Capacity Development and Transition Plan for the Ministry of Health of the Republic of Zambia

Transcription

1 Capacity Development and Transition Plan for the Ministry of Health of the Republic of Zambia Republic of Zambia MINISTRY OF HEALTH A Plan for Transitioning the Global Fund Principal Recipient Role from UNDP to the Ministry of Health facilitated by UNDP MoH & UNDP - 1 February 2011 CD Plan for Transition of PR Role - Zambia 1 February 2011 (final)

2 Table of Contents ACRONYMS AND ABBREVIATIONS... 3 INTRODUCTION... 4 EXECUTIVE SUMMARY OVERVIEW PRINCIPLES SCOPE BASIS CAPACITY DEVELOPMENT AND TRANSITION RELATED PLANS PARTNERING AND RESOURCING CAPACITY DEVELOPMENT PLAN OBJECTIVES AND APPROACH ELEMENTS OF THE CAPACITY DEVELOPMENT PLAN Program Management Financial Management and Systems (FMS) Pharmaceutical and Health Product Management (PHPM) Monitoring & Evaluation (M&E) TRANSITION PLAN OBJECTIVES AND APPROACH PROJECTIONS OF GLOBAL FUND GRANTS THE MOH AS PRINCIPAL RECIPIENT Principles for MoH Structures to Manage GF Grants GF Organisational Structure within MoH ELEMENTS OF THE TRANSITION PLAN Program Management Financial Management and Systems (FMS) Pharmaceutical and Health Product Management (PHPM) Monitoring and Evaluation (M&E) CAPACITY DEVELOPMENT AND TRANSITION SCHEDULE OBJECTIVES AND APPROACH SEQUENCED CAPACITY DEVELOPMENT INDICATORS AND TRANSFER MILESTONES FUNDING, MANAGING AND IMPLEMENTING THE PLANS Financial Resources Management and Implementation Structure Oversight, Governance and Risk Management MECHANISMS FOR UPDATING THESE PLANS Ownership, Reviews, Recommendations and Approval Workflow... Error! Bookmark not defined. ANNEX I: INDIVIDUALS CONSULTED ANNEX II: SELECTED RESOURCES CONSULTED ANNEX III: EXAMPLES OF PR STRUCTURES FROM TEN AFRICAN COUNTRIES ANNEX IV: BUDGET ESTIMATES MoH & UNDP 1 February 2011 Page 2

3 Acronyms and Abbreviations CBOH... Central Board of Health CCM... Country Coordinating Mechanism CPs... Cooperating Partners DHMT... District Health Management Team FMS... Financial Management and Systems GF... Global Fund for AIDS, Tuberculosis, and Malaria GFATM... Global Fund for AIDS, Tuberculosis, and Malaria Global Fund... Global Fund for AIDS, Tuberculosis, and Malaria GRZ... Government of the Republic of Zambia HMIS... Health Management Information System HSS... Health System Strengthening LFA... Local Fund Agent M&E... Monitoring and Evaluation MoF... Ministry of Finance and National Planning MoFNP... Ministry of Finance and National Planning MoH... Ministry of Health, the Republic of Zambia MSL... Medical Stores Ltd. PHO... Provincial Health Office PHPM... Pharmaceutical and Health Product Management PMU... Programme Management Unit PR... Principal Recipient PSM... Procurement and Supply Chain Management PSU... Procurement and Supply Unit PTWG... Procurement Technical Working Group SDP... Service Delivery Point SOP... Standard Operating Procedure SR... Sub-recipient UNDG... United Nations Development Group UNDP... United Nations Development Programme WHO... World Health Organisation MoH & UNDP 1 February 2011 Page 3

4 Introduction This document provides a capacity development plan for the Ministry of Health (MoH) of the Republic of Zambia. The specific capacities addressed are those required by MoH to assume the role of Principal Recipient (PR) for Global Fund for AIDS, Tuberculosis and Malaria (GFATM) grants, which fall under the capacity areas of: Program Management Sub-recipient Management Financial Management and Systems (FMS) Pharmaceutical and Health Product Management (PHPM) Monitoring and Evaluation (M&E) Although these capacities areas provide the scope of the plan so that the MoH can reassume the role of PR for Global Fund grants, capacity gaps and recommended objectives will address improvements in the Ministry beyond the ability to manage Global Fund grants. It should be noted that Sub-recipient Management capacity area is not addressed in this plan, since during the capacity diagnosis phase it was determined that as a PR, MoH will not engage sub-recipients to support the management of Global Fund grants. The purpose of this document is twofold: to provide MoH with both a plan for addressing capacity gaps, and also to provide a plan for transitioning PR responsibilities in a sequential manner from UNDP to MoH. These plans are linked, in that elements of the transition plan are triggered by measured improvements in capacities addressed in the capacity development plan. This document is produced by MoH with facilitation support from UNDP, and is intended for use by MoH. The capacity development plan is guided by the capacity assets and gaps identified using the UNDP Capacity Diagnostic Tool for Organisations Assuming the Principal Recipient Role in Support of Global Fund Grants. This diagnostic tool was used in reviewing capacities at the MoH in October, 2010, just prior to developing this plan, and the details of the diagnostic are reported separately. Both this capacity development plan and the preceding capacity diagnosis were developed from existing documentary evidence (MoH assessments and reports, OIG audit, Governance Action Plan, etc.) as well as through consultations and meetings with MoH management and staff representatives. This capacity development plan is a living document and must be reviewed and updated through inputs from MoH units, as well as from audits and reports to be completed (including MoH finance and systems & procurement audits). This document is organised as follows: Section 1 provides an overview of the context, approach, and structure of the capacity development and transition plans Section 2 details the capacity development plan Section 3 details the transition plan Section 4 outlines the schedule of indicators and transition milestones for the plans, as well as a high-level budget Annex I lists persons consulted in developing the plans Annex II lists resources consulted Annex III provides a listing of example PR structures used in ten selected African countries Annex IV details budget estimates by functional area MoH & UNDP 1 February 2011 Page 4

