Review Rationale & Context for
MER: Programmatic Shifts
Amy Gottlieb, PhD, MPH
OVC M&E Meeting
February 19 – 20, 2014
PEPFAR Support – A View of the First 10 Years
PEPFAR after 10 years, two phases
• Emergency to sustainability
• Increased collaboration with multilateral partners
• Emphasizing contribution to national programs, alignment with national
strategies, evidence based for national epidemics
• Continued emphasis on results and efficiencies
Phase I (FY04-FY08) driven by 2-7-10
• PEPFAR processes routinized and country teams formed
• Reported on: Direct, Indirect, and Total
• With many revisions in first five years
• (e.g. Reduced burden of reporting)
Phase II (FY09-FY13) driven by 3/6-12-12
• Reported on: Direct and National
• Limited attention to policy, quality, capacity (lab), HSS (HRH)
• Implementation in context of Partnership Frameworks with multilaterals, in
support of national program
Phase III (FY14-FY18) seeks to evolve how we describe PEPFAR support
• Reporting on: Direct Service Delivery & Technical Assistance
• Improved M&E of capacity, quality, country ownership, impact
• Implementing in context of Country Health Partnerships to advance results and
country ownership, in close collaboration with multilaterals
2
PEPFAR MER Introduction 2013_11_21
Background of Phase III
• As part of the MER, an interagency task team was
established to review the definition of ‘direct’ and
provide guidance for FY14-18.
• The task team proposed that PEPFAR should adhere
to the historical intent of ‘direct’ while refining and
clarifying its definition.
• Field and TWGs provided input on revised definition.
Definition was further clarified in response to their
feedback.
3
Why Revise the Definition of “Direct”
• To date, PEPFAR has counted individuals as ‘directly supported
by PEPFAR’ using broad criteria, largely left to program areas
and country teams to define.
• As PEPFAR support evolves, we need a more rigorous and
standardized definition of ‘direct support’.
• As country capacity increases, PEPFAR support evolves in
response, and PEPFAR results will change.
• This revised definition acknowledges that not all PEPFAR
efforts will count as ‘directly supported’.
• This change is appropriate because it more accurately
characterizes the nature of our support.
4
Defining “Direct Support” – Before and After
Previous
Updated
• ‘Direct support’ is interpreted
broadly
• Definition is clarified
• Refers largely to individuals
• Few alternative indicators to
document TA/capacity building to
sites, organizations, communities,
and health systems at various level.
• New MER indicators allow focus on
TA/capacity building and application
of definition now allows teams to
report these areas as ‘directly
supported’ by PEPFAR
• PEPFAR reporting helps ensure
accountability at the agency level
(i.e. help agencies manage
implementing partner contracts &
aggregate results at country level)
• Same
• Allows PEPFAR to report to internal
stakeholders (OMB, Congress, etc)
on program progress
• Within the context of national
results; retain ability to speak to
program achievements
4
Revised Definition of PEPFAR Support
More accurately describes PEPFAR’s evolving
contributions in alignment with national HIV strategies
and programs:
• Refined definition of direct service delivery (DSD)
support to individuals
• Introduce definition of technical assistance (TA)
support to sites and above sites
•
What is a ‘site’? ‘Site’ is a proxy for ‘points of service delivery’ and refers to health
facilities, labs, communities, CBOs, school wards, and other such entities.
•
Above ‘site’ level includes support to districts, regions, and national government
offices that is above the level of service delivery.
6
Revised Definition of PEPFAR Support
Individual Level
Individuals receiving HIV related services will be counted as
receiving direct support for service delivery (DSD) from
PEPFAR when the support:
1) is critical* to the delivery of the service to the counted
individuals;
AND
2) involves established presence at and/or routinized,
frequent (at least quarterly) support to those services to
those individuals at the point of service delivery.
Both conditions must be met in order to count individuals as
directly supported by PEPFAR.
* “Critical support” is defined on an indicator by indicator basis
7
Examples of Critical Support & Established Presence
(TA Support) by Indicator
Indicator:
Number of HIV-infected adults and
children receiving ART
Number of key populations
reached with individual and/or
small group level HIV preventive
interventions that are based on
evidence and/or meet the
minimum standards required
Critical Support:
Commodities, human resource salary
support. For ART this can include
ongoing provision of critical re-occurring
costs or commodities (such as ARVs) or
funding of salaries or provision of Health
Care Workers for ART clinic services.
