1. MERG Meeting Geneva - Cambodia GFATM M&E; October 2004 1 Cambodia Experiences in Relation to M&E for PR/MoH-GFATM Presented by Dr. Or Vandine, PN, MD, MPH Deputy-Director, CDC Department Manager, PR/MoH-GFATM The Eighth MERG Meeting, Geneva, Switzerland 25 - 26 October, 2004

2. MERG Meeting Geneva - Cambodia GFATM M&E; October 20042 PGA Round 1 (Jan 2003) PGA Round 2 (Oct 2003) PGA Round 4 * (Not signed yet) 1 PGA: 1) HIV/AIDS 1) HIV/AIDS 3 PGAs: 1) HIV/AIDS (42%) 1) HIV/AIDS (42%) 2) Malaria (39%) 2) Malaria (39%) 3) TB (19%) 3) TB (19%) 2 PGAs: 1) HIV/AIDS (63%) 1) HIV/AIDS (63%) 2) Malaria (37%) 2) Malaria (37%) Total: USD 11.2 million for 2 yrs for 2 yrs Total: USD 12.9 million for 2yrs for 2yrs Total: USD 14.02 million ? for 2yrs for 2yrs I. Background Information: * : In September 2004, the TRP of GF approved the clarification provided by the CCC in August 2004.

3. MERG Meeting Geneva - Cambodia GFATM M&E; October 20043 I. Background Information (Cont...): Multiple Sub-Recipients (SRs) Component Round 1 (11 SRs) Round 2 (10 SRs) Round 4 (13 SRs) HIV/AIDS (R1: 11 SRs) (R2: 5 SRs) (R4: 9 SRs) CRC, YCC, MoND, MoSALVY, KHANA, MDM, DSF, SHCH, NCHADS, PSF, PSI SHCH, NCHADS, PSF, RHAC, FRC CARE, CPN +, DSF, MDM, NCHADS, NMCHC, NPH/WVI, PSF, SHCH Malaria (R2: 4 SRs) (R4: 4 SRs) n/a CNM, PFD, HU, PSI TB (R2: 1 SR) n/aCENATn/a

4. MERG Meeting Geneva - Cambodia GFATM M&E; October 20044 II. Roles & Responsibility of PR in Relation to M&E Prepare all plans, reports and requests to be sent to the GF including the preparation of quarterly progress reports (financial/implementation); Prepare all plans, reports and requests to be sent to the GF including the preparation of quarterly progress reports (financial/implementation); Assist SRs with their reports and/or M&E plans (as needed); Assist SRs with their reports and/or M&E plans (as needed); Organize PRTRT meetings to review plans/reports; Organize PRTRT meetings to review plans/reports; Monitor SRs program activities on quarterly basis and/or as frequent as needed during the course of implementation; Monitor SRs program activities on quarterly basis and/or as frequent as needed during the course of implementation; Participate in national efforts to strengthen national M&E processes/systems; Participate in national efforts to strengthen national M&E processes/systems; Facilitate the LFAs assessment process. Facilitate the LFAs assessment process.

5. MERG Meeting Geneva - Cambodia GFATM M&E; October 20045 III. PRs Key M&E Activities in 2004 : Jan 2004M&E Plans for Round 2 developed for 3 components: HIV/AIDS, Malaria, TB Feb 2004M&E training for SRs R1 & 2; Finalized the PRs M&E assessment reports; Field visits Mar 2004Field Monitoring Visits to R1 SRs April 2004Meeting with SRs and Quarterly Report preparation and hosted the Asia Regional Conference for GFATM May 2004 Revisions of the field monitoring approach; activity-specific checklists & issue-oriented reports;