5 Executive Summary This report provides an initial plan for developing capacities in the Ministry of Health and transitioning functions so that the Ministry can reassume the role of PR for Global Fund grants. This report is a start, in the sense that the plans and schedules outlined will need to be managed and updated based on new inputs (e.g., pending audit reports) and progress towards results. The results to be achieved are also an initial set, targeted within the next two years, again with the focus on addressing areas of importance for the MoH to reassume the PR role. This report outlines a plan that can allow the MoH to reassume the role of PR in two years. However, the indicator targets to be achieved are the measure of progress in this plan, and will ultimately determine whether the MoH will have sufficient capacity to become PR. In addition, success in achieving indicator targets is not a guarantee, as the MoH must be recommended by the LFA to resume its PR function based on assessment they will conduct in 18 months (as noted by the Global Fund Secretariat). The fundamental areas of capacity development that must be addressed by the MoH include the following: Clarifying the structure and providing sufficient authority within the Ministry to manage and control Global Fund operations within MoH Reasserting clearly defined and structured Global Fund oversight mechanisms, roles, and responsibilities Improving the capture, control, quality, timeliness, and accuracy of financial transactions through implementation of a computerised accounting system Integrating communications, oversight, and information from end to end in the procurement and supply chain Ensuring that District level financial and logistics staff are sufficiently trained and able to accurately record necessary information and report in a timely fashion Integrating planning, budget, procurement, financial, and programmatic data to effectively manage operations and report to the Global Fund in a timely fashion While this list is not exhaustive, it is a high-level compilation of the areas defined in this report, and defines the primary areas for capacity improvement. As this report is a plan, the proof of achievement is in implementation, and ensuring that sufficient human and financial resources are dedicated to managing and working towards targeted results is a fundamental condition for progress against capacity gaps. To move towards implementation, it is critical that the Ministry quickly determine responsibilities to own, and arrangements to drive this plan forward. One element of this is timely approval and recruiting of a Capacity Development Advisor from UNDP. MoH & UNDP 1 February 2011 Page 5

6 1 Overview This report outlines a capacity development plan and a transition plan. A capacity development plan to address capacity gaps related to performing the Global Fund PR role, and a transition plan to move the PR role from UNDP to MoH once capacity improvements have been addressed. UNDP defines capacity development as the process through which individuals, organizations, and societies obtain, strengthen, and maintain the capabilities to set and achieve their own development objectives over time. Capacity development goes beyond training, and addresses improvements in institutional systems, structures, and processes, to improve performance, stability, and adaptability. Following this definition, the capacity development plan in this report addresses one of the five steps of the UNDG capacity development approach illustrated below: This plan addresses Step 3: Designing Capacity Development Strategies, which is preceded by a capacity development assessment (the capacity diagnosis exercise conducted prior to the development of this plan), and followed by implementation of capacity development strategies. 1.1 Principles In formulating this capacity development plan, several principles were followed: The capacity development plan is MoH owned and led The indicators and objectives of the capacity development plan as articulated in this report are short-term, though these capacity development efforts will continue, and further objectives will need to be defined The capacity development plan is augmented by a transition plan to move the PR function from UNDP to MoH The transition plan must include a clear articulation of the management structure to be followed by MoH when reassuming the PR role The transition plan should allow for gradual and incremental transition of PR functions from UNDP to MoH The capacity development plan and the transition plan should progress through stages that allow for measuring progress and changing plans accordingly Readiness for transitioning the PR role should be measured by progress achieved against capacity development indicators rather than calendar dates or completion of activities MoH & UNDP 1 February 2011 Page 6

7 Both the capacity development plan and the transition plan should be clear, concrete, and credible, and provide direction for the MoH to assume the PR role as soon as possible Both the capacity development plan and the transition plan should be integrated within existing MoH plans and strategies 1.2 Scope While the functional areas addressed in the capacity development plan are those reviewed when assessing an organisation to fulfil the role of PR, the plan primarily addresses capacity gaps in broader MoH systems and structures, rather than those only related to Global Fund operations. In other words, the plan addresses areas of health system strengthening (HSS), and as shown in the diagram below, fit within the general framework of HSS as developed by WHO in Areas addressed within this plan primarily address the following system building blocks of the WHO model: Information, Leadership & Governance, Service Delivery, Financing, Medical Products, and Health Workforce. The diagram below attempts to explain the scope of the capacity development plan and transition plan defined in this report, and longer-term capacity development. While the capacity gaps identified and addressed in this report may require longer-term capacity development efforts, the definition of capacity objectives, target indicators, and recommended actions are focused on the short-term (one to three years), and address specific improvements associated with assuring that the PR role can be quickly reassumed by the MoH. Longer-term capacity development efforts will be required to continue to address health system strengthening areas within MoH, as outlined in the WHO framework, which will include system building blocks such as health workforce, leadership and governance, and service delivery. 1.3 Basis The capacity development plan and transition plan were formulated based on the capacity assets and gaps identified in a capacity diagnosis exercise conducted with MoH just prior to producing these plans. Along with consultations with MoH management and staff members, and MoH partners and stakeholders, gaps identified in the diagnosis provide the focus for areas to address in the capacity development plan. MoH & UNDP 1 February 2011 Page 7

8 1.4 Capacity Development and Transition The capacity development plan and transition plan are defined in this report separately, but are linked. They are recorded separately due to their different perspectives of objectives, governance, and timeframes. The capacity development plan is owned and led by MoH, with a long-term perspective, targeting primarily MoH health system strengthening areas along with improvements to support assuming the role of Global Fund PR. MoH will be supported by other partners in delivering elements of the capacity development plan, but partner support should, as in all capacity development support, have clear transition and exit strategies. The overarching objective of the capacity development plan is to improve capacities to an extent that MoH is self-sustaining in continuing to provide and improve its health services delivery objectives. The transition plan is owned by MoH, but jointly led with UNDP, as both organisations have key responsibilities and tasks to ensure a successful transition of the PR role. The transition of the PR role into MoH also requires a transition out of the PR role from UNDP. The transition plan has a short-term perspective, and addresses specific PR functions and responsibilities to be passed from UNDP to MoH. The linkages between the capacity development plan and the transition plan include certain dependencies, in that the transition plan cannot be completed unless certain objectives of the capacity development plan are realized. The completion of the transition plan is also dependent on an assessment by the LFA, and it should be clearly understood that completion of the transition plan and capacity development plan milestones are not a guarantee of success in gaining approval from the LFA for MoH to assume the role of PR. 1.5 Related Plans The capacity development and transition plan should not stand alone, but should be integrated within existing MoH plans and strategies. In this light, it is assumed that the plans should integrate into the MoH 2011 Action Plan. The high-level budget for the capacity development plan is structured in Excel in the format required for the Action Plan, and after review and confirmation, can be incorporated. The National Health Strategic Plan , currently in draft, may also be updated to incorporate appropriate components of the capacity development plan. In addition, it is important to coordinate this plan with the MoH Governance Action Plan and other relevant plans produced by MoH and partners. The scope of this plan in relation to other plans and programs developing capacity in the Ministry of Health is illustrated below. MoH & UNDP 1 February 2011 Page 8

