Periodic Review ccm request template

The grant has over the majority of its 9 years of implementation maintained an A1-A2 rating. Targets have been continuously met which has contributed to the growing success of the outcome and impact indicators. The grant is unique, extended over periods that were previously not permissible by the GF. Based on the innovative approach of the grant to ensure government support of GF supported areas through the full integration of the WC grant into the WCDOH’s district health care platform, as well as its sterling performance, and achievement of grant targets, support was extended over a further period into an RCC period, during which the responsibility of the objective’s elements such as ART facilities and staff are incrementally taken over by the WCDOH so as to ensure sustainability of the GF investment in the WC. Key grant results have included:

Thus the further ratings of A1-A2 applied by the Global Fund, are based on the above factors, and confidence that the WCDOH is in a position to cement gains attained, and continue diligent implementation and grants management over a further grant period.

As the WCDOH GF grant is fully integrated into the WC district health care platform in addition to the GF M&E and verification processes it has an added level of accountability through the WCDOH systems. For example: the GF grant is subject to be audited both by the internal WCDOH auditors and the Auditor General WCDOH audits. Financially the WCDOH GF grant is mandated to adhere to the South African Public Finance Management Act as well as the WC provincial G54 as amended in 2009 financial regulation. This provides good fiduciary frameworks that further aid the maintenance of the grant rating.

5.2 Financial Performance

5.2.1 Financial situation at cut-off date

Table 27: Cash in hand WCDOH

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

Table 28: Budget Analysis Summary WCDOH

Cumulative Budget		Cumulative Expenditure				Variance
ZAR	USD	ZAR		USD		ZAR		USD
411,860,168	51,482,521	284,057,283		37,542,184		127,802,885		13,940,337
Percentage of Budget Spent
73%

There are primary contributing factors to the under expenditure (variance):

• 
  The inability of the WCDOH to procure GF Quality Assured Products (QAP) compliant medicines for a large portion of the RCCI phase;
  
• 
  The change of laboratory testing protocol(s);
  
• 
  The slower than expected completion of Capital Works projects;
  
• 
  Late submission of expenditure claims for the latter months of 2012;
  
• 
  To some extent the non-filling of all posts at all times; and
  
• 
  Delayed signing of Service Level Agreements.
  

Please note that in relation to the above the following have caused the under expenditure (variance)

• 
  The newly awarded tender HP13 2013 included specifications for 10% of the award to meet GF QAP requirements. The awarded tender caters for most of the products required for the Programme excepting 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 / Emtricabine / Efavirenz fixed dose combination meeting GF QAP requirements, the need for Lamivudine 300mg will be reduced;
  
• 
  For the next Implementation Phase the laboratory tests have been aligned with standard operating procedures: moving from bi-annual to annual testing of CD4 Count and Viral load;
  
• 
  The completion of all remaining GF capital works projects is scheduled to occur before 30 September 2013. Should there be no unforeseeable events this will result in an increased rate of expenditure;
  
• 
  Expenditure incurred during the latter months of the 2012 calendar year are often submitted for payment by implementing organizations within the first two months of 2013. In accordance the overall expenditure will increase once this process is completed;
  
• 
  Due to the contract nature of GF posts the WCDOH has found that when compared to permanent posts there is a higher attrition rate. Although this is being constantly addressed by the WCDOH, it does have an impact on overall expenditure over the life of the grant; and
  
• 
  Delayed signing of Service Level Agreements with implementing organizations has the effect of delaying expenditure claims until the final quarter of 2012/13.
  

Expenditure is in line with Programmatic performance as of 31 December 2012, as seen by the Programmatic Performance against target:

Table 29: Programmatic Performance against target WCDOH

Objective No.	Indicator Description	Intended Target to date	Actual Result to date	% achievement
1	Number of PLHIV receiving ARV treatment	24940	25735	103%
1	% of HIV-infected pregnant women receiving dual PMTCT therapy or HAART	89%	91%	102%
2	Number of secondary schools with NPO-supervised peer educations Programme	124	124	100%
2	Number of peer educators trained in the PE Programme	10448	11407	108%
2	Number of young people in schools reached with peer education	104 064	92025	88%
3	Number of patients admitted to hospices for palliative/step-down care	2969	2564	86%
4	Number of sub-districts with functional Multi-Sectoral Action Teams in place	32	33	103%
4	Number of CBO projects approved for funding	579	590	102%
4	Number of OVCs reached through CBO projects	2500	9420	377%
4	Number of people reached through CBO income generation projects	1250	2536	203%