Periodic Review ccm request template

There have been many challenges and lessons learnt as well as considerable progress in overcoming them in the last 12 months. Many of the challenges related to work done with civil society SRs and hence will not apply to the next Phase, as NDOH will not have any civil society SRs. However, the principles for change have been accepted and will be monitored and evaluated regularly by the GF CCM to ensure that NDOH get the necessary feedback, technical support and training.

5.2 Financial Performance

5.2.1 Financial situation at cut-off date

Table 20: Table 17: Cash at cut-off date NDOH



Liabilities summary at cut-off date

Table 21: Liabilities NDOH

Liabilities at cut-off date:	USD 32,667,494.13
Obligated amount:	USD 23,767,494.13
Reprogramming amount:	USD 8,900,000

Notes:

• 
  Obligated amount is for an existing contract for purchase orders already issued, which varies from audits for sub-recipients to purchase drugs;
  
• 
  Reprogramming amount is for the purchasing of additional 125 GeneXpert Machines to complete the country rollout plan. This is part of the funds that were in transit in December 2012.
  
  Have all liabilities at cut-off date been taken into account in the post-cut-off date budget? Yes
  

5.2.2 Analysis of expenditures versus budget

With reference to the latest available EFR at cut-off date, please summarize the main reasons for any under-spending or over-spending against budget.

The latest Enhanced Financial Report (EFR) illustrates a 17% expenditure output from 1 July 2011 to 31 December 2012. There are numerous factors that contributed to the overall under expenditure; the causes of those factors cannot be directly linked to a specific organization or stakeholder. The condition precedents centred around the under expenditure in general.

• 
  The grant agreement between the PR and the GF was signed 5 months 15 days after the inception date of the programme. Whilst the grant agreement was being analysed by the GF, the PR and the SR were not able to implement much given the uncertainty of the grant agreement. This delay de-escalated to the PR/SR grant agreements;
  
• 
  The first tranche of funding for the grant was received mid-January 2012 and already six months had passed, therefore time constraints for programme implementation was becoming a challenge;
  
• 
  The full PMU staff establishment was only realized in June 2012, four PMU personnel appointed between March 2012 and June 2012;
  
• 
  The cost driver of the programme is the procurement and distribution of ARV drugs. The PR only received the funding to complement the objective in June 2012. The reason for this delay in particular is conditions precedent for storage of buffer stock;
  
• 
  The employment of 500 data capturers which is essentially a material programme as far as expenditure is concerned, only commenced in November 2012, therefore having lost 17 months of operations. The monthly budget for the programme is estimated around R4,500,000/ USD562,500; and
  
• 
  The Training plan was approved by the GF in November 2012, meaning the SR’s could not utilize the training budget until December 2012. Whilst some SR’s have conducted some training, the quantity and costs was relatively minimal.
  

Please comment on whether the overall % expenditure versus budget variance at the cut-off date is in line with the average % achievement against all indicators in the performance framework. If not, please explain the reasons.

The overall expenditure for the cumulative period from July 2011- December 2012 is 17%. The average performance achievement is 92%, which depicts a correlation disparity between programme performance and financial management. Part of this misalignment is contributed mainly to the co-funding between various donors. Whilst there was a delay in funding from the GF, the SRs and Government continued to implement programmes and reporting performance using either the Government voted funds or other sources of funding i.e. co-funding mechanism.

The PR could not discourage this tendency, because the SR’s mostly had employed personnel to implement programmes and, it would not be effective use of resources if the said employees, would come to work and not be occupied with what they have been employed to do. Unfortunately the end result of this challenge has produced an inconsistency between performance and financial management. The cost efficiency implementation strategy by various stakeholders has also contributed although minimally. In order for the two reporting categories to be aligned, a consistent flow of funding needs to be maintained at all times.

SECTION 6: CCM REQUEST FOR RENEWAL (PR 1 - NDOH)

6.1 Programmatic Proposal

6.1.1 Programme Objectives, SDAs, Indicators and Targets

Please provide a Performance Framework for the next Phase/Implementation Period and comment on whether indicators and targets are aligned with the national Programme strategy, plans and systems.