9 Coverage of CD Plan and Related Capacity Development Efforts Program Management Financial Management Procurement, Pharmaceutical & Health Product Management Monitoring & Evaluation Capacity Development and Transition Plan Governance Action Plan World Bank Malaria Capacity Strengthening 8 This diagram shows that the capacity development and transition plans described in this paper must be managed in the context of the larger overall programme of change at MoH and Cooperating Partners should be encouraged to join this CD plan with their inputs. 1.6 Partnering and Resourcing To be effective, this plan should be broadly communicated, coordinated, updated, and refined in discussions with relevant partners and stakeholders. These efforts will improve the plan and avoid duplication of effort, and also to identify appropriate partners to provide support and financial resources. The capacity development plan outlined in this report will require human resources to manage and coordinate implementation, and financial resources as outlined in the high-level budget estimate in Section and Annex IV. While Global Fund grant funding can be used for capacity development and health system strengthening objectives, it is assumed that funding from GRZ and donors will also be required to resource this plan. 2 Capacity Development Plan 2.1 Objectives and Approach The objective of the capacity development plan is to provide a set of clear and concrete capacity development targets to address identified capacity gaps. A summary of required capacity enhancements as identified in the capacity diagnosis exercise is as follows: Summary of Capacity Enhancements by Functional Area Functional Area Items for Capacity Enhancement Program Management 1. Clearly defined management structures for GF operations 2. Clarity of GF oversight mechanisms, roles, and responsibilities 3. Improved cross-directorate business processes and evidence-based management MoH & UNDP 1 February 2011 Page 9

10 Summary of Capacity Enhancements by Functional Area Functional Area Financial Management & Systems (FMS) Pharmaceutical & Health Product Management (PHPM) Items for Capacity Enhancement 4. Comprehensive, accurate and timely financial data capture, reporting, and monitoring system 5. Understanding and use of updated financial regulations, policies, and procedures 6. District accounting staff qualified and understand how to follow basic financial management and accounting principles and procedures 7. Central accounting staff skills developed in effective financial analysis and financial projections 8. Comprehensive, integrated, accountable, and up-to-date procurement and supply chain management 9. Effective oversight and partnering mechanisms for procurement and supply chain management 10. Understanding and use of updated procurement regulations, policies, and procedures Monitoring & Evaluation (M&E) 11. Comprehensive, accurate and timely program data capture 12. Timely and integrated reporting to meet agreed schedules The capacity development plan begins with addressing these areas for enhancement, then target indicators are identified to set objectives to be achieved, and finally recommended actions are identified. The development of target indicators and recommended actions was driven through consultations with MoH staff, partners, and stakeholders in discussing the history, rationale, and root causes associated with the capacity gaps. Many of these capacity enhancements will require long-term and ongoing capacity development efforts. In addition to specific objectives related to structures and systems, cultural adaptation and change management will be required. For example, in moving from a manual paper-based system to track financial transactions, the use of a computerised system will require adaptation and change in the behaviour of workers, and in the business processes and procedures. The target indicators and recommended actions defined in this capacity development plan are therefore short-term, and address objectives that can be achieved within a two to three-year timeframe. Continuing capacity development, and definition of longer-term objectives (e.g., improving evidence-based management practices) should evolve as this plan proceeds through implementation. The prioritisation and scheduling of achievement of targeted indicators for each capacity gap was driven by areas that would more likely lead towards improvements in fulfilling the role of PR. Although addressing all capacity gaps would assist in improvements in the PR role, some are more targeted (e.g. lack of clearly defined management structures for GF operations ) than others (e.g. number of national suppliers with knowledge to effectively bid on MoH tenders. ). Key levers of change in capacity development, as outlined by UNDP, are those interventions that address change in the following areas: Institutional arrangements institutional reform and incentive mechanisms Leadership leadership development Knowledge education, training and learning Accountability accountability and voice mechanisms In targeting capacity development objectives, indicators, and recommended actions for MoH, the UNDP areas were adapted into more broadly defined groups, shown below mapped to the UNDP areas: MoH & UNDP 1 February 2011 Page 10

11 Areas of Intervention Leadership & Management Accountability, Transparency & Control Performance & Efficiency Data & Information Policies & Procedures Skills & Knowledge Related UNDP Areas of Intervention Leadership Accountability Accountability, Institutional Arrangements Knowledge, Institutional Arrangements Institutional Arrangements Knowledge These areas of capacity development intervention are identified with proposed indicators and recommendations for each functional area as outlined in the capacity development plan. 2.2 Elements of the Capacity Development Plan The following sections outline, by functional area, capacity development indicators and recommended actions to address identified capacity gaps Program Management A summary of areas for capacity enhancement and recommended actions for the program management area is listed in the table below. Program Management Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 1 1. Clearly defined management structures for GF operations Leadership & Management Accountability, Transparency & Control Performance & Efficiency High GF management structure and TORs defined Documented GF management accountability structure Regular and up-todate GF plans and reports integrating program, PSM, and financial data Sufficient administrative support to coordinate GF operations Confirm and implement a clear management structure for GF Define accountability structures for GF management decisions, payments, and approvals Develop rationale and TOR to recruit an administrative coordinator to support GF management Conduct orientation in GF operations and requirements to GF functional staff and MoH program managers Q Q Q Q Clarity of GF oversight mechanisms, roles, and Leadership & Management Accountability, High Documented mechanisms and responsibilities for oversight and sharing Develop clear and concrete oversight roles and responsibilities in Q Timelines are indicative; they are contingent on approval of the plan and resources to implement it MoH & UNDP 1 February 2011 Page 11

12 Program Management Capacity Gap Areas Priority Indicators responsibilities 3. Improved cross- Directorate business processes and evidence-based management Transparency & Control Leadership & Management Accountability, Transparency & Control Performance & Efficiency Skills & Knowledge Medium of information Regularly scheduled CCM and LFA coordination meetings Global Fund Steering Committee reestablished (or function supported by an existing MoH oversight mechanism) Comprehensive and up-to-date reports linking plans to actuals across program, PSM, and financial areas Management meetings supported with comprehensive reporting Capture variances in actual versus planned activities and budgets, with corrective action taken as necessary Recommended Actions coordination with CCM and LFA Reinstate Global Fund Steering Committee or alternatively use existing mechanism Conduct corporate governance training workshop for management (IoD) Comprehensive and integrated plans and actuals across program, PSM, and financial areas Extend scope of weekly meetings held by PHO and DHMTs to include critical analysis of actual versus planned activities and budgets Timeframe 1 Q Q Q Q Two capacity gaps in the area of program management, with respect to managing Global Fund operations, are the need for clearly defined management and accountability structures, and the need for clearly defined oversight mechanisms. Strong leadership in the Ministry of Health is necessary to support the implementation of management and oversight structures, through regular strategy development and visioning exercises, planning, monitoring and oversight of the use of Global Fund resources, in the larger context of multilateral and bilateral assistance to the Ministry of Health. Addressing the need for clearly defined management and accountability structures is outlined in Section 3.3, The MoH as Principal Recipient, including principles for these structures to support the Global Fund, with optional organisational structures. Based on the current structure, and likely for any change, it is recommended that an additional administrative coordinator be recruited to support the Global Fund Grant Manager. This role would support the Manager in coordinating plans, schedules, proposals, data collection, communications, and reporting for the Global Fund. All MoH staff involved with the Global Fund, and program managers who have a need to know, should go through an orientation in Global Fund principles, operations, rules, and regulations. Clarifying the oversight mechanisms for the PR includes improvements required in the roles, responsibilities, and communications of the CCM and LFA. The previous and current situations clearly illustrate a lack of ownership, responsibility, initiative, involvement, and communications with respect to these oversight bodies. The CCM has engaged Global Management Systems (GMS) to assist in strengthening the systems and capacities of the CCM to effectively fulfil their oversight role, and the Global Fund Secretariat plans to re-tender LFA responsibilities in Zambia. While these changes will be clear improvements, the roles, relationships, and communications mechanisms between the CCM, LFA, and PRs should be documented and confirmed to avoid future misunderstandings and oversight issues. MoH & UNDP 1 February 2011 Page 12

