Capacity Assessment of South Sudan Health Ministry for Global Fund Programs

1. Capacity Assessment of South Sudan Ministry of Health for Global Fund ProgrammesPreliminary Findings & Recommendations Russell Armstrong, Savita Acharya, Dr. Luca Monoja Consultants, UNDP June 28, 2018

2. Background and Purpose • MOH is SR under UNDP and PSI (malaria) and currently under zero-cash restriction—but, “Zero cash does not mean zero responsibility.” • UNDP Global Fund programme has a policy of capacity development and transition. • Process begins with a baseline Capacity Assessment using Global Fund/UNDP standards and tools. • Findings inform a Capacity Development and Transition Plan. • Transition is never an issue of ‘if’ but ‘how’ and ’when.’

3. Minimum Standards for PRs & SRs The Global Fund expects ALL grant implementers to meet 9 minimum standards: 1. The PR/SR demonstrates effective management structures and planning. 2. The internal control system of the PR/SR is effective to prevent and detect misuse or fraud. 3. The financial management system of the PR/SR is effective and accurate. 4. The PR/SR data-collection capacity and tools are in place to monitor program performance. 5. A functional routine reporting system with reasonable coverage is in place to report program performance timely and accurately. 6. The distribution systems and transportation arrangements are efficient to ensure continued and secured supply of health products to avoid treatment disruptions. 9. The PR/SR has the capacity and systems for effective management and oversight of SRs/SSRs. 7. Central and regional warehouse have capacity, and have good storage practices to ensure adequate condition, integrity and security of health products. 8. Implementers have capacity to comply with quality requirements and to monitor product quality throughout the in-country supply chain.

4. Standards have measurable components: • For example, components for Standard 1: • The PR/SR has sufficient number of skilled and experienced staff to manage the program (programme management, finance, M&E). • The PR/SR shows effective organizational leadership, with a transparent decision-making process. • Staff for key functions have relevant technical knowledge & health expertise for HIV/AIDS, tuberculosis and/or malaria.

5. Ratings

6. Example

7. Capacity Assessment Process • Set out in UNDP capacity assessment tool kit—assessment tools and guidance for conducting assessment. • Administration of tools and collection of supporting documents. • Analysis and rating. • Recommendations on capacity strengthening.

8. Summary of Findings

9. Cross-cutting challenges and opportunities Challenges: • Systemic issues: human resources, infrastructure. • Many partners providing/planning capacity development interventions but limited coordination. • MOH ownership/leadership not always clear. Opportunities: • There is adequate technical knowledge about what should be done; however, need a strategy to manage systemic issues.

10. Governance and Structure • Central MOH is restructuring—new structure not yet approved. • Strong technical skills across DGs but systemic issues (retention/infrastructure/budget) limit effectiveness. • Although structures/processes defined they are not always used. • Ownership of Global Fund programme not clear. Recommendations: • Establish a semi-autonomous PMU as an interim measure to anchor the Global Fund programme within MOH and to be a starting point for capacity strengthening. • Establish a Project Coordinating Committee (MOH, UNDP, USG, PSI) to oversee the capacity development/transition plan implementation.

11. Programme Management • GF programmes are implemented as vertical projects within MOH structures with need for better coordination and collaboration. • Some technical capacity (TB?) but at director level but challenges for teams—partner dependent and staff motivation and retention an issue. • No policy or tools in place to identify and manage programme risk. • Programmes are coordinated through Technical Working Groups but not all are active and functional. Recommendations: • Along with establishment of PMU, clarify structure of programmes within MOH and cross-programme coordination. • Coordinate with partners to address recruitment/retention challenges in programmes. • Put in place stronger joint planning, management, monitoring and reporting process between PR and SR.

12. Financial Management and Systems • Although there is some technical capacity in financial management and procurement, individuals cannot function adequately due to systemic issues. • Regulations, policies, guidelines define clear procedures but many are no longer used/cannot be fully applied because of functional state. • Major investments are necessary to address these issues that are beyond the scope of what the proposed capacity development and transition process can currently address. Recommendation: • At some future date MOH and technical partners should develop a ‘recovery strategy.’ Global Fund supported capacity investments could contribute to this.

13. Monitoring and Evaluation (1) • Some functional capacity (at least at central level) although limited staff and very reliant on partners. • No integrated, national M&E Framework to guide M &E activities • Quality and accuracy of the data is an issue--no strong measures in place to improve data quality/accuracy besides few ad-hoc activities. • Significant challenges at lower levels—recruitment, retention and skills affecting reporting—completion, timeliness, quality. • Capacity development support for DHIS2 will address some of these issues.

14. Monitoring and Evaluation (2) Recommendations: • Clarify and strengthen structures/process linking M&E unit and GF programmes. • Address recruitment retention challenges in collaboration with partners—afterwards, invest in skills. • Develop one integrated, national health M & E framework to guide the M &E functions/activities. • Strengthen quality assurance measures—routine and reliable. • Develop one consolidated capacity development/technical assistance plan to coordinated/harmonized support.

15. Procurement and Supply Management • Issues have been well-mapped by others—partner driven process. • Some technical skills at senior level but limited ability to apply them and significant challenges to coordinate donors. • Opportunity within Global Fund programme for collaboration and skills transfer but human resources issues limit opportunities to build capacity. • However, moving forward depends on larger issue of finalising CMS role. Recommendation: • Develop one integrated capacity development plan for PSM with strong coordination mechanism lead by MOH—strong TWG. • In short-term, focus on priorities for warehouse management—systems, skills transfer, consolidation across programmes.

16. Overall Approach (2018-2020) Skills development, mentoring, job shadowing, embedded TA, etc.

17. PMU—preliminary ideas • Semi-autonomous unit reporting to Under Secretary • Role: • Lead the administrative and reporting functions of Global Fund programme management. • Support programmes for effective implementation of Global Fund activities—progammes focus on timeliness and quality of implementation. • Functional liaison between PRs—ensuring that on the MOH side there if full compliance with policies, procedures and processes. • What the role is not: • Implementation • Representation of MOH on Global Fund issues—this should be the Minister or his designate.

18. Short term actions (6 months) • Develop the PMU structure (terms of reference, job descriptions, budget, functional relationships, etc.). • Establish/equip PMU—joint recruitment • Provide intensive skills-building and, at the same time, develop policies/procedures/processes. • Clarify/strengthen links with programmes—procedures, processes, systems. • Begin functioning (planning, monitoring, reporting) in close collaboration with UNDP and PSI. • Provide general orientation to central level MOH on basics of Global Fund and the roles and responsibilities of Global Fund implementers.

19. Some important assumptions for success • There is high level commitment and engagement by the MOH to make the process a success. • The plan is endorsed, the roles and responsibilities are clear, and everyone agrees to stick to the plan. • There is willingness to learn and to own responsibilities and accountabilities. • UNDP and other relevant partners are fully invested in capacity development and there is flexibility/willingness to change as the MOH progresses. • There is full transparency and accountability.

20. Next Steps • Complete Capacity Assessment Report (July). • Develop draft Capacity Development and Transition Plan (July). • Review, validation, costing of the plan (July-Aug). • UNDP as PR then leads the process of approval through the respective channels (MOH, CCM, Global Fund, etc.).