRs, SRs, PR, CCC,

LFA, GF)LFA, GF)• Communication delays: multiple responses/approvals Communication delays: multiple responses/approvals

pending – unclear timelines – information sharing pending – unclear timelines – information sharing internally and read?internally and read?

2. Lack of transparency in assessment procedures and lack 2. Lack of transparency in assessment procedures and lack of clear expectationof clear expectation• Role & capacity of LFA in M&E unclearRole & capacity of LFA in M&E unclear

3. Limited M&E experience among some SRs3. Limited M&E experience among some SRs• Delays in submitting final reportsDelays in submitting final reports• Non-compliance of few SRS will penalize allNon-compliance of few SRS will penalize all• Extensive assistance from PR requiredExtensive assistance from PR required


VII. Issues and Challenges VII. Issues and Challenges (Cont...) :(Cont...) :

4. Requirement of M&E Plans and Reports based on the 4. Requirement of M&E Plans and Reports based on the GF formats GF formats sometimes makes PR’s responsibility to sometimes makes PR’s responsibility to “provide rigorous monitoring of program “provide rigorous monitoring of program implementation” rather challengingimplementation” rather challenging duedue to to lack of lack of direct linkage between indicators and activities direct linkage between indicators and activities

5. Quarterly Report with 45 days 5. Quarterly Report with 45 days submission requirement submission requirement light reporting vs. more burden to the PR light reporting vs. more burden to the PR and even and even more difficult for some SR such as national programmore difficult for some SR such as national program

6. Confusion of cumulative versus actual number 6. Confusion of cumulative versus actual number in in reporting requirement for process indicatorsreporting requirement for process indicators

7. Monitoring visits by the PR to SRs 7. Monitoring visits by the PR to SRs • difficult to organize due to frequent changes by difficult to organize due to frequent changes by

some SRS some SRS


VII. Issues and Challenges VII. Issues and Challenges (cont…): (cont…):

8. Issue of “additionally” raised by the CCC-Sub-Committee 8. Issue of “additionally” raised by the CCC-Sub-Committee • difficult to identify by PRdifficult to identify by PR

9. Issue of “Partnership” versus “Ownership” in 9. Issue of “Partnership” versus “Ownership” in implementing the GFATM Program at country levelimplementing the GFATM Program at country level

• How to apply this in the reality at the grass-root level How to apply this in the reality at the grass-root level when implementing it when implementing it

10. Adjustment of actual implementation with original 10. Adjustment of actual implementation with original proposalproposal

• Unclear – how to do?Unclear – how to do?

11. Criticism about creating parallel M&E system just for the 11. Criticism about creating parallel M&E system just for the GF reporting purposes: GF reporting purposes: cannot find 1 system covering cannot find 1 system covering all needed information to be reported to the GF?all needed information to be reported to the GF?


VII. Issues and Challenges VII. Issues and Challenges (cont…):(cont…):

12. Evolving of M&E New Formats by the GF 12. Evolving of M&E New Formats by the GF • Need for adjustment in the middle way of Need for adjustment in the middle way of

implementation and time consuming in doing implementation and time consuming in doing so (especially very difficult for the large so (especially very difficult for the large number of SRs)number of SRs)

13. Delays in the approval of Procurement 13. Delays in the approval of Procurement

PlanPlan• Significant adverse effect on program involving Significant adverse effect on program involving

ARV drugs and anti-malarial drugsARV drugs and anti-malarial drugs


VIII. Recommendations :VIII. Recommendations : GF to speed up the approval process GF to speed up the approval process

LFA to communicate and discuss with PR before sending LFA to communicate and discuss with PR before sending recommendations to GFrecommendations to GF

GF to reconsider the frequency of reporting from GF to reconsider the frequency of reporting from quarterly to semi-annually quarterly to semi-annually

GF to reconsider the deadline of 45 days for report GF to reconsider the deadline of 45 days for report submission (may be from 45 days to 60 days?)submission (may be from 45 days to 60 days?)

GF to provide clear guidance on proposal adjustments GF to provide clear guidance on proposal adjustments based on actual needsbased on actual needs

GF to inform the PR with clear guidance and timeline if GF to inform the PR with clear guidance and timeline if there is any change or need to use the new formatsthere is any change or need to use the new formats


VIII. Recommendations VIII. Recommendations (Cont...) :(Cont...) :

How to MONITORING THE ADDITIONALITY OF GF’S How to MONITORING THE ADDITIONALITY OF GF’S FUNDS ?FUNDS ?

Multiple SRs (especially large ones) receive funding from multiple sources and report results as a “joint effort” ; It is difficult to ensure and demonstrate the additionally of GF funds in such cases

OPTION 1: OPTION 1: Request that results are reported as GF-exclusive; that

would require setting a separate reporting system (contrary to GF guidance)

OPTION 2:OPTION 2: Request that SRs program GF funding in a distinct manner,

either by specific results, or geographically from THE ONSET OF THE PROGRAM

CLEAR GUIDANCE FROM GFATM-HQ NEEDEDCLEAR GUIDANCE FROM GFATM-HQ NEEDED !!!!!!


IX. Recent M&E IX. Recent M&E Accomplishments :Accomplishments :

1.1. Strengthening monitoring visitsStrengthening monitoring visits Developed and implemented 8 activity-specific (1

page) M&E tools Feedback at the filed and to SRs Using information from reports and filed visits to

provide special intervention/support to weaker and/or link those with stronger SRs for improvement (feedback loop)

2.2. Revised M&E Guidelines Revised M&E Guidelines 2 2ndnd. Edition. Edition

Incorporated lesson learned and adapted with M&E Guidelines issued by GF (M&E Tool Kit of June 2004)

Included all 3 diseases Introduced PR’s new QA M&E Tools Added Annual Workplan to promote more effective

program monitoring


IX. Recent M&E Accomplishments IX. Recent M&E Accomplishments (Cont...) :(Cont...) :

3.3. Reorganized Regular Quarterly Meeting with Reorganized Regular Quarterly Meeting with SRsSRs

Group them by program sub-component that provided a chance for SR of Round 1 and Round 2 to interact and to share experiences

4.4. Requested for Changing Reporting SequenceRequested for Changing Reporting Sequence Change from quarterly to semi-annually (on going

process) Maintain regular quarterly reporting with SRs Extension of Annual Report for Round 1 (through

December 2004)


Thank You!Thank You!

MERG Meeting Geneva - Cambodia GFATM M&E; October 2004 1 Cambodia Experiences in Relation to M&E for PR/MoH-GFATM Presented by Dr. Or Vandine, PN, MD,

Documents

srs r2

r1 srs

srs presentation

srs r4

srs crc

development of srs

srs hivaids r1

srs r1 r2