13 In addition to the CCM and LFA, the MoH should clarify its internal oversight for Global Fund management and operations. This is also discussed under Section 3.3, The MoH as Principal Recipient. While the scope and focus of this capacity development plan and supporting capacity diagnosis were limited to functional areas in support of the Global Fund PR role, some more general needs in the area of program management within MoH were identified. These needs are not comprehensive or complete, and are not based on detailed analysis or study, but include the need for better cross-directorate information sharing and coordinated business processes. The evidence for this need is based on processes reviewed that required cross-directorate coordination, that were unknown or unclear across the Directorate areas. As an example, when Global Fund workplans were updated based on new demands, this information was not often distributed to procurement (to updated procurement projections and quantities) or accounts (to update financial schedules and budgets). While cross-departmental coordination is a challenge in every public and private institution, using comprehensive and integrated plans and reports is one way to help drive coordinated and evidence-based management decisionmaking. In addition, based on discussions with the Institute of Directors (IoD) and various Directors, it is suggested that the customised corporate governance training provided by IoD may improve the focus and coordination within and among the Directorates. The IoD conducted similar training with MSL last year Financial Management and Systems (FMS) A summary of areas for capacity enhancement and recommended actions for the financial management area is listed in the table below. Financial Management and Systems (FMS) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 2 1. Comprehensive, accurate and timely financial data capture, reporting, and monitoring system Data & Information Accountability, Transparency & Control Performance & Efficiency High Navision or IFMIS solution confirmed and plans approved >90% of accounts managed in Navision/IFMIS >75% of DHMTs reporting through Navision/IFMIS Verified comprehensiveness and accuracy of financial reporting Tracked and verified audit trail of funds remitted to Districts Bank reconciliation statements prepared on time per financial regulations Confirm solution (Navision or IFMIS) and develop full deployment plans and schedule; including PHO and DHMT in deployment plans Deploy solution to HQ Deploy solution to PHO and DHMT levels Verification exercise to confirm comprehensiveness and accuracy of financial reports If Navision deployed; develop IFMIS plans, schedules, budgets and transition system Q Q Q Q Districts to maintain separate records in the form of ledger cards for costs Q Timelines are indicative; they are contingent on approval of the plan and resources to implement it MoH & UNDP 1 February 2011 Page 13

14 Financial Management and Systems (FMS) Capacity Gap Areas Priority Indicators Recommended Actions incurred using GF funds. Bank reconciliation statements prepared by 15th of the following month Timeframe 2 Q Understanding and use of updated financial regulations, policies, and procedures Policies & Procedures Medium >90% of staff trained >90% of staff following SOPs Train accounting staff (HQ, PHO, DHMT) in MoF s updated financial rules, regulations, and SOPs Verify adherence to financial regulations and SOPs Q Q District accounting staff qualified and understand how to follow basic financial management and accounting principles and procedures Skills & Knowledge Medium >75% of DHMT accounting staff qualified Clarify and communicate TORs and conditions of service for Districtlevel accounting staff Train DHMT accountants to be fully qualified and knowledgeable in fundamentals of finance and accounting principles Q Q Central accounting staff skills developed in effective financial analysis and financial projections Skills & Knowledge Medium Increased ability to provide financial analysis and projections on a quarterly basis Train HQ accounts in effective financial analysis and financial projections Q The most fundamental and highest priority capacity gap in the FMS area is the ability to accurately and promptly record financial transactions, disbursements, payments, and balances with adequate controls. This gap affects timely reporting, the ability to do effective financial analysis, timely and informationbased financial management, and effective financial accountability structures and control. The manual capture of financial information in written ledgers and Excel spreadsheets at District, Province and Central levels is a key area to address in this regard, and a computerised system to link and control financial information at all levels will help to ensure timely, accurate, and quality-controlled data capture and access. To address this, MoH have plans to deploy the Navision financial management system at the Central level in 2011 (Navision is currently being used at the Central level for the Malaria Booster programme). Navision was used by CBOH, and is therefore a proven system, and MoH accounting staff that were previously at CBOH are familiar with its use and functionality. In addition, the MoFNP have plans to deploy the SAP-based IFMIS system to all government Ministries (only to HQ and Provincial levels), which will eventually take the place of the current MoH system (or a MoH & UNDP 1 February 2011 Page 14

