1. Capacity Assessment of South Sudan Ministry of Health for Global Fund Programmes Preliminary 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.
9. The PR/SR has the capacity and systems for effective management and oversight of SRs/SSRs.
8. Implementers have capacity to comply with quality requirements and to monitor product quality throughout the in-country supply chain.
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.
7. Central and regional warehouse have capacity, and have good storage practices to ensure adequate condition, integrity and security of health products.
6. The distribution systems and transportation arrangements are efficient to ensure continued and secured supply of health products to avoid treatment disruptions.
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.

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
Level of Risk
No Issues: Adequate capacities and systems are in place to implement the grant.
Minor Issues: Required capacity and systems are generally in place. Capacity gaps pose minor risks that can be managed and/or strengthening measures can be implemented in less than 6 months.
Major Issues: There are significant gaps in capacities and systems that pose major risks to a successful grant implementation. Addressing these gaps requires longer-term (more than six months) technical assistance and/or capacity building and/or a temporary outsourcing of the function (e.g. fiduciary agent, procurement agent, etc.) .
Degree of Compliance
Fully compliant
Partially compliant
Not compliant
Unknown
Not assessed

6. The PR/SR demonstrates effective management structures and planning.
Example
Standard 1
The PR/SR demonstrates effective management structures and planning.
Component
Results
The PR/SR has sufficient number of skilled and experienced staff to manage the program (programme management, finance, M&E).
SR meets standard (minor issues): In some provinces there are vacancies, or acting appointments in key positions that should be addressed as grant implementation proceeds. Retention of current staff should also be improved.
The PR/SR shows effective organizational leadership, with a transparent decision-making process.
SR meets standard (minor issues/major issues): Effective management systems and practices are in place although there are challenges with competing priorities and managing unplanned activities. Implementation risk management does not take place in a systematic way.
Staff for key functions have relevant technical knowledge & health expertise for HIV/AIDS, tuberculosis and/or malaria.
SR meets standard (no issues): Staff have relevant knowledge and health expertise in HIV, TB and malaria.

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 Rating Level of Risk
Governance and Programme Management (Standard 1)
Partially compliant
Major issues
Financial Management and Systems (Standards 2 & 3)
Not compliant
Monitoring and Evaluation (Standards 4 & 5)
Compliant
Minor issues
Procurement and Supply Management (Standards 6 & 7)
SR/SSR Management
Not assessed

9. Cross-cutting challenges and opportunities
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. Skills development, mentoring, job shadowing, embedded TA, etc.
Overall Approach ( )
Month 3-6
Infrastructure
Systems
People
Skills
Begin core functions
Month 7-12
Competent in core functions
Correct reporting
Small imprests
Month 13-18
‘Ownership’
Accurate reporting
Increased threshold for cash management
Month 19-24
Performance maintained
Performance assessment
First disbursement with full accountability
Month 25-30
Additional disbursement
Full capacity assessment in preparation for next funding cycle
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.).