Periodic Review ccm request template
Programme Objectives, SDAs, Indicators and Targets
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- 6.1.2 Pharmaceutical and Health Product Management (if applicable)
6.1.1 Programme Objectives, SDAs, Indicators and TargetsTable 30: Performance Framework WCDOH
The detail on the Objectives, SDAs and Activities can be found as the WCDOH Annex 1 called Description of Activities–WCDOH. During the development of the Performance Framework all indicators and targets were aligned with the NSP, other national programme strategies, plans and systems. The M & E team supplement the programme by identifying problems in planning and implementation. Thereafter recommend adjustments to be made to ensure the programme is effective and efficient. Due dates for GF specific reports dovetail with the department’s requirements. Finance reports are due on a daily basis with report back from the Provincial office given on a weekly basis. All financial claims are submitted by the 7th of each month together with programmatic reports. Thereafter, finance and programmatic reports are compared to ensure that money claimed for repayment is in accordance with implementation organisation’s programme performance. Finance Reporting is regulated by the WC financial instruction G3 of 2013, as amended. WCDOH advances a maximum of 2/12ths of an annual budget to an implementing organization. Thereafter submissions are required in relation to incurred expenditure, supported by proof of relevant expenditure documentation. This needs to be in accordance with the budget signed within the Service Level Agreement with the department. All advances are cleared by the end of a financial year. Additionally National Financial Acts and regulations such as the section 38(1) (j) of Public Finance Management Act 1(PFMA) of 1999 are adhered to. Please refer to WCDOH Annex 16, WC financial instruction G3 of 2013, as amended. Programmatic Reporting follows the same timeline as the financial reports. Each objective has its own M&E framework. Common to all are the inclusion of the programme in the HIV/AIDS STI and TB (HAST) directorate district and site verification visits. Which are further supplemented with site visits and spot checks by the GFM&E team. Additionally, the six annual GF Management meetings are intended to trouble shoot existing and resolve anticipated challenges within the programme. M&E processes and systems relevant to a specific objective are as follows: ART: During the WC continuation of funding period the Infectious Disease Epidemiology Unit of the School of Public Health of the University of Cape Town will continue to be contracted by the Department to provide technical support to the monitoring and evaluation of the Provincial ARV Treatment Programme. The UCT School of Public Health has provided these support services during both Phase 1 and Phase 2 of the previous grant Programme and will continue to do so for the current funding period of the WC GF Grant. Support is provided in respect of two areas related to the M&E of the ARV Treatment Programme:
Reports relating to the ART objective take place within a three tier system:
There are eleven sites that receive GF support. Three of the eleven treatment sites in the Khayelitsha Sub-District are large Community Health Centres (CHCs) with relatively large components of medical personnel. The Clinics are managed by the Cape Town City Health Department. Each of the clinics is linked for referral and support purposes to one of the three CHCs. It is intended that most patients receiving ARV treatment at the Clinics will be stable chronic patients referred to the Clinics from the CHCs for nurse-based follow-up. There is very close co-operation and co-ordination between the Provincial and Municipal health services in the Sub-District at both the management and facility levels of operation. The ARV treatment services at the 8 Municipal Clinics is provided by the City Health Department in terms of an annual Service Level Agreement (SLA) between the Provincial Health Department and the City Health Department, funded from the Grant Programme. The SLA specifies the above output indicators and monthly targets for each of the eight clinics (as provided for in the WC Grant Programme), and the reporting requirements. Additionally clients are referred to clinics from the Khayelitsha District Hospital. In line with the latest GF Quality Assurance Policy (QAP), the WCDOH will embark on a process to implement an ARV medicine Quality Control System (QCS) to conduct quality control testing on medicines down to a facility level during continuation of funding period. This will be conducted on all products awarded in the latest National Department of Health ARV medicine tender [H13 2013] which comply with GF QAP. Palliative Care: Provision is made for the continuation of the current external support, training and M&E services for the Palliative / Step-Down Care Programme provided by the WC Hospice Palliative Care Association of South Africa (HPCASA). The HPCASA continues to add value to the programme through regular assessment of needs, training of staff and ensuring continual quality of care within each facility. Additionally the HPCA works with the WCDOH to replicate