15 future Navision deployment). MoH may possibly be considered as a selection for IFMIS rollout, depending on the readiness of MoH and the timeliness and success of seven pilot IFMIS rollouts planned to start in January 2011 (IFMIS pilot rollouts to date have not met planned schedules). Due to the potentially close timing of a Navision rollout at MoH and the opportunity to participate in the IFMIS rollout, it is recommended that a review and confirmation activity be conducted to recommend whether Navision should be deployed, or wait for IFMIS, and develop appropriate deployment plans. To drive the decision, MoH should have a computerised accounting system in place and fully operational, at least at the Central level, by end Strong consideration should be given to deployment of a computerised accounting system at all levels (HQ, PHO, and DHMT). Without a tightly connected system from HQ to Provinces to the District level, the timeliness and accuracy of recording financial transactions may be compromised. Deployment of the system to the District level will help to improve weak financial links and accountability all the way to the 72 District end-points of the system. In addition, discrepancies have been found between resources disbursed by HQ and received by Districts, or differences between expected disbursement at the District level and received disbursement. In some cases, Districts may not be aware of changes in their budgets since submission of their annual plan. One advantage of the IFMIS system is the inclusion of modules to support budget management, procurement, contracts management, and asset management. Therefore in IFMIS grants, budgets, procurement, and financial transactions are linked and reconciled. Currently (and possibly with Navision), budget and procurement areas are not easily linked to financial management. If Navision is deployed prior to IFMIS, a system to effectively link budgets and procurement with financial information in Navision should be developed, to ensure budget control. These links will also allow effective tracking of grants utilised to procurement and financial expenditures. An important requirement for the deployment of either Navision or IFMIS is the ability to tag or track finances that are received from various programmes or tracks (e.g., Global Fund, basket, expanded basket, GAVI, etc.). The tagging of financial resources will allow for effective recording and reporting of donor-specific or programme-specific reporting, one requirement of the Global Fund. In addition to an improved system of financial transaction recording and management, MoH have gaps in the skills and knowledge of accounting staff. MoFNP are finalising updated financial rules, regulations, and SOPs, which are expected to be in place for Ministries by Q MoH accounting staff at all levels should be trained in these new regulations and procedures in early 2011, and a verification of their adherence to these regulations and procedures should be conducted later in the year. In addition, any deployment of Navision or IFMIS should ensure that system processes follow updated MoFNP regulations and procedures. At the District level, staff assigned to do accounting functions need clear TORs and conditions of service, followed by training in basic financial management and accounting principles. This training should lead towards staff qualification or certification, to verify skill levels attained and provide professional value to the staff. At the Central level, HQ accountants need to be trained in effective financial analysis, to develop timeseries projections, estimates, trends, and other appropriate analytics to better inform MoH management of current and projected financial status Pharmaceutical and Health Product Management (PHPM) A summary of areas for capacity enhancement and recommended actions for the PHPM area is listed in the table below. Pharmaceutical and Health Product Management (PHPM) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 3 1. Comprehensive, integrated, Data & High Defined, tracked, and published Confirm and deploy a computerised Q Timelines are indicative; they are contingent on approval of the plan and resources to implement it MoH & UNDP 1 February 2011 Page 15

16 Pharmaceutical and Health Product Management (PHPM) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 3 accountable, and up-to-date procurement and supply chain management Information Accountability, Transparency & Control Performance & Efficiency Skills & Knowledge procurement metrics (efficiency, timeliness, value for money) Improved results in procurement metrics Increased accuracy and timeliness of procurement and supply chain information Linked procurement cycle and supply chain management information Operational computerised procurement cycle management system Effective contract tracking and management Dedicated logistics staff in Clinical Care for forecasting in areas of HIV, Malaria, and Tuberculosis procurement cycle management system (ECM) including contract management Design, track, and report appropriate procurement performance metrics Link procurement cycle information with budget, financial, forecasting, and supply chain information Develop rationale and TORs, and recruit 3 logisticians in the Clinical Care Directorate Design and deploy standard bidding documents and evaluation report templates Q Q Q Q Standard bidding documents and evaluation report templates in use >75% of proof of delivery confirmations from SDPs >75% match of confirmed deliveries to SDPs to confirmed deliveries to District >85% of District level logistics staff trained District-level procurement in >75% of Districts Identify and follow an approach for complete accountability from District levels to SDPs, with accurate and timely information capture Provide necessary training in logistics and reporting at District levels Define criteria and methods to empower Districts to procure for themselves Q Q Q Effective oversight and Accountability, Transparency High Regular Procurement TWG meetings, Renew the Procurement TWG Q MoH & UNDP 1 February 2011 Page 16

17 Pharmaceutical and Health Product Management (PHPM) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 3 partnering mechanisms for procurement and supply chain management & Control Performance & Efficiency minutes, and actions Increased level of partner involvement in preparing tenders and reviewing bids MoH leading forecasting and quantification planning Define and implement a process for external involvement to review and improve the tendering process Q High levels of partner involvement and awareness of procurement forecasting, plans, and status 3. Understanding and use of updated procurement regulations, policies, and procedures Policies & Procedures High >90% of staff trained >90% of staff following SOPs Completion of pharmaceutical procurement SOPs Train procurement staff at HQ in updated procurement rules, regulations, and SOPs Verify adherence to financial regulations and SOPs Q Q Develop pharmaceuticalspecific procurement SOPs Q In the PHPM area, a key and high priority capacity gap is the ability to comprehensively and accountably manage procurement and supply chain management operations from planning to tendering, ordering, receipt, distribution, and delivery. To be clear, areas of the procurement and supply chain management are working, but gaps exist. For example, managing the supply chain from the MSL warehouse and distribution centre to District warehouses is well controlled and tracked, but gaps exist in confirming deliveries from the District level to service delivery points. In general processes in the procurement cycle are functioning, but gaps exist in linking forecasting information to procurement plans, in transparency of information, in timeliness of procurement activities, and information links from procurement schedules to MSL and other partners involved. Addressing the information gaps require linking processes and information between forecasting (Clinical Care) to budgeting (Planning & Budgeting) to procurement (PSU) to distribution and supply chain (MSL and District warehouses). At the start of the cycle, forecasting is by the Clinical Care directorate with other partners and stakeholders in quantification review meetings. The Clinical Care directorate has one logistician on staff to support these duties, when at least three additional staff members are required. Due to lack of human resources to support forecasting, MoH is often in a reactive mode with respect to quantification activities that are often led and directed by partners. MoH should, as agreed by partners, lead the quantification and forecasting area, and it is recommended that three additional logisticians be recruited into the Clinical Care directorate to support forecasting for HIV, Tuberculosis, and Malaria. It is important that MoH manages a consolidated plan of forecasting information, leading to a consolidated procurement plan managed by the PSU. To more effectively manage the procurement cycle, the PSU is in the process of purchasing a procurement management system, ECM (Enterprise Content Management System), based on an SAP platform, through support from DfID. This system is planned to be in place by Q1 2011, and should MoH & UNDP 1 February 2011 Page 17