Table 22: Performance Framework NDOH

Linked to objective(s) #

Outcome indicator

Original baseline

Updated baseline

Targets

value

Year

Source

value

Year

Source

Yr. 1:

Report due date

Yr. 2:

Report due date

Yr. 3:

Report due date

Oct 2013- Mar 2014

Apr 2014- Mar 2015

April 2015 - Mar 2016

OBJ 3: OCI05

Total number of individuals remaining in HIV care

NA

NA

NA

1 900 000

2012

HMIS

2 460 100

31-Mar-14

2 935 898

31-Mar-15

3 430 116

31-Mar-16

Objective & Indicator #

Service Delivery Area

Output/ coverage indicator

Initial baselines

Latest available baseline/result

Targets

Period 1

Period 2

Period 3

Period 4

Period 5

N #

Year

N #

%

Year

Source

1-Oct-13

1-Apr-14

1-Oct-14

1-Apr-15

1-Oct-15

D #

D #

31-Mar-14

30-Sep-14

31-Mar-15

30-Sep-15

31-Mar-16

OBJ 3: OPI11

ARV treatment and monitoring

Total number of adults and children started on ART

131 507

2012

131 507

105.2%

2012

HMIS

250 000

NA

262 500

NA

262 500

NA

275 000

NA

275 000

NANA

125 000

125 000

NA

NA

NA

NA

NA

The detail on the Objectives, SDAs and Activities can be found as the NDOH Annex 1 called Description of Activities– NDOH. During the development of the Performance Framework all indicators and targets were aligned with the NSP, other national programme strategies, plans and systems. .

Key M&E systems strengthening activities:

To respond to the GF’s Performance Based Funding principle, the PR has developed the M&E Plan to detail specific M&E activities to be conducted under phase 2. The GF grant M&E plan is built on existing systems to ensure harmonization with national level efforts. The M&E plan is aligned with both the NSP and the existing M&E Framework of the NDOH and describes how the data will be measured and reported as well as the verification procedures.

In order to strengthen to M&E approach in the phase 2 grant, the M&E Plan of the PR will be supported by indicator protocols for the output, outcome and impact indicators in the grant’s PF.

The M&E of the GF supported activities is built into the programme design, i.e. both strategic and operational plans, to ensure that M&E functions are designed and carried out in a systematic manner from the start and provides data to managers at all levels over the life of the programme. M&E implementation plan of the GF supported activities is built on existing systems to ensure harmonization with national level efforts. In developing the plan, it was important to ensure alignment with both the NSP and the existing M&E Framework of the NSP. M&E plan describes the GF commitment indicators (as listed in the grant’s PF and describes how the data will be measured and reported as well as the verification procedures. See phase 2 M&E plan, NDOH Annex 2.

The data that informs GF reports follow the same reporting lines as all departmental data flow lines. As such data classified as national indicator dataset (NIDS) flows through the District Health Information System (DHIS) from implementation entity to the sub district, district and provincial offices and thereafter to the National M&E unit which share it with the relevant programme unit within the NDOH Office. The GF M&E team also receives data from the National M&E unit and engage with respective programme manager to concur and jointly review reports before writing GF report. At each level of flow the data is verified and checked for quality purposes and weighed against set targets within the operational plans. At PMU level, the reported data is weighed against the target set out in the Performance Framework of the grant; this is done by the PMU M&E team and supported by the programme officers.

M&E is a key component of the performance based funding. Through M&E, programme results at all levels (input, process, output, outcome and impact) can be measured to provide the basis for accountability and informed decision making at both programme and policy level. Therefore the M&E unit will routinely monitor programme implementation through identified indicators and facilitate the process of data collection, processing and transforming it into strategic information (SI), to allow for informed decision-making at all programme levels and GF level

In order to fulfil the recommendations of the OIG on strengthening of the M&E systems, the M&E unit at PMU level is adequately staffed and strategies to enable the M&E team to best monitor the implementation of programme in line with programme policies, NSP and GF requirements are in place. The M&E unit is comprised of the Senior M&E and Research Specialist, M&E manager and 3 M&E assistants. As part of improving M&E data quality the PMU is intending to review and redesign data collection tools. The strategy will also assist to improve the reporting of progress made towards the achievement of stated targets and ensuring accountability of allocated resources.

6.1.2 Pharmaceutical and Health Product Management (if applicable)