6. MERG Meeting Geneva - Cambodia GFATM M&E; October 20046 III. PRs Key M&E Activities in 2004 (Cont...) : June 2004 Revisions of TB & Malaria M&E Plans; 2nd Quarter Field Monitoring visits to SRs (R1 & R2) July 2004Meeting with SRs and Quarterly Report preparation; Field visits; M&E presentation at AIDS Conference in BKK Aug 2004Finalized reports sent to the GF; Working draft of 2 nd Edition M&E Guidelines developed; Presentation to CCC Sub-Committee Sept 2004Round 4 M&E Orientation Meeting for SRs; Presentation to CCC Sub-Com.; 3 rd Quarter Field monitoring visits to SRs (R 1 & R2) Oct 2004Meeting with SRs and Quarterly Report preparation; Finalization of M&E Guidelines 2 nd. Edition; Finalization of M&E Plans for Year 2 of Round 1; Work on the M&E Plans for Round 4; M&E Presentation to 8 th. MERG Meeting in Geneva

7. MERG Meeting Geneva - Cambodia GFATM M&E; October 20047 IV. PRs M&E Guidelines : Developed with WHO TA ; largely adapted from and drawn upon other GF, UNAIDS & USAIDs documents, MoH M&E Framework, and other relevant documents at national levelDeveloped with WHO TA ; largely adapted from and drawn upon other GF, UNAIDS & USAIDs documents, MoH M&E Framework, and other relevant documents at national level 1.Introduce key M&E concepts and framework 2.Provide guidance for development of SRs M&E plans 3.Provide instructions on GF reporting forms and requirement 4.Introduce GFs performance-based disbursement concept

8. MERG Meeting Geneva - Cambodia GFATM M&E; October 20048 V. PRs M&E Plans 1. Developed with WHO TA & key stakeholders at national level engaged in an intensive participatory & consultative process 2. All M&E plans developed first by each SRs, next cumulative PRs (GF formats) first by each SRs, next cumulative PRs (GF formats) Indicators selected via consensus, ensuring consistency with the approved proposal and the MOH M&E framework Indicators selected via consensus, ensuring consistency with the approved proposal and the MOH M&E framework Existing data collection systems incorporated whenever possible Existing data collection systems incorporated whenever possible

9. MERG Meeting Geneva - Cambodia GFATM M&E; October 20049 VI. Quarterly Reports Sequence : Steps Specific Action Timeline (after Q end) 1 SRs submit Quarterly Rpt to PR 2 weeks 2 PR combines all SR reports into 1 PR report and sends to PRTRT members 4 weeks 3 PR convenes PRTRT meeting to review reports and provide feedback 5 weeks 4 PR submits finalized report to CCC 6 weeks 5 PR submits the report to LFA (KPMG) 45 days 6 KPMG reviews, drafts recommendation to GF and submits report to GF ??? 7 GF reviews, approves and grants next disbursement ???

10. MERG Meeting Geneva - Cambodia GFATM M&E; October 200410 VII. Issues and Challenges : 1. Complexity of GF structure in Cambodia Multiple players interdependent (SSRs, SRs, PR, CCC, LFA, GF) Multiple players interdependent (SSRs, SRs, PR, CCC, LFA, GF) Communication delays: multiple responses/approvals pending – unclear timelines – information sharing internally and read? Communication delays: multiple responses/approvals pending – unclear timelines – information sharing internally and read? 2. Lack of transparency in assessment procedures and lack of clear expectation Role & capacity of LFA in M&E unclear Role & capacity of LFA in M&E unclear 3. Limited M&E experience among some SRs Delays in submitting final reports Delays in submitting final reports Non-compliance of few SRS will penalize all Non-compliance of few SRS will penalize all Extensive assistance from PR required Extensive assistance from PR required

11. MERG Meeting Geneva - Cambodia GFATM M&E; October 200411 VII. Issues and Challenges (Cont...) : 4. Requirement of M&E Plans and Reports based on the GF formats sometimes makes PRs responsibility to provide rigorous monitoring of program implementation rather challenging due to lack of direct linkage between indicators and activities 5. Quarterly Report with 45 days submission requirement light reporting vs. more burden to the PR and even more difficult for some SR such as national program 6. Confusion of cumulative versus actual number in reporting requirement for process indicators 7. Monitoring visits by the PR to SRs difficult to organize due to frequent changes by some SRSdifficult to organize due to frequent changes by some SRS

12. MERG Meeting Geneva - Cambodia GFATM M&E; October 200412 VII. Issues and Challenges (cont…): 8. Issue of additionally raised by the CCC-Sub-Committee difficult to identify by PRdifficult to identify by PR 9. Issue of Partnership versus Ownership in implementing the GFATM Program at country level How to apply this in the reality at the grass-root level when implementing itHow to apply this in the reality at the grass-root level when implementing it 10. Adjustment of actual implementation with original proposal Unclear – how to do?Unclear – how to do? 11. Criticism about creating parallel M&E system just for the GF reporting purposes: cannot find 1 system covering all needed information to be reported to the GF?