18 provide a more effective and transparent way to manage and run procurement operations. It is important that the integration of this system with other systems and processes by designed and implemented (forecasting, planning and budgeting, finance, supply chain systems at MSL, etc.). In particular, the linking of this system with the planned computerised accounting system (Navision or IFMIS) should be designed. In the long term, the IFMIS system may include all the functionality of ECM, and therefore ECM may be made redundant. Therefore a long-term view of the integration and use of ECM must be developed. The issue of confirmed delivery from District warehouses to service delivery points (Health Centres and Health Posts) requires more control and management at the District and SDP levels. This issue has been considered as part of a pilot sponsored by the World Bank and USAID, testing three models. The recommended model includes a dedicated Commodity Planner at the District level, responsible for logistics management. This model, however, requires significant funding to provide an additional resource at each of the 72 Districts. It is recommended to continue to address this gap, either through the recommended model or through other means. In the interim or as part of any solution, developing the knowledge and skills of District-level staff providing logistics support is recommended. Currently the procurement and tendering process is often lengthy and protracted, and while a procurement MIS such as ECM should provide some improvements, the PSU is increasing the number of framework tenders to provide longer-term arrangements with suppliers and therefore fewer tenders. In addition, developing standard bidding documents and evaluation report templates should improve performance. A system to track and manage contracts should be implemented and followed, which will be supported through the deployment of ECM. To track, manage, and improve procurement cycle performance, it is recommended that procurement performance metrics in the areas of cycle timing, efficiency, and value for money be developed, tracked, and openly reported. These metrics can assist in determining and improving full-cycle procurement performance and procurement value. A second high-priority capacity gap is the need for effective oversight mechanisms and increased partnering in procurement and supply chain management. The Procurement Technical Working Group (TWG) should be renewed and restarted, with regular meetings. This group can help to review and prioritise appropriate activities as outlined in this section, and ensure that information and plans are transparently and openly shared between MoH and partners. In addition, the PSU may consider involving external members in preparing tenders and reviewing bids, to learn and improve processes as well as share information. Regarding procurement policies and procedures, an updated procurement manual including processes and procedures, developed with support from CIDA, is to be available by the end of the year. PSU staff should be trained in the updated procedures, and a verification exercise should be scheduled to measure adherence. In addition, pharmaceutical-specific procedures should be developed, to support the understanding and use of specific requirements and regulations relating to the procurement and quality control of pharmaceuticals Monitoring & Evaluation (M&E) A summary of areas for capacity enhancement and recommended actions for the monitoring and evaluation area is listed in the table below. Monitoring & Evaluation (M&E) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 4 1. Comprehensive, accurate and timely program data capture Data & Information Performance & Efficiency Skills & High Confirmed set of comprehensive program data indicators incorporated into HMIS Conduct indicator design review to confirm completeness for all reporting requirements Q Timelines are indicative; they are contingent on approval of the plan and resources to implement it MoH & UNDP 1 February 2011 Page 18

19 Monitoring & Evaluation (M&E) Capacity Gap Areas Priority Indicators Recommended Actions Timeframe 4 Knowledge 100% completion of quarterly District data verification meetings Program data capture training conducted at all data verification meetings >50% HMIS data capture at community levels >85% completion of Smartcare installations Benchmark data capture timing and implement targeted improvements Develop District-level skills in accurate and timely program data capture as part of data verification meetings Increase coverage of HMIS to the community level Q Q Q Complete Smartcare deployment Q Timely and integrated reporting to meet agreed schedules Data & Information Performance & Efficiency High Meet agreed schedules in providing quarterly program data for GF reporting Integrated program, budget and expenditure reporting >50% increase in reporting cycle times Meet GF quarterly reporting cycle requirements (all data areas) >90% M&E staff have adequate computer systems Integration of MoH reporting data into CCM dashboard Integrate data capture from various systems (Smartcare, HMIS, Navision/IFMIS, budget) to support appropriate donor tagging for selective reporting Analyse and address timeliness and efficiency gaps in data capture and reporting processes Improve systematic data capture and reporting to meet GF requirements Integrate reporting with required inputs to CCM dashboard Q Q Q Q For the monitoring and evaluation area, the primary capacity gaps to address involve comprehensive, accurate, and timely program data capture; and timely, integrated reporting to meet agreed schedules. For capture of program data, enhancements to HMIS to include a hospital-specific system (design underway), expanding coverage to the community level (pilot planned but not funded), and a design review to ensure the comprehensiveness of indicators for all reporting requirements. Smartcare rollout, currently approximately 50% complete, should continue, though further deployment is hampered due to availability of electricity in remaining deployment locations. It is the objective of the M&E unit in MoH to avoid donor, fund, or program-specific data capture procedures if at all possible. The burden of specific data capture requirements is high, requiring additional time, effort, and skills at the District and Health Centre levels. Therefore the design of a MoH & UNDP 1 February 2011 Page 19

20 comprehensive set of indicators, followed by data capture procedural training at the District level as part of quarterly data verification meetings, should improve the accuracy and timeliness of program data capture. In the area of reporting, the M&E unit captures program data, and relies on data from other units for budget and expenditure data to produce integrated reports linking plans to expenditure to results achieved. The ability to produce these integrated reports is vital, and specifically for requirements of the Global Fund, provides a link between grant amounts utilised and results achieved, to measure efficiency in utilisation of funds. Currently these integrated reports are compiled manually, and often do not clearly show links between funds utilised and results achieved. To produce these integrated reports, the M&E unit should integrate data elements required, to systematically report as necessary for Global Fund and other programs. The planned CCM dashboard report is one external system to consider in the design, so that data required for the dashboard can be readily extracted. Although program data is only one element of required information for Global Fund reporting, the M&E unit should analyse timeliness and efficiency gaps in the reporting cycle, in order to meet Global Fund as well as other required reporting schedules. MoH have struggled, and have failed to date to meet Global Fund reporting requirements, and addressing the causes is a fundamental area to address. If it is clear that the Global Fund quarterly reporting schedule cannot be met by MoH by the time MoH assumes the PR role, MoH should negotiate an alternative reporting schedule with the Global Fund until the time when a defined plan to address reporting timeliness gaps can be implemented. Ideally, if following MoH systems and procedures for procurement and financial operations, with Global Fund resources appropriately tagged through the systems, M&E should be the only functional area (besides program management) requiring specific Global Fund knowledge. This knowledge entails the understanding and skills to produce accurate and timely Global Fund reports, quarterly and annually. Therefore the M&E staff supported through Global Fund grants will need to have more specialised knowledge in the data and reporting requirements of the Global Fund. This knowledge will need to be provided through orientation and training, along with and possibly in addition to coordination with UNDP as part of the transition plan. 3 Transition Plan 3.1 Objectives and Approach The objective of the transition plan is to provide a sequenced and measurable blueprint to allow for the functions and responsibilities of the Principal Recipient to increasingly move from UNDP to MoH, ideally within a two-year timeframe. The approach to developing the transition plan is to understand the projected Global Fund grant situation in Zambia, understand the structures within MoH to assume management and implementation of Global Fund grants as PR, include necessary capacity development activities required, and define a sequenced transfer of responsibilities to MoH. 3.2 Projections of Global Fund Grants To plan for the transition of the PR role from UNDP to MoH, it is important to project the schedule and status of Global Fund grants and milestones in the coming two years. The diagram below illustrates this schedule, with more firmly assured grants in a darker shade of grey, and less assured grants in a lighter shade of grey with question marks in the description. This schedule is also not tied to the calendar year, but begins when UNDP receives its first disbursement from the Global Fund, although this disbursement is expected on or before January Assuming this disbursement date falls on or near January 2011, the proposed MoH PR assessment, and preceding proposal of the MoH as PR by the CCM, are noted. The proposed MoH PR assessment has been noted by the Global Fund Secretariat, in the OIG Country Audit of Global Fund Grants to Zambia, as scheduled to occur in 18 months, presumably from October 2010: After 18 months, the Secretariat will assess MOH to establish whether it has gained sufficient capacity to re-take the role of PR. MoH & UNDP 1 February 2011 Page 20

