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2017-2022 Corporate KPI Framework: Initial proposal for Board Constituency review

22 th Jan 2016 Doc No.: KPI/bc02

2017-2022 Corporate KPI Framework: Initial proposal for Board Constituency review 22 t h Jan 2016 Doc

Developing the 2017-2022 Corporate KPI Framework

1
1

Status of framework development

2
2

Context & guiding principles for framework revision

3
3

Framework overview

4
4

Indicator proposals

Annex

1
1

Status update of framework development

Overview

The KPI Framework for the new strategy has been in development with technical and operational teams

since April 2015 with brief updates provided to SIIC over this period

The 2017-2022 Strategic Framework was approved by the Board at its 34 th meeting in November 2015 providing the firm basis on which this first draft KPI framework has been designed

Five MEC & Steering Committee meetings since the autumn provided strong guidance on Gender, RSSH, Key populations, Human Rights, Domestic investments indicator development

Technical partners have been engaged in reviewing the technical soundness of indicator proposals

Preliminary feedback from the OIG audit of the current KPI framework has showed good level of acceptance of framework design

Next Steps

This document and the accompanying narrative sets out the preliminary first draft of the proposed framework for Board constituency input

Written feedback is requested from constituencies which will then be reviewed and summarized by the Secretariat (see accompanying form)

Consultation meetings with constituencies will be held to resolve differing viewpoints on major issues

This input will be integrated into the second draft of the proposals for review by the Board Committees 8/9 th March 2016

After Board approval of Corporate KPI framework, Secretariat will fully develop the framework of cascaded Operational KPIs

1
1

Developing the 2017-2022 Corporate KPI Framework Proposals are being developed with significant input from internal and external stakeholders

1 2 3 4 5 Committee Technical Constituency Consultation Review & update development review meetings
1
2
3
4
5
Committee
Technical
Constituency
Consultation
Review &
update
development
review
meetings
approval

June Oct 2015

April 2015 - ongoing

High level framework design

All proposals developed in partnership with

shared with June

technical teams (60+

SIIC

staff involved)

Example KPI development

No presentations

Ongoing consultation with technical partners

thinking shared with

Five MEC & Steering

October SIIC

Committee meetings over autumn provided

yet made to FOPC

strong guidance on:

(or AEC)

Gender

RSSH

Key populations

Human Rights

Domestic

investments

Jan Feb 2016

One-on-one meetings with constituency groups

Implementer group

meeting (date TBC)

Civil society meetings Jan 19 th & Feb 11 th

Donor group meeting (date TBC)

March 8 th 9 th

Review of second draft of framework incorporating

constituency feedback by

Board Committees

April

Final revisions will be incorporated into submission

to Board for approval

May - November

Final methodological development, baseline & target setting for Board approval

Full development of

cascaded Operational KPIs

development, baseline & target setting for Board approval • Full development of cascaded Operational KPIs 3

3

2
2

New framework design draws from best practice structures and guiding principles

 

Best practice from comparable organizations

 

Performance management framework includes

Leveling

multiple levels of KPIs targeted to different audiences: global trends, contributive and attributive indicators, as well as operational monitoring and management data

indicators

Thematic

Tracking and reporting on strategic themes are consistently provided to fill information gaps at goal-level tracking

reporting

Variance

Clear concise analysis is required to link and contextualize results and enable target

analysis

audiences to better understand and use

performance information for strategic decision making

Lesson learned

Strategic and activity-level KPIs will track Global

Fund’s contribution to mission, while additional monitoring from operational KPIs and management information will provide deeper analysis, in particular on levers for action

Corporate indicators will be directly underpinned by operational KPIs, consistent management

information, and thematic reporting for each strategic

objective

Increased clarity will be provided on the levers for management action available, accountability for action and how information across and between the different levels links together

2
2

Hierarchy of performance management framework

2 Hierarchy of performance management framework Current focus A few, measurable, results- oriented KPIs covering the

Current focus

A few, measurable, results-oriented KPIs covering the life of the Strategy…

Corporate

level

Secretariat

level

Strategic KPIs
Strategic KPIs

KPIs focused on global targets & impact

Activity specific KPIs 2022 2017
Activity specific KPIs
2022
2017

KPIs to enable Board/

Committee oversight for

governance on key activities

for strategy goals

More granular measures

measuring management

performance at entity levels of the Global Fund

 Operational KPIs
Operational KPIs
2
2

Principles guiding revision of the framework have been updated

Principles used to guide development of the 2014-2016 KPI Framework

Align the framework with the 2012-2016 Strategy

Set the Framework for the lifetime of the Strategy

Define a clear hierarchy with logical links between the levels

Reduce the number of KPIs and increase focus

Complement the KPI framework with a regular Quarterly Dashboard of other specific indicators

Ensure indicators are visible and measurable

Additional principles

Activity specific KPIs should measure the overall effect of the Strategic Objectives and not the specific effect of each sub- objective