13. MERG Meeting Geneva - Cambodia GFATM M&E; October 200413 VII. Issues and Challenges (cont…): 12. Evolving of M&E New Formats by the GF Need for adjustment in the middle way of implementation and time consuming in doing so (especially very difficult for the large number of SRs) Need for adjustment in the middle way of implementation and time consuming in doing so (especially very difficult for the large number of SRs) 13. Delays in the approval of Procurement Plan Significant adverse effect on program involving ARV drugs and anti-malarial drugsSignificant adverse effect on program involving ARV drugs and anti-malarial drugs

14. MERG Meeting Geneva - Cambodia GFATM M&E; October 200414 VIII. Recommendations : GF to speed up the approval process GF to speed up the approval process LFA to communicate and discuss with PR before sending recommendations to GF LFA to communicate and discuss with PR before sending recommendations to GF GF to reconsider the frequency of reporting from quarterly to semi-annually GF to reconsider the frequency of reporting from quarterly to semi-annually GF to reconsider the deadline of 45 days for report submission (may be from 45 days to 60 days?) GF to reconsider the deadline of 45 days for report submission (may be from 45 days to 60 days?) GF to provide clear guidance on proposal adjustments based on actual needs GF to provide clear guidance on proposal adjustments based on actual needs GF to inform the PR with clear guidance and timeline if there is any change or need to use the new formats GF to inform the PR with clear guidance and timeline if there is any change or need to use the new formats

15. MERG Meeting Geneva - Cambodia GFATM M&E; October 200415 VIII. Recommendations (Cont...) : How to MONITORING THE ADDITIONALITY OF GFS FUNDS ? How to MONITORING THE ADDITIONALITY OF GFS FUNDS ? Multiple SRs (especially large ones) receive funding from multiple sources and report results as a joint effort ; It is difficult to ensure and demonstrate the additionally of GF funds in such cases OPTION 1: OPTION 1: Request that results are reported as GF-exclusive; that would require setting a separate reporting system (contrary to GF guidance) OPTION 2: OPTION 2: Request that SRs program GF funding in a distinct manner, either by specific results, or geographically from THE ONSET OF THE PROGRAM CLEAR GUIDANCE FROM GFATM-HQ NEEDED !!! CLEAR GUIDANCE FROM GFATM-HQ NEEDED !!!

16. MERG Meeting Geneva - Cambodia GFATM M&E; October 200416 IX. Recent M&E Accomplishments : 1.Strengthening monitoring visits Developed and implemented 8 activity-specific (1 page) M&E tools Feedback at the filed and to SRs Using information from reports and filed visits to provide special intervention/support to weaker and/or link those with stronger SRs for improvement (feedback loop) 2.Revised M&E Guidelines 2 nd. Edition Incorporated lesson learned and adapted with M&E Guidelines issued by GF (M&E Tool Kit of June 2004) Included all 3 diseases Introduced PRs new QA M&E Tools Added Annual Workplan to promote more effective program monitoring

17. MERG Meeting Geneva - Cambodia GFATM M&E; October 200417 IX. Recent M&E Accomplishments (Cont...) : 3.Reorganized Regular Quarterly Meeting with SRs Group them by program sub-component that provided a chance for SR of Round 1 and Round 2 to interact and to share experiences 4.Requested for Changing Reporting Sequence Change from quarterly to semi-annually (on going process) Maintain regular quarterly reporting with SRs Extension of Annual Report for Round 1 (through December 2004)

18. MERG Meeting Geneva - Cambodia GFATM M&E; October 200418 Thank You!