21 Based on this schedule, likely grants to transition to MoH as PR include: Phase 2 of Round 8 HIV grant Phase 2 of Round 10 HIV grant Phase 1 of Round 11 Malaria and TB grants, if the timing of initial grant disbursements can be aligned to follow successful assessment of the MoH as PR 3.3 The MoH as Principal Recipient As part of the transition plan, it is important to define and prepare for the organisational and management structure of the PR within MoH. This definition of the end state PR structure at MoH is important to confirm soon, so that the structure can be setup and in place during the period of transition as MoH moves from an SR to the PR role Principles for MoH Structures to Manage GF Grants Regardless of the organisational and management structure employed by MoH to manage Global Fund grants and operations, some general principles should apply in the case of Zambia: 1. Financial resources received from the Global Fund provide one of many channels for MoH funding, and should be managed, implemented, and reported as consistently as possible with other funding channels 2. To avoid parallel systems and/or structures, the receipt and implementation of Global Fund grants should ideally follow existing MoH systems and structures to the greatest degree possible 3. Managing Global Fund operations within the MoH will require clear management structures with ownership, accountabilities, and authorities documented and approved 4. Managing Global Fund operations within the MoH should include clear oversight and review structures within MoH, ideally following existing structures 5. A single Grant Manager should be identified within MoH to be the lead in managing all Global Fund activities 6. The Grant Manager should have the authority to approve Global Fund workplans, procurement plans, payments, and reports MoH & UNDP 1 February 2011 Page 21

22 7. Managing Global Fund operations within the MoH will require access to and coordination of staff and information across various Directorates and units (including: Clinical Care, Public Health, Policy & Planning, Procurement, Accounts, and Internal Audit). 8. Managing Global Fund operations across Directorates and units will require a level of authority commensurate with these responsibilities 9. The impact of receiving Global Fund grants to the supporting functions of procurement and finance should ideally only increase the volume in the procurement and supply chain, the number of financial transactions, and thus amount of work, requiring additional staff based on the workload 10. The impact of receiving Global Fund grants to the supporting function of monitoring and evaluation should ideally only affect the knowledge and systems required to produce Global Fund specific reports 11. All staff members contracted through Global Fund grants or with specific Global Fund responsibilities should have clear TORs and performance criteria including their Global Fund responsibilities, with the Grant Manager reviewing these performance areas Resources received through Global Fund grants represent a sizeable percentage of the MoH budget, and thus should be accorded a level of management focus and attention to ensure that funds are received promptly, utilised effectively, and results reported in a timely fashion GF Organisational Structure within MoH Currently, the MoH have 14 staff members supported by Global Fund grants. These staff members are required to support the increased workload associated with the management and implementation of Global Fund grants. These 14 staff positions are allocated as follows: 5 positions supporting procurement functions 5 positions supporting finance functions 4 positions supporting monitoring and evaluation functions While UNDP assumes the PR function, these positions will remain within the MoH structure to assist in transition efforts and ensure continuity as MoH assumes the PR role. Current Management Structure for GF Permanent Secretary Directorate of Technical Support Services Directorate of Clinical Care Directorate of Public Health Directorate of Policy & Planning Directorate of Human Resource & Administration 1 x GF Grant Manager Monitoring & Evaluation Procurement 4 x GF M&E 5 x GF Procurement Accounts 5 x GF Finance 3 MoH & UNDP 1 February 2011 Page 22

23 In the current structure, the Grant Manager reports to the PS, as well as the Director of Public Health, and manages all Global Fund related activities. This structure follows the principle of using existing MoH systems and structures, and has a Grant Manager reporting to the PS that should allow sufficient authority and ownership. However, clear TORs and authorities need to be documented and agreed. In consultations during the capacity diagnosis and planning process, suggestions were raised to consider alternative structures for managing Global Funds within MoH when assuming the PR role. In reviewing alternative structures for the PR role within MoH, management structures employed by a set of ten selected countries in Africa where the Ministry of Health is a Global Fund PR showed three different structural typologies (see Annex III for information on structures employed in each of these countries): Integrated the PR structure is fully aligned with the systems and structures for management, procurement, financing, and M&E as found in the MoH Mixed the PR structure uses existing MoH systems and structures, but also has some elements specific to the Global Fund, typically for overall management, administration, and M&E PMU the PR structure uses a programme management unit with separate structures and staffing for management, procurement, finance, and M&E Based on these typologies, the current MoH structure is mixed, using existing systems and structures with the exception of the Grant Manager. In general, the advantages of an integrated or mixed structure include avoiding parallel systems and following an existing and sustainable system; these advantages are included as principles for MoH to follow. In general, the advantages of a separate and parallel structure include better coordination and focus, and typically higher performance (generally seen in the grant performance results in Annex III). The structure best suited for MoH is the one that fulfils the requirements of the Global Fund while adhering to the principles previously outlined; which imply that ultimately an integrated or mixed structure is optimal. In determining different options, MoH could follow a structure that initial operates in parallel until performance and efficiency are achieved, and then staff transition into existing structures. 3.4 Elements of the Transition Plan The transition plan outlined in this document provides a high-level view of the scheduling of responsibilities within each of the functional areas of program management, finance, procurement, and M&E. Transitioning the role of PR also includes a number of handover responsibilities, many of which are documented in Global Fund operational guidelines, and may include: transfer of records and files, transfer of contracts, transfer of equipment, transfer of personnel, etc. These and other specifics should be outlined in a more detailed transition plan, developed jointly by UNDP and MoH. The diagram below provides a general outline of intentions for the gradual transition of PR responsibilities from UNDP to MoH. The sections shaded in red highlight areas of MoH responsibility. As shown, M&E responsibilities, particularly with respect to capturing and reporting programming data, are, and will remain the responsibility of MoH. Plans for gradual transition of finance and procurement responsibilities begin at the end of the first year, in line with improvements in these areas of MoH outlined in the capacity development plan. A schedule of milestones and indicators for capacity development and transition is found in Section 4. The following sections describe the transition plan in the areas of program management, finance, procurement, and M&E. MoH & UNDP 1 February 2011 Page 23