Indicators should be measured on a meaningful number of countries

Accountability should be clear and interpretation defined

accordingly

2 Secretariat-level information will complement Corporate level KPIs Corporate  KPIs focused on global targets
2
Secretariat-level information will complement Corporate level KPIs
Corporate
 KPIs focused on global targets &
impact
level –
Strategic KPIs
2022
current
2017
focus
Activity specific KPIs
 KPIs to enable Board/ Committee
oversight for governance on key
activities for strategy goals
2017
 More granular measures measuring
Secretariat
level –
to be fully
developed
once the
corporate
Operational KPIs
management performance at entity
levels of the Global Fund
 Example Operational KPIs provided
in this document for illustration
level KPI
framework is
Thematic Reporting &
Management Information
approved
Routine tracking at management level should
provide underpinning analysis. Important
gaps currently exist here, and the proposed
performance management framework will fill
these gaps, notably on programmatic
investments, activities, results and impact
3
3

Proposed change to the current framework

4

4

6

2

3 Proposed change to the current framework 4 4 6 2 Retain Revise Delegate to operational

3 Proposed change to the current framework 4 4 6 2 Retain Revise Delegate to operational

3 Proposed change to the current framework 4 4 6 2 Retain Revise Delegate to operational

3 Proposed change to the current framework 4 4 6 2 Retain Revise Delegate to operational

Retain Revise Delegate to operational Drop

   

Strategic goals

 

Strategic targets

 

Strategic KPIs

 
1
1

Performance against strategic goals

 
2
2

Quality and coverage of services

3
3

Performance against strategic service delivery targets

   

Invest more

Evolve the

Actively support grant implementation success

Promote and

 

Sustain the

Strategic enablers

Strategic

strategically

funding model

protect human

gains, mobilize

Implementing operational excellence

Objectives

rights

resources

   

Enhance partnerships

 
4
4

Efficiency of

7

Access to

9
9

Effective

 

12

Human rights

13
13

Resource

15
15

Efficiency of grant

Global Fund

 

funding

operational risk

 

protection

mobilization

management

investment

 

management

   

operations

decisions

   
5
5

Health system

8

New Funding

10
10

Value for money

 

14

Domestic financing for AIDS, TB & Malaria

16

Quality of management and leadership

Activity specific

strengthening

Model

   

KPIs

 

transition

6
6

Alignment

 
11
11

Grant expenses

     
       
 

with national

reporting

forecast

 

Transition out

more operational measures and

 

replace with fewer, but more strategic measures

systems

4 Retained 3 4 Revised Initial view on the 2017-2022 framework 4 Addition Strategic targets
4
Retained
3
4
Revised
Initial view on the 2017-2022 framework
4
Addition
Strategic targets
Strategic KPIs
1
Performance against impact targets
2 Performance against service delivery targets
Maximize Impact Against
HIV, TB and malaria
Build resilient & sustainable
systems for health
Promote and protect human
rights & gender equality
Mobilize increased resources
Strategic
Objectives
Strategic vision
Invest funds to maximize
portfolio impact
Improve the performance of
strategically important
components of national systems
for health
Reduce human rights
barriers to service access; &
Reduce gender and age
disparities in health
Increase available resources for
HIV, TB & Malaria; &
Ensure availability of affordable
quality-assured health technologies
3
Alignment of
investment & need
6
Strengthen systems for
health
8
Gender & age
equality
10
Resource mobilization
Activity specific
Investment efficiency
7
Fund utilization
9
Human rights
11
Domestic investments
KPIs
Service coverage for
12
key populations
Availability of affordable
health technologies
3
3

The guiding principles were used to examine the proposed indicators

Dimensions

Definition

Accountability

Contribution: Global Fund is one actor among many contributing to results achieved Attribution: Global Fund can largely attribute results to its actions

Data availability

Data may currently be available in an existing system; collected in a structured manner (but not available in an existing system); or not yet available at Secretariat

level and/or country level

Actionable & reliable results

Results are replicable, reliable and guide Global Fund decision-making

Coverage

What segment of countries, donors, etc., is represented in result

Projections available

Is it possible to forecast this KPI’s results, thus enabling the Secretariat to take action

to mitigate potential future underperformance

Frequency of reporting

Given the frequency of data collection, or the size cohort sampled, how often will meaningful KPI results be produced? (eg. Annually, quarterly)

A summary by indicator is provided on the next page

Data Actionable & Projections Frequency 3 KPI Proposals Accountability Coverage availability reliable results
Data
Actionable &
Projections
Frequency
3
KPI Proposals
Accountability
Coverage
availability
reliable results
available
of reporting
1
Performance against impact targets
Contribution
Structured
Full portfolio
Annually
2
Performance against service delivery
targets
Semi
Contribution
System
Full portfolio
annually
3
Alignment of investment with need
Attribution
System
Full portfolio
Quarterly
Semi
4
Investment efficiency
Contribution
Structured
Portfolio segment
annually
Not yet
5
Key population service coverage
Contribution
Portfolio segment
?
Annually
available
6
Resilient & sustainable systems for
health
Not yet
Mix
Portfolio segment
Annually
available
7
Fund utilization
Mix
System
Mix
Mix
Quarterly
8
Gender & age equality
Contribution
Structured
Portfolio segment
?
Annually
Not yet
9
Human rights
Mix
Portfolio segment
Mix
Annually
available
10
Resource mobilization
Contribution
System
Full portfolio
 Quarterly
11
Domestic investment
Contribution
Structured
Full portfolio
 Annually
12
Availability of affordable health
technologies
Mix
Structured
Mix
Mix
Annually
11

Key issues and Secretariat’s proposed approach

Accountability

Data

Challenges

Time lag to ascertain measurable effect

Challenge

Most corporate indicators report on a contribution basis. Because many are outcome/impact measures, Global Fund is one of many actors and

cannot be held solely accountable for results

Many indicators will require significant development of data collection systems/processes, only some of which will be covered by Project AIM.