lessons learnt within the GF funded facilities across the province. The HPCASA (WC) routinely submits to the WCDOH Quarterly evaluation reports on the service provided by each of the contracted NPO service providers. Additionally, the HPCSA submits annual reports on the GF as well as own funded WCDOH facilities. CBR: M&E of the Community Based Response Programme is the joint responsibility of the Department’s District CBR Programme Coordinators within the Community Based Services component (reporting to the Directorate: Community Based Services) and of the identified CBR Programme implementing agencies in the different districts supported by the GF M&E team. Additionally the MSATS oversee implementation and monitoring of CBR projects across all districts. Provision is made for the procurement of support, mentoring, capacity development and networking services for the civil society organizations involved in the community-based projects. The Networking AIDS Community of South Africa (NACOSA) currently carries this out. For a more detailed outline, please refer to WCDOH Annex 3: M&E Plan. The formal responsibility for data quality lies with the GF M & E unit, reports to the GF programme manager. Operational management of data quality is the responsibility of the districts, assisted by provincial programmes managers, responsible for quality assurance checking, reporting and improvement, and for strategic planning of data quality initiatives. The GF M & E unit, whose role involves checking adherence to the relevant Policies and Procedures, undertaking data quality audits and providing feedback on data quality issues in their area. In addition to the above, in respect of the ARV and Palliative Care Programmes provisions have been made in this next implementation period for external services to provider further M & E services. Refer to M & E plan, WCDOH Annex 4, for further details. ARV Treatment Programme Monitoring and Evaluation: During this next Implementation phase, the Department will continue to contract the services of the Infectious Diseases Epidemiology Unit of the UCT School of Public Health to provide support to the province-wide monitoring and evaluation of the provincial ARV Treatment Programme. Hospice Quality of Care Evaluation: As in the current Grant Programme, the Department will continue engage the services of the Hospice Palliative Care Association of South Africa (Western Cape) during the RCC period to conduct quarterly evaluations of the quality of care provided by the contracted NPO service providers. Evaluations will be carried out using the national Hospice Palliative Care Association audit tool. The HPCASA (WC) will submit Quarterly evaluation reports to the WCDOH, on the service provided by each of the contracted NPO service providers.
The biggest challenge to the WCDOH grant has been the inability of the WCDOH to procure GF Quality Assured Policy compliant medicines. We have embarked on three solutions to ensure that there are no stock-outs and no non-delivery of ARV by pharmaceutical companies Short term: to ensure that ART was continued in the Khayelitsha treatment sites, the WCDOH utilized funds from the WCDOH’s conditional grant to supply non GF QAP compliant medicines. Please note: This was a temporary solution and cannot continue further as it has restricted service delivery in other service delivery areas due to reduced funding availability. Medium term: A WC limited bid tender allowed for the procurement of GF QAP compliant Tenofovir during the third quarter of 2012/13. GF QAP compliant products on tender RT71 2010MF from Aspen [Lamivudine 150mg / Nevirapine 200mg / Zidovudine 300mg] and Cipla [Efavirenz 600mg / Lamivudine 300mg], as arranged by NDOH, where delivered although with a delay of between 6 and 18 months. The Abacavir syrup from Cipla arranged by NDOH has yet to be delivered. Long term: The recent ARV tender specifications included a 10% proportion of products to meet GF QAP requirements. The awarded tender [HP13 2013] will run from January 2013 for a 2 -year period until December 2014. For this period the majority of the products required for the GF ART Programme will be available with the exception of the following line items: Didanosine 25mg / 50mg / 100mg / 400mg; Lamivudine 300mg; Stavudine 15mg; Zidovudine syrup and Zidovudine 300mg / Lamivudine 150mg combination tablet. Most of these products are not key cost drivers, with the exception of Lamivudine 300mg. However with the award of a Tenofovir / Emtricitabine / Efavirenz fixed dose combination meeting GF QAP requirements, the need for Lamivudine 300mg will be reduced. Access to GF QAP compliant medicines for the final period of the grant: January 2015 to March 2016, will be dependent on the subsequent tender also awarding products meeting GF QAP requirements. Table 31: Products available on tender H13 2013
The risk of treatment interruptions should be minimal if: the tender H13 2013 is contract managed efficiently at a National Department of Health level; accurate forecasting and timeous ordering is conducted at a provincial depot level and efficient stock management is maintained at a facility level. Table 32: Risk matrix of treatment interruptions WCDOH
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