Five-Year Evaluation of The Global Fund

Prof. Rose Leke, Vice-Chair of the Technical Evaluation Reference Group

The Global Ministerial Forum on Research for Health

Bamako, Mali

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Origins of the Five-Year Evaluation

The Five-Year Evaluation is a major effort to review the functioning and performance of the Global Fund as an institution, a partnership, and its contribution to disease impact, and identify areas of strength and weakness that will lead to improved operations

The Global Fund's 2003 Board-approved M&E Strategy called for:

“…a first major evaluation of the Global Fund’s overall performance against its goals and principles after at least one full grant funding

cycle has been completed (five years)”

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Five-Year Evaluation Study AreasO

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Study Focus and Methodology

Institutional Arrangements

Grant Performance Impact Measurement

Organizational Efficiency

Partnership System

Disease Impact

Architecture Business model

GovernanceResources

TAPartner systems

National ownership Effects on systems

(pos. and neg.) CoverageReduction of

infections, illness &deaths

1

2

3

4

Global representation with focus in 25 countries

Study Area 2

Study Area 3

Study Areas 2 + 3

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Highlights from Study Area 1 Findings

The Evaluation finds:

An organization that has made rapid and inspiring achievements and has learned and adapted rapidly

Critical challenges that the Global Fund needs to meet new responsibilities for its next stage of growth

Governance and management systems and processes now in place will not meet the needs of an expanded Global Fund

Key recommendations made in the areas of: - Strategy

- Partnership

- Governance

- Organizational Structure

- Processes and Grant Management

- Mission-critical systems

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Exceptionally rapid start-up New model for global public-

private partnerships Significant levels of funding Inclusion of new

constituencies Country led and demand-

driven

Without a field structure High standards of transparency Performance-based funding Contribution to strengthening

health systems

After six years the Global Fund has made notable and significant contributions towards its original aims, specifically:

But: Several areas identified where the paradigm shift of

development assistance is still on going for all partners, and where improvements are required

in the establishment of effective partnerships

Highlights from Study Area 2 Findings

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Study Area 3: Health Impact Evaluation

Goal:

To comprehensively assess the collective impact that the Global Fund and other national and international partners have achieved on reducing the disease burden of HIV, TB and malaria and beyond

Methodology:

Studies in 10 countries based on secondary analysis of existing data: Benin, Burundi, DRC, Ghana, Kyrgyzstan, Lesotho, Moldova, Mozambique, Rwanda, Vietnam

In-depth studies in 8 countries designed to fill data and information gaps through primary data collection, to include significant capacity building: Burkina-Faso, Cambodia, Ethiopia, Haiti, Malawi, Peru, Tanzania, Zambia

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Impact Evaluation Framework

Has funding increased? Amount? Sources?

Have access and quality of servicesimproved?

Has coverage improved and risk behaviour changed?

Have health outcomes improved?

OutputsHealth

Services Delivery

Quality

BehaviouralInterventions& knowledge

OutcomesIntervention

coverage

Behavioural change

Impact

Morbidity

Disease consequences

Mortality

ProcessTraining &

Capacity Building

Supplies

GuidelinesIEC

Community mobilization

Reduced inequity

InputsFunding

Global Fund

Other int'lResources

Domestic resources

Contextual factors

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Development Approach to Health Impact Evaluation

Country ownership and alignment through the creation of 17 country-level task forces

Capacity strengthening of 47 local institutions & consultants responsible for conducting the evaluation at country level

Harmonization through sharing an early draft report with partners for comments; and provision of $3.5 M from PEPFAR for additional capacity building and dissemination

75% of budget spent on activities with direct benefit in-country: provision of tools, financing of local costs, TA, support for report writing

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Roles and responsibilities

The health impact evaluation is a country–driven evaluationThe process is coordinated by an impact evaluation task force (IETF) in each country

The impact evaluation work plan is built by the country

The work is carried-out by local persons/institutions

The contractor responsibilitiesDefine the evaluation framework (workplan template and methodology)

Provide technical assistance

Channel the budgets (contract in-country partners)

Organize pooled analysis and modeling activities to generalize findings

Produce the final cross-country report

The role of the Technical Evaluation Reference Group (TERG) Overseeing the study to ensure its quality and independence

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Data uses

• Build upon existing data collection and analysis efforts in countries

• Utilize information from a wide variety of data sources and fill data gaps where possible

• Use common methods and instruments across countries• Strengthen country capacity and improve foundation for long

term M&E

Sources of data • National record reviews• Secondary analysis: household surveys• Comprehensive district assessments• National Health Accounts

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Status and Next steps

Study Area 1: Organizational efficiency and effectiveness of the Global Fund

Final Report available on GF website since November 2007

Study Area 2: Global Fund partnership environment and grant performance

Final Report available on GF website since November 2008

Study Area 3: Impact of collective efforts on reduction in disease burden

Final Report to be presented to the GF Board in May 2009

Synthesis Report: Synthesizing findings from all three study areas

Final Report to be presented to the GF Board in May 2009

Dissemination workshops in countries from March 2009

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Thank you…

TERG MEMBERS EX-OFFICIO MEMBERS

Rolf KORTE - Chair Jaap BROEKMANS

Rose LEKE - Vice Chair Paul DE LAY

Atsuko AOYAMA Bernard NAHLEN

David BARR Paulo TEIXEIRA

Stefano BERTOZZI

Lola DARE

Bashirul HAQ

Loretta PESCHI

Annex

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Evaluation Framework

* : Supplementary data collection

Cluster Country Health Impact Evaluation (SA3) Partnerships (SA2)

Eastern Europe & Central Asia Kyrgyzstan    

Moldova    

Latin America & Caribbean Haiti*    

Honduras    

Peru*    

North Africa & Middle East Yemen    

East Asia & Pacific Cambodia*    

Vietnam    

South Asia India (1)    

Nepal    

Sub-Saharan Africa: West & Central Benin    

Burkina Faso*    

DRC    

Ghana    

Nigeria    

Sub-Saharan Africa: East Burundi    

Ethiopia*    

Kenya    

Rwanda    

Tanzania*    

Uganda    

Sub-Saharan Africa: Southern Malawi*    

Mozambique    

South Africa    

Zambia*    

TOTAL 25 20 16

(1) India and South Africa did not participated in the Health Impact Evaluation as planed; Lesotho replaced South Africa