For some indicators, there will be important time

lags before expected scale up effects will be visible

on the ground

e.g. 5 th Replenishment starts 2017; first new grants signed end-2017; first data from new grants available mid-2018; 6 th replenishment 2019

Proposed approach

Framing of accountability and available levers for action should be made clear. Operational indicators and management information will be more attributable to the Global Fund. Initial thinking on potential more

attributable operational KPIs for each Strategic

Objective are outlined in this document for information

Retain the ambition of what we aim to achieve, and invest in data systems where feasible; operational progress towards longer term achievements should be reported until data is available to measure proposed KPI

Acknowledge that for outcome/impact indicators, a time lag to measurable effect will always exist.

Accurate projections of expected future performance and KPI target setting should reflect expected lag

4
4

Indicator proposals by Strategic Objective

Each Strategic Objective section includes:

Outline of Strategic Objective

Proposed Corporate KPIs for discussion and input

Analysis of each proposal (data availability, accountability, etc.)

Examples of potential Operational KPIs as illustration of tracking information that is more attributable to the Global Fund’s management and operations

4
4

Investing to End Epidemics: Strategic Targets 2017-2022

Strategic targets Impact Under development with partners targets Global Fund Global Plans leading targets
Strategic targets
Impact
Under development with partners
targets
Global Fund
Global Plans
leading targets
Indicators for other
selected services
Rapidly reduce HIV mortality and incidence
HIV /
through scaling up universal access to HIV
AIDS
prevention and treatment in line with the
UNAIDS Fast Track and WHO Global Strategy
Rapidly reduce TB, TB-HIV and MDR-TB
TB
incidence and related mortality through
universal access to high quality care and
prevention in line with the End TB Strategy and
Global Plan to End TB
Under development with partners
Scale up and maintain interventions to reduce
Malaria
Malaria transmission and deaths and support
countries to eliminate Malaria, in line with the
Global Technical Strategy and AIM
delivery targetsService
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 1

Performance against impact targets

Strategic Vision

Measure

Invest funds to maximize portfolio impact

a)

Estimated number of lives saved or reduction in deaths

b)

Reduction in new infections/cases

Aim of indicator

Measures the extent to which Strategic Objectives are achieving high level goals of lives saved (or reduction of deaths) and reduction of new infection/cases.

Given limitations inherent in modeling methodology, data timeliness, and projection reliability, this indicator provides a high level view on overall progress. However, coupled with KPI 4, cascading these targets down to regional/country level will increase accountability and help to “close the loop”.

The measure should be interpreted with these limitations in mind or reported separately as a high level tracking measure rather than a KPI.

Limitations & mitigation actions

Estimates produced by WHO/UNAIDS use standardized models and country-specific data with variable quality and availability. Country-level impact modelling is being undertaken for select countries

Decision required on whether impact measures should be

expressed in terms of lives saved or reduction in deaths. Numerical targets will be aligned with the investment case modelling which has been developed with partners

Data is available with a one-year lag, and is sensitive to changes to the modelling methodology and changes to

historical data

available with a one-year lag, and is sensitive to changes to the modelling methodology and changes

15

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

KPI 1

Performance against impact targets

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Structured

Data is sourced externally. Global Fund contribution to overall impact is estimated in-house

   

Indicator works as more of a high level tracker. Target setting will be

Actionable & reliable results

informed by the replenishment result and allocation model assumptions. Disaggregation of targets to region/country levels will inform analysis of performance along with results for KPIs 2, 3, 4 & 7.

Coverage

Full portfolio

 
   

Sophistication of the projection methodology is being improved. Targets will

Projection available

require periodic recalibration to take into account changes to modelling methodology and historical data

Frequency of reporting

Annually

Data is reported with a one-year lag due to partner data collection schedules

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 2

Performance against service delivery targets

Strategic Vision

Measure

Invest funds to maximize portfolio impact

a) # of people alive on ARV therapy

b) # of TB cases treated according WHO end TB strategy

c) # of LLINs distributed

d) # of bacteriologically confirmed drug resistant TB treated with a 2 nd line regimen

e) # males circumcised

f) # of IRS services delivered

g) # of people who received HIV testing & counseling and know their results

Aim of indicator

Measures extent to which the Strategic Objectives are achieving the high level service delivery targets.

Services tracked as part of the measure will be reviewed with technical partners to ensure alignment.

As projection methodology is strengthened and results forecast is institutionalized, the indicator will drive portfolio performance management in conjunction with ITP project.

Limitations & mitigation actions

Validity: Global Fund share of national results will be based on a contribution model

Availability: Data reported with a 6 month lag

Reliability: Country- and secretariat-level data/system limitations

Work with partners to ensure consistent application of reporting guidance (eg. Reporting of full national results)

Accurate projections will be key: An operational KPI tracking forecast accuracy will embed results forecast into Secretariat decisions

Data Management for Impact initiative & Project AIM will improve

data and systems for reporting internally and at country level

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

KPI 2

Performance against service delivery targets

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

It is proposed that all grants will report national results, however, the Global Fund share of national results will be determined based on a contributive model

Data availability

System

 
   

Target setting will be informed by the replenishment result and allocation model

Actionable & reliable results

assumptions. KPI performance is affected by expected levels of service delivery being signed into grants and intervention level grant performance.