For example, procurement of
condoms, salary of personnel
providing any of these services
(i.e. outreach workers, program
manager), or program design i.e.
the development of training
curricula, prevention guidance
development, or standard
operating procedures (SOPs), &
follow-up to ensure fidelity to the
program design)
TA - Established presence,
routinized frequent (at
least quarterly) support:
For example, clinical mentoring and
supportive supervision of staff at ART
sites, Quality Improvement services
support, patient tracking system
support, routine support of ART M&E
and reporting, commodities
consumption forecasting and supply
management
Such as mentoring/supportive
supervision; training;
organizational strengthening;
QA/QI; regular assistance with
M&E functions and DQAs; or
condom forecasting and supply
management
7
8
Revised Definition of PEPFAR Support
“Site” Level
Distinguished as DSD or TA-only
Sites, facilities, labs, organizations, communities, schools, etc.
can be counted as receiving PEPFAR direct service delivery
(DSD) support when:
• individuals served at that ‘site’ are receiving support as
defined on the previous slide.
Sites, facilities, labs, organizations, communities, schools, etc.
can be counted as receiving PEPFAR technical assistance (TA)only support when PEPFAR is:
• providing recurrent (at least quarterly) technical support
to improve the functioning or capacity of that entity
8
Revised Definition of PEPFAR Support
Above “Site” Level
Districts, regional, and national governments or organizations
above the service delivery level can be counted as receiving
PEPFAR technical assistance (TA) support when PEPFAR is:
• providing recurrent (at least quarterly) technical support to
improve the functioning or capacity of that entity.
9
Applying Revised Definitions Through
Portfolio Review
Review Partner Agreements
Re-Classify Partner Support
By Program Area, By Facility
DSD
TA
Neither
Re-Allocate FY14 Targets and Results
to DSD, TA, Neither
10
Site
Individuals
Type of Partner Support Influences Reporting
Requirements
Partners providing DSD support to sites will report
individual level counts for all applicable indicators
Partners providing TA only support to sites will report
individual level counts only for selected indicators
(determined by our legislative reporting requirements)
Partners providing DSD or TA only support will both report
on site level quality indicators (when applicable)
• Mostly likely scenario: partner provides same type of support within a
given program area. However, we need to create room for exceptions.
• For example, within the same program some partners may provide DSD to
some sites, TA only to other sites. Again, this is about classifying the type
of support provided to the site.
12
What does this mean for our numbers?
They will change
2,500,000
2,000,000
1,500,000
1,000,000
500,000
NATIONAL
NGI Direct
MER DSD
Some of distance
between green and red
will be explained by TAonly support
0
13
Here’s the “How to”:
Applying MER definitions in
COP14
(Practical examples are in the next slides…)
14
Example: Applying MER Definitions to a
Prevention (Key Pop) Support Partner
In FY14, will the partner report on P8.3.D Number of key populations reached with individual
and/or small group level HIV preventive interventions that are based on evidence and/or
meet the minimum standards required using NGI definition of Direct?
yes
In FY14, does the partner provide support ‘critical’
(i.e. procurement of condoms, salary of personnel providing any of these services (i.e. outreach workers,
program manager), or program design i.e. the development of training curricula, prevention guidance
development, or standard operating procedures (SOPs), & follow-up to ensure fidelity to the program design)
no
to the delivery of Key Pop interventions to individuals where
services are delivered ?
yes
no
In FY14, does the partner provide recurrent (at least
quarterly) technical support to the service delivery
org/ site to improve functioning/capacity in key pop
interventions (such as mentoring/supportive supervision; training;
organizational strengthening; QA/QI; regular assistance with M&E
functions and DQAs; or condom forecasting and supply management)?
yes
no
DSD
Neither
In FY14, does the partner provide recurrent (at least
quarterly) technical support to the service delivery
org/ site to improve functioning/capacity in key pop
interventions (such as mentoring/supportive supervision; training;
organizational strengthening; QA/QI; regular assistance with M&E
functions and DQAs; or condom forecasting and supply management)?
yes
TA
DETERMINE REPORTING REQUIREMENTS
*If not previously NGI – not critical, no recurrent tech support, continue not to report
no
Neither*
15
Revised PEPFAR REPORTING
TIMELINE
Oct/Nov/Dec
• Q1FY14
Jan/Feb/March
April/May/June
July/Aug/Sept
• Introduction of MER
& TA Indicators
Oct/Nov/Dec
• Q2
Jan/Feb/Marc
h
• Q3
April/May/Jun
e
• Q4
July/Aug/Sept
• Q1 FY15
Thank you!
Questions, Comments?
17