1. 10 October 2013 Islamabad OIG Findings & Recommendations in public health

2. Intro… If a monkey is amongst dogs, why won't it start barking? Nigerian proverb

3. GF is making a difference. But concerns were raised around: –appropriateness of indicators (type, numbers and quality) and targets –robustness of systems to collect and verify reported data –weak collaboration of financial with programmatic results (Value for money?) –Reliability of data –Alignment and harmonization to/with national systems Trends –Shift from parallel to national systems –Improvement of indicators and targets –Anecdotal evidence of data quality issues –Status of M&E systems better known – DQAs, OSDVs Where we are coming from?

4. Where we are...

5. Case study What can we do differently?

6. The Global Fund investments in the Country A HIV programs is USD 250 million. Grants are classified as B2 – Inadequate but potential demonstrated. Country A would like to reduce its HIV incidence by 30% by 2015. However, it −remains the only high HIV burden country with an overall rising HIV incidence in the past five years. −Its HIV prevalence has increased from 6.4% in 2005 to 7.3% in 2011. −Country A has also recorded a 16.4% increase in new HIV infections among adults between 2007 and 2011. −The new infections outstrip AIDS-related deaths two-fold and net enrollment into antiretroviral therapy (ART) three-fold. What can we do differently? −Has our focus been right? −Do our current practices help us feel the actual pulse? −Is our coverage reasonable? −Do we analyze root causes of what we see? An Example

7. Appropriateness of interventions in creating the desired impact – Proving it Vs Investing it Whether results are contributing to impact Coverage of key affected populations and human rights Effect of health systems on disease programs Value for money Effectiveness of partnerships – government and other donors Holistic view to risk and assurance Shifting focus with GF strategy (including NFM)… Raise it Invest it Prove it

8. What does this mean for all of us? The hunter in pursuit of an elephant does not stop to throw stones at birds… Ugandan proverb Looking past systems and numbers Moving past M&E to public health Understanding the three diseases - epidemiology Providing insights to root causes where impact is not as expected No reinventing the wheel – moving away from being data collectors and stepping into an analyst role (The so what question) Evolving into an effective partner

9. Thank you!