24 3.4.1 Program Management With the MoH as an SR, it is presumed that program management functions will be to some degree shared with open communications between UNDP and MoH from the outset. Certainly in developing new grant proposals, reviewing and updating workplans, reviewing program results, and compiling and submitting reports, UNDP and MoH will need to work cooperatively on a regular basis. As MoH begins to assume the role of PR, there will likely be an overlap period in the range of 6 months when both UNDP and MoH will be legally functioning as PR for a specific grant. This overlap is outlined in Global Fund operational guidelines, and ensures that the retiring PR can complete any necessary inprogress contracts and transactions while the new PR assumes responsibilities for new contracts and transactions Financial Management and Systems (FMS) In the area of financial management, transitioning selected payments to MoH as SR is linked to improvements in the accuracy and timeliness of financial data capture and reporting, and District-level accounting skills development. Indicators include these results: MoH have operationalised a computerised accounting system, a large percentage of DHMT staff have been qualified, and financial reports from the system have been verified to be comprehensive and accurate. The type and number of payments to be transitioned should be planned and arranged through discussions with UNDP, with the assumption that with continued success MoH will handle an increasingly higher volume of payments Pharmaceutical and Health Product Management (PHPM) For the PHPM area, transition is linked to improvements in managing information and efficiency in the PSM cycle, and in improvements in oversight and partnering mechanisms. Indicators include the use of a computerised procurement cycle management system, linking procurement information with SCM areas, confirmation of delivery from DHMTs to delivery points, regular Procurement TWG meetings, involving partners as appropriate to participate and improve tender preparation and bid reviews, and MoH taking a lead role in forecasting and quantification efforts. MoH & UNDP 1 February 2011 Page 24

25 When capacity development indicators reach agreed levels, UNDP will begin to transition selected Global Fund procurements to MoH, and will plan to increase the volume of procurements done by MoH as long as the arrangement operates as planned Monitoring and Evaluation (M&E) For M&E, the planned transition includes different stages. Initially, without any transition, MoH will continue to provide, as it has done continuously, programmatic data for Global Fund reporting. The indicator for this is timely reporting of programmatic data to UNDP, who will integrate this data with financial information to provide the integrated quarterly reports to the Global Fund. As the M&E area confirms indicators, conducts data verification reviews, and analyses data capture and reporting efficiency, it will pilot test integrated Global Fund reporting with MoH systems by preparing mock Global Fund quarterly reports. These mock reports will test the completeness, accuracy, and timeliness of reporting to the Global Fund, using MoH programmatic data linked to selected procurement and financial data (e.g., from GAVI or another program). Once MoH begin to perform selected procurement and financial functions as an SR, these mock reports can become actual integrated reports of Global fund programmatic and financial information. These integrated reports will not be comprehensive, as additional procurement and financial transactions will be done by UNDP, but will demonstrate the timeliness and integration of producing Global Fund quarterly reports. 4 Capacity Development and Transition Schedule While the capacity development plan is directed towards sustainable improvements in systems and structures, the transition plan is focused on transferring PR functions from UNDP to MoH in the areas of management, finance, procurement and M&E. The schedule for transitioning functions is primarily based on three factors: 1. The readiness of UNDP to coordinate transferred functions 2. The readiness of MoH to perform functions transferred to them 3. The timing of Global Fund activities and grant milestones The readiness of MoH is primarily a factor of demonstrated improvements in capacity as outlined in the capacity development plan. While not all objectives of the capacity development plan are required to be completed prior to transferring the PR role, this plan suggests certain capacity development gaps and indicators that should be addressed prior to or during transition. 4.1 Objectives and Approach The timing of the transfer of the PR role from UNDP to MoH has been discussed by MoH and various stakeholders as occurring in approximately two years. In fact, the Global Fund Secretariat presumes this in stating that the MoH will be assessed as a PR in eighteen months. Rather than build the plan based on a targeted date, the scheduling of capacity development and transition as outlined here is based on addressing certain capacity development gaps, as measured through specific indicators. 4.2 Sequenced Capacity Development Indicators and Transfer Milestones As noted, the sequence and scheduling of capacity development improvements is based on indicators for a subset of capacity development gaps outlined in Section 2.2. The assumption is that this subset addresses more fundamental and high priority gaps that indicate functional capacities are sufficiently improved for the MoH to reassume the Global Fund PR role. The remaining capacity gaps are important to address and should not be avoided, but it is assumed that the selected subset, which should be reviewed and confirmed, addresses fundamental leverage points for improvement. The table and diagram on the following pages illustrate these selected capacity development indicators, and in the diagram, transfer milestones by quarter. It is suggested that indicators be included in MOH worlplans, measured, reviewed and reported on quarterly (from MOH to UNDP), to suggest alternative actions or changes in activities to address indicators that are not achieving objectives as planned. In MoH & UNDP 1 February 2011 Page 25

26 addition as capacities are not static they will need to be refreshed and evolve to changing needs even after the PR-ship is handed back to the MOH. Specific activities to achieve targeted results for these indicators are not illustrated on the diagram, but should be confirmed based on the recommended actions listed within each functional area in Section 2.2, and also included as activities in the budget estimates (see Section 4.3.3). MoH & UNDP 1 February 2011 Page 26

27 Capacity Development Target Indicators by Quarter 5 Area Q1 Q2 Q3 Q4 Q1 Program Management 1. GF management structures and TORs defined 2. Documented GF management accountability structure 4. Documented mechanisms and responsibilities for oversight 5. Regular and up-to-date GF plans and reports integrating program, PSM, and financial data 3. GF Steering Committee or equivalent established Financial Management & Systems 6. Navision or IFMIS solution confirmed and plans approved 7. 90% of accounts managed in Navision/IFMIS (HQ) 8. >80% of DHMT accounting staff qualified 9. Verified comprehensiveness and accuracy of financial reports Pharmaceutical & Health Product Management 10. Regular Procurement TWG meetings 11. Partner involvement in tenders and bid reviews 12. MoH logistics staff lead forecasting 13. Operational computerised procurement cycle management system 14. Linked procurement and SCM information 15. >75% proof of delivery confirmations from SDPs Monitoring & Evaluation 16. Meet agreed schedules in providing programming data for quarterly GF reporting 17. Meet GF quarterly reporting cycle requirements (all data) 18. Integrated program, budget and expenditure reporting 5 Timelines are indicative; they are contingent on approval of the plan and resources to implement it MoH & UNDP 1 February 2011 Page 27

28 MoH & UNDP 1 February 2011 Page 28

29 MoH & UNDP 1 February 2011 Page 29