Coverage

Full portfolio

Countries representing 90% of investment will report semi annually with annual

reports from whole portfolio. Projections could fill gaps for semi-annual reporting

Projection available

 

Frequency of

Semi

Data is reported with a six-month lag

reporting

annual

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Op-KPI

Strategic targets

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Examples of more attributable Operational KPIs that aim to monitor whether:

Strategic level service delivery targets are built into grant agreements

Programs are able to deliver the expected levels of service

Programs are able to expend the funds budgeted for service delivery

Examples of potential Operational KPIs

Percentage of expected service delivery targets:

i. Built into concept note submissions;

ii. Signed into grant agreements

Percentage of program level service delivery targets achieved

Intervention level absorptive capacity (grant expenditure / grant agreement budget)

Aim

Portfolio level targets of KPI 2 will be aggregated from estimates of country level service delivery. The first step in ensuring these targets will be achieved will be to ensure that expected service delivery is built into concept notes and grant agreements

This will enable service delivery performance to be disaggregated and more effectively tracked at the regional & country level

An early warning of potential underperformance on service delivery

will be underspending in grants at the intervention budget level

4
4

Investing to End Epidemics strategic objectives

Maximize Impact Against HIV, TB and malaria Build Resilient & Sustainable Promote and Protect Human
Maximize Impact
Against HIV, TB
and malaria
Build Resilient
& Sustainable
Promote and
Protect Human
Systems for
Rights & Gender
Health
Equality
Mobilize
Increased
Resources

1. Maximize Impact Against HIV, TB and malaria

Innovative approaches to meet diverse country needs are essential to accelerate the end of the epidemics

a)

Scale-up evidence-based interventions with a focus on the highest burden countries with the lowest economic capacity and on key and

vulnerable populations disproportionately affected by the three diseases

b)

Evolve the allocation model and processes for greater impact, including innovative approaches differentiated to country needs

c)

Support grant implementation success based on impact, effectiveness, risk analysis and value-for-money

d)

Improve effectiveness in challenging operating environments through innovation, increased flexibility and partnerships

e)

Support sustainable responses for epidemic control and successful transitions

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 3

Alignment of investment with need

Strategic Vision

Further improve alignment of investments with

country “need”

Measure

Alignment between investment decisions and country "need"; with

need defined in terms of disease burden and ability to pay

Aim of indicator

The measure tracks the extent to which the Global Fund is able to rebalance the grant portfolio to effectively invest funds in the countries where need is greatest.

The current replenishment period has seen a major

improvement in rebalancing, providing a solid basis for further improvements going forward.

Performance is driven by the design of the allocation model and the ability of countries, particularly those with high burden and low economic capacity, to use allocated funds.

Limitations & mitigation actions

Accuracy of target setting will be determined by the Mid-Tem Plan three year financial forecast

Country “need” is determined by the allocation model. The feasibility

of revising the disease burden metric of the model is being assessed

GNI has limitations as a measure of ability to pay in the health and development context relevant outcomes of the Equitable Access Initiative may be considered by the SIIC as it reviews the allocation methodology, specifically with respect to economic capacity

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

KPI 3

Alignment of investment with need

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Attribution

 

Data availability

System

 
   

Illustrates extent to which grant expenses are committed to countries with most

Actionable & reliable results

need, and not necessarily those with best absorption. Provides a control for KPI7

Fund utilization

Coverage

Full portfolio

 

Projection available

Based on Mid-Term Plan commitments forecast

Frequency of reporting

Quarterly

 
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 4

Investment efficiency

Strategic Vision

Increase the efficiency of program design to

maximize impact of fund investments

Measure

Improvement in cost per life saved or infection averted from

supported programs

Aim of indicator

Increased use of disease impact models to improve the

design of country-level programming will increase value

for money of grant investments this indicator will track the these gains

The indicator will “close of the loop” by linking grant level programmatic targets and investments with strategic targets which will be set using partner supported disease impact models

The indicator provides a strong link to the objective on strengthening national strategic plans, and provides an opportunity to link this modelling effort to cost-effective service modalities (e.g. community based care models) and the work on program level quality

Limitations & mitigation actions

Limited partner capacity currently available to support country

level modelling

A new regional approach to providing country support is being implemented through the Value for Money Special Initiative

Costing data needs to be improved for this exercise to become effective

A ‘Cost consortium’ partnership with the Gates foundation has

recently started with aims to address these gaps

 A ‘Cost consortium’ partnership with the Gates foundation has recently started with aims to address

23

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

KPI 4

Investment efficiency

Indicator dimensions

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

Focus is on the national strategic plan, not Global Fund specific

Data availability

Structured

Building disease modeling into grant processes will increase data availability

Actionable & reliable results

Close country engagement during modelling process will increase scope for taking action

 

Portfolio

Initial focus on high impact portfolios, but there is also a demand for modelling in UMICs

Coverage

segment

Projection available

The KPI result is already a projection

 

Semi

Countries will mostly use disease models during Concept Note and/or NSP development there may be one data point every 3 years per country assessed

Frequency of reporting

annually

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 5

Service coverage for key populations

Strategic Vision

Measure

Reduce the number of new infections in key and

vulnerable populations disproportionately affected

by the three diseases

Aim of indicator

Indicator will track provision of comprehensive HIV

prevention services to specified key population groups

These groups face the double burden of low coverage of prevention services and high rates of infection. Increased coverage of preventions services will be essential to accelerate the end of the epidemic

Indicator builds on work undertaken during the current

strategy to measure the size of key populations in 55 countries

Proposal has close links to the strategic objectives in SO3 on removing barriers to accessing services, SO2 on data systems

Coverage of comprehensive prevention services in key populations

Limitations & mitigation actions

Considerable data limitations: Advice from technical partners

indicates that data on new infections is not readily available or

may lack in sufficient quality to use to track HIV incidence in key populations, and treatment provision to key populations is not tracked

Technical partners suggest to track service coverage for these population groups

A number of issues are currently being addressed: methodology

of coverage measurement; how to bridge data gaps between surveys; potential risk of harm to these populations and minimization of that risk; country coverage

Indicator focuses on HIV only

New Global Plan for TB has a focus on key populations, but work

remains at an early stage of development

25

HIV only  New Global Plan for TB has a focus on key populations, but work
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

KPI 5

Service coverage for key populations

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Not yet

No routine data collection exists at country level either through surveys or

available

programmatic monitoring

Actionable & reliable

 

results

 

Portfolio

Countries will be selected from the 55 expected to have key population size estimates by the end of 2016 (HIV only)

Coverage

segment

   

If baseline coverage data available, projections may be possible based on

Projection available

?

availability of service delivery targets in Performance Frameworks focusing on key population interventions

Frequency of reporting

Annually

Each reporting period will include few new data points as countries may only conduct surveys every 2-3 years

Each reporting period will include few new data points as countries may only conduct surveys every

26

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Maximize impact against HIV, TB & malaria

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Examples of more attributable Operational KPIs that aim to monitor whether:

Disease impact modelling is being used to inform national program design

Programs are adequately investing in and delivering services targeting key populations to maximize impact against the three diseases

Examples of potential Operational KPIs

Percentage of prioritized countries where country level modelling has been employed to maximize the impact of program design

Percentage of prioritized countries with a comprehensive package of interventions for key populations built into

program design

Aim

Country disease impact modelling, with full engagement of country level actors, will ensure that program design is informed by the best available evidence

Tracks roll out of key population programming across the portfolio

Percentage of program level key population service delivery targets achieved.

Absorptive capacity for key populations interventions and population groups

(grant expenditure / grant agreement budget)

This will enable service delivery performance to be disaggregated and more effectively tracked at the regional & country level

An early warning of potential underperformance on intervention coverage for key populations will be underspending in grants on these services

underperformance on intervention coverage for key populations will be underspending in grants on these services 27

27

4
4

Investing to End Epidemics strategic objectives

Maximize Impact Against HIV, TB and malaria Build Resilient & Sustainable Promote and Protect Human
Maximize Impact
Against HIV, TB
and malaria
Build Resilient
& Sustainable
Promote and
Protect Human
Systems for
Health
Rights & Gender
Equality
Mobilize
Increased
Resources

2.

Strengthening systems for health is critical to attain universal health coverage and to accelerate the end of the epidemics

Build Resilient and Sustainable Systems for Health

a)

Strengthen community responses and systems

b)

Support reproductive, women’s, children’s, and adolescent health, and platforms for integrated service delivery

c)

Strengthen global and in-country procurement and supply chain systems

d)

Leverage critical investments in human resources for health

e)

Strengthen data systems for health and countries’ capacities for analysis and use

f)

Strengthen and align to robust national health strategies and national disease-specific strategic plans

g)

Strengthen financial management and oversight

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 6

Strengthen systems for health

Strategic Vision

Measure

Increase the share of countries with resilient and

Share of the portfolio that meet expected standards for:

sustainable national systems for health that meet

a)

Procurement and supply chain systems

standards for use by Global Fund programs

b)

Financial management systems

c)

Data systems and analytical capacity

Aim of indicator

Indicator should provide portfolio-level view of national health system strength based on explicit risk, functional and quality standards

Measure should improve alignment between risk assessment and systems strengthening investments

Indicator provides a common metric for comparing quality of systems differentiated standards for systems would align with aid effectiveness and IHP+ principles and could link to strategic objectives on sustainability and transition

This measure will aggregate data from a number of linked

operational KPIs (see slides 33-45) providing a more granular

assessment for each of the three sub-systems

Limitations & mitigation measures

Agreement will be needed internally and with relevant partners on

expected functional and quality standards

Careful consideration will be needed to ensure that definitions and standards are relevant to country context, in particular for procurement systems where potential incentives to exit pooled procurement will need to be countered

Data collection mechanisms do not yet exist or will require considerable revision for the linked operational KPIs

A clearly defined control structure for signing off systems as compliant would need to be developed and implemented to limit potential gaming

structure for signing off systems as compliant would need to be developed and implemented to limit

29

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

KPI 6

Strengthen systems for health

Indicator dimensions

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Not yet

Systems do not yet exist for some of this data. Health facility assessments & PQR may provide some data

available

Actionable & reliable results

Measure represents aggregate measure for strategic level reporting. Operational indicators should drive performance improvement in each focus area

 

Portfolio

 

Coverage

segment

Cohort of countries sampled may differ across the three focus areas

Projection available

Likely no projections will be available for forecasting system improvements

Frequency of

Annually

Each reporting period may include few new data points for some elements, as countries may only conduct health facility assessments every 2-3 years

reporting

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 7

Fund utilization

Strategic Vision

Increase the rate at which countries effectively absorb

allocated funds

Aim of indicator

A resilient and sustainable system for health should be able to effectively use the full allocation of funds to deliver services to increase program impact. This will be measured in two ways:

a) Allocation utilization provides high level view on the extent to which:

countries can use their allocation, and

the Secretariat can optimize portfolio level investments

b) Absorptive capacity measures whether programs can spend the budgeted funds

measure will focus on the 20 ITP countries with strong links to Supply Chain Investment work and other

‘absorption’ related initiatives

Measure

a)

Allocation utilization

Grant Expense (actual + MTP) / Allocation

b)

Absorptive capacity Cum. expenditure / Cum. grant agreement budget

Limitations & mitigation measures

The Allocation utilization indicator risks two negative incentives:

1. Over-commitment to meet allocation

Risk controlled by indicators tracking absorption and cash balance (absorptive capacity, fund absorption rate, cash

balance)

2. Re-direction of funds through portfolio optimization from portfolios with the greatest “need” to portfolios better able to absorb funds without dealing with underlying health system constraints

Risk controlled by KPI-3 on alignment between investments and ‘need’

underlying health system constraints  Risk controlled by KPI-3 on alignment between investments and ‘need’ 31

31

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

KPI 7

Fund utilization

Indicator dimensions

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Mix

Allocation utilization: attribution; Absorptive capacity: contribution

Data availability

System

Sourced from existing systems for grant expense actuals and forecasts, as well

as Enhanced Financial Reporting systems to provide expenditure data

Actionable & reliable results

Directly highlights absorption problems as they arise and guides portfolio optimization efforts

Coverage

Mix

Allocation Utilization will cover whole portfolio, while Absorptive Capacity will

cover only selected countries

Projection available

Mix

Allocation Utilization will be forecast as part of the Mid-Term Plan, but Absorptive Capacity is based on country expenditures and cannot be forecast

Frequency of reporting

Quarterly

 
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Example Operational KPIs for RSSH

Note: The proposed Corporate KPI 5 Strengthen systems for health has been designed to

aggregate the results of a series of operational KPIs. For that reason these operational KPI proposals have been further developed as set out in this next section. This information would be complemented by expenditure tracking for each of the RSSH three focus areas.

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Op-KPI

Strengthen systems for health: a) procurement

Strategic Vision

Countries have sufficient procurement capacity to achieve improved procurement outcomes

Measure

Improved outcomes for procurements conducted

through countries’ national systems:

a) Price; b) OTIF delivery; c) Administrative lead time

Aim of indicator

Ensure that procurement capacity is actually delivering improved outcomes in terms of prices, on-time delivery and lead time

Focus procurement capacity-building efforts on

delivery of results, rather than delivery of service

Should lead to OIG country audits identifying procurement activities as major area of concern is decreasing

Limitations & mitigation measures

PQR could be primary data source, but this would mean delays in data reporting (sometimes up to one year)

May be challenging to track administrative lead time without additional data request to country

Outcomes can be impacted by factors outside the procurer’s control (e.g. changes in market conditions for API can impact price or OTIF)

Could consider amending trigger for data entry to PQR
Compare country outcomes to international benchmarks

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Strengthen systems for health: a) procurement

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 
 

Not yet

available

Currently data systems only exist for countries participating in PPM. Price data,

Data availability

OTIF and Lead Time could be sourced through PQR, though with up to one-year

lag

Actionable & reliable results

 

Coverage

Portfolio

Countries that participate in procurement and capacity building programs. Issue

segment

also of considerable relevance to UMICs

Projection available

Projected prices may be available, OTIF and Lead Time forecasts may not be possible

Frequency of reporting

Annual

Data points available at each reporting period may be limited given PQR and

OTIF data coverage

Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data
Annual Data points available at each reporting period may be limited given PQR and OTIF data

35

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Strengthen systems for health: b) supply chains

Strategic Vision

Measure

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Health facilities have the tracer medicines and diagnostics required to deliver high quality services for AIDS, TB & Malaria

a)

Percentage of health facilities with tracer medicines available

on the day of the visit

b)

Percentage of health facilities providing diagnostic services with tracer items on the day of the visit

Aim of indicator

To measure the extent to which investments in strengthening the different components of health product management systems contribute to the

uninterrupted availability of essential health products at

service delivery points

This is based on the mean availability score for 10 -15 tracer items, and aligned with the recommendations of the interagency task force.

Diagnostic services readiness (i.e. the capacity of the

health facility to provide laboratory diagnostic services) based on a list of tracer lab items

Limitations & mitigation measures

Health facility assessments would provide data every two years, other systems may exist in country but data quality is uncertain
Range of tracer items is country specific, may include items for programs other than HIV, TB and malaria

Stock out on the day is a Y/N; not a measure of stock-out days

Harmonize indicator measurement (guidance on tracer items & calculation of availability)

Exploring potential option to collect additional, more frequent measures (stock outs, expired medicines) through sentinel surveillance as part of Assurance Model to complement health

facility assessments every 3 years

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Strengthen systems for health: b) supply chains

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Not yet

Some data may be available through health facility assessments, but likely not

available

at the frequency required for this indicator to be useful

Actionable & reliable results

Depending on system developed for data collection, results should reveal where supply chains are in need of strengthening

Coverage

Portfolio

Likely data will only be available from countries conducting health facility

segment

assessments or similar surveys

Projection available

 

Frequency of reporting

?

tbc

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Op-KPI

Strengthen systems for health: c) financial management

Strategic Vision

Implementer financial management systems in key countries are sustainable and meet standards for use by Global Fund programs

Measure

a)

Number of public financial management transition efforts in high priority

countries completed

b)

Number of countries with financial management systems meeting defined standards for optimal absorption & portfolio management

Aim of indicator

Financial management is a critical process and enabler in delivering program impact from investments. The indicator goals are as follows:

Indicator (a): will focus on use of country systems (i.e. elements of public financial management system) and will measure #/% of

PFM system components used by GF in concert with development

partners under the IHP+ framework in 15 high priority countries

Indicator (b): will address routine financial management capacity gaps outside PFM scope in indicator (a) and will measure #/% qualified audits; #/% of timely & accurate financial reports (AFR, quarterly expenditure reports); #/% of qualified finance personnel

Limitations & mitigation measures

Partner buy-in for use of country systems may not be forthcoming

Effective engagement within IHP+ to influence other partners and foster harmonization

In-country capacity, ownership and co-ordination is a challenge for public financial management initiatives

Mobilize IHP+ partners to conduct Joint Financial Management Capacity Assessments (JFMAs) with consolidated action plans; and engagement of

CTs for follow up of action plans

Co-ordination with IHP+ including in-country studies to collect required data

Weak PR capacity & coordination in capacity building

Co-ordinate approach to provision of financial management technical

Establishing baseline data for PFM performance may be a challenge

assistance & provide clarity on requirements (e.g. financial management

handbook for implementers)

be a challenge assistance & provide clarity on requirements (e.g. financial management handbook for implementers) 38

38

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Op-KPI

Strengthen systems for health: c) financial management

Indicator dimensions

Mobilize Increased

Resources

Dimension

 

Accountability

Mix

Indicator a: Contribution; Indicator b: Attribution

Data availability

Not yet

System to track this information is not yet available

available

Actionable & reliable results

Assessment of national system strength should guide investment and system strengthening focus in the 15-20 selected countries

 

Portfolio

 

Coverage

segment

15-20 priority countries will be targeted

Projection available

 
 

Semi

Each reporting period will include few new data points as 15-20 countries may only conduct assessments periodically (tbc)

Frequency of reporting

Annually?

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Op-KPI

Strengthen systems for health: d) HMIS coverage

Strategic Vision

Well functioning HMIS enables better decision making and

ultimately better programs

Measure

Percent of high impact countries with fully deployed (80%

of facilities reporting for combined set of indicators), functional (good data quality per last assessment) HMIS

Aim of indicator

While many Global Fund supported countries can now report on key indicators for HIV, TB and malaria, many are

still reliant on survey data or global estimates. To really be

able to use data for program improvement, data need to be

available routinely. Significant investments are being made to building these routine HMIS and this indicator measures the success of these investments

The indicator is designed to measure two key aspects of an HMIS system that have proven problematic in the past

coverage (fully deployed) and functional (defined in terms of

data quality)

This also aligns with international priorities set out at the Measurement Summit in June by Global Health Leaders

Limitations & mitigation measures

This indicator does not measure data use directly, rather the completeness and functionality of the information systems needed for facilities/districts to have access to the data and tools to use the data

This aligns well with the significant GF investments into deploying and improving these systems, as well as with international priorities

This KPI option’s alignment with investments and priorities, and its feasibility to measure and reflect change, make it a preferred option of for this KPI. However, the data are still more likely to be available for high impact and core countries than focus countries

Strengthening HMIS is a priority workstream of the Global Collaborative from the Measurement Summit, and specific tasks are

planned around this

priority workstream of the Global Collaborative from the Measurement Summit, and specific tasks are planned around

40

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Strengthen systems for health: d) HMIS coverage

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

 

Accountability

Contribution

 

Data availability

Not yet

HFAs and HMIS desk review are proposed as primary data sources

available

Actionable & reliable results

Assessment of HMIS coverage and data quality should guide investment and data system strengthening focus in the countries monitored

 

Portfolio

 

Coverage

segment

Data will be more prevalent in High Impact and core countries

Projection available

 

Frequency of reporting

Annually

 
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Op-KPI

Strengthen systems for health: e) ability to report on key indicators

Strategic Vision

Countries are able to report on the minimum set of outcome

and impact indicators to enable country monitoring and meet international commitments

Aim of indicator

A set of high level indicators have been selected for each diseases/program area that measure key aspects of the

program in terms of measuring performance. It is critical that

GF-supported countries have this minimum set of data for their own purposes to understand the epidemic and their programs, as well as for Global Fund (and other donors) to understand basic performance and any changes to the epidemiology

The indicator will include the ability of countries to report data disaggregated by age and sex, and to report on selected key populations indicators

Gaps remain even within the High Impact countries ability to report on these indicators. This indicator aims to bring attention to this issue for PRs and key stakeholders

Measure

The percent of high impact and priority countries that were able to

report on core set of HIV, TB, Malaria and RMNCH indicators

Limitations & mitigation measures

Establishing data systems or a survey to produce data is a longer-term process. This indicator may not show rapid change, but should show progress over time

In the short-term, having the basic data is important, but this indicator

doesn’t demonstrate the source of the data. A country may be reliant on

a survey or modelling for some data values, when quality routine data is preferable for program utility

A comprehensive mapping has been done by country and by indicator in the High Impact and other priority countries to specifically identify gaps and resource needs

GF is investing significantly in routine HMIS systems through grants

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Op-KPI

Strengthen systems for health: e) ability to report on key indicators

Indicator dimensions

Mobilize Increased

Resources

Dimension

 

Accountability

Contribution

 
   

Indicator will use existing grant performance frameworks complemented by

Data availability

Structured

additional data collection on key indicators. Current systems do not track

country’s ability to report data disaggregated by age and sex

Actionable & reliable results

 
 

Portfolio

Indicator will likely assess High Impact and core countries

Coverage

segment

Projection available

 

Frequency of reporting

Annually

Cohort of countries assessed at each reporting period will change depending on expected update schedule

Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule
Annually Cohort of countries assessed at each reporting period will change depending on expected update schedule

43

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Op-KPI

Strengthen systems for health: f) use of data

Strategic Vision

Countries not only have data available, but also use those

data to improve planning, budgeting, allocation process and quality improvement

Measure

Number of countries that are using WHO DQR or PRISM

tools to analyze their data, and/or are putting into place quality improvement monitoring

Aim of indicator

To track the extent to which countries have the data systems and the capacity for analysis and decision making to improve the efficiency and effectiveness of service provision

Ethiopia, Rwanda and Senegal cited as examples to inform development of this strategic objective

Limitations & mitigation measures

Indicator does not measure true use of data, but rather the country’s use of data quality and data use tools

Periodic surveys would provide data on this KPI every two years, and for only a portion of the portfolio

As a complement to this KPI, evaluations every three years on

data use for in-country decision making may provide additional information beyond the use of tools

There are current discussions of harmonizing and incorporating data use measurement into the WHO’s Data Quality Review tools which the Global Fund is supporting - this would provide an option for measuring data use across high impact countries in the long term

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Op-KPI

Strengthen systems for health: f) use of data

Indicator dimensions

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Not yet

Annual desk reviews and PR interviews will provide indicator data

available

Actionable & reliable results

Results should guide future investments in health systems

 

Portfolio

 

Coverage

segment

Evaluations would be rolled out only in High Impact portfolio, for example

Projection available

 

Frequency of reporting

Annual

Additional outcome evaluations on data use for decision-making could provide information on the efficiency and effectiveness of program management

Investing to End Epidemics – strategic objectives 4 Maximize Impact Against HIV, TB and malaria
Investing to End Epidemics – strategic objectives
4
Maximize Impact
Against HIV, TB
and malaria
Build Resilient
& Sustainable
Promote and
Protect Human
Systems for
Rights & Gender
Health
Equality
Mobilize
Increased
Resources

3. Promote and Protect Human Rights and Gender Equality

Promoting and protecting human rights and gender equality is required to accelerate the end of the epidemics

a) Scale-up programs to support women and girls, including programs to advance sexual and reproductive health and rights

b) Invest to reduce health inequities including gender- and age-related disparities

c) Introduce and scale-up programs that remove human rights barriers to accessing HIV, TB and malaria services.

d) Integrate human rights considerations throughout the grant cycle and in policies and policy-making processes

e) Support meaningful engagement of key and vulnerable populations and networks in Global Fund-related processes

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 8

Gender & age equality

Strategic Vision

Reduce gender and age disparities in health

Measure

HIV incidence in women aged 15-24

Aim of indicator

HIV infection rates among young women are twice as high as among young men in some regions. The indicator will track the extent to which an enhanced programmatic focus on women and girls results in a reduction in new

infections in selected countries with large disparities in

incident infections

This objective is closely linked to other strategic objectives focused on scale-up of programs supporting women and girls; advancing sexual and reproductive health and rights; support to women’s, children’s, and adolescent health; and removing barriers to access

Limitations & mitigation measures

Considerable data limitations: Advice from technical partners indicate that current modelled data on numbers of new infections can indicate a trend but not a statistically significant change attributable to an enhanced focus on ‘women and girls’

Technical partners recommend use of improved sex and age disaggregated models that are currently under development and should provide data from 2017. Any targets approved in 2016 may need to be recalibrated in 2017

Data are reported with a one year lag

Projection models would need to be developed to enable effective tracking

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

KPI 8

Gender & age equality

Indicator dimensions

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Dimension

Comment

Accountability

Contribution

 

Data availability

Structured

Sourced from UNAIDS, modelled data of new incident cases, reported with a one year lag

Actionable & reliable

 

results

 

Portfolio

 

Coverage

segment

Cohort of countries to be defined based on where disparities are greatest

Projection available

?

Projections will be required if performance on this objective is to be effectively

managed

Frequency of reporting

Annually

With a one year lag emphasizing the need for good projections and complementary data

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 9

Human rights: a) Reduce human rights barriers to services

Strategic Vision

Human rights barriers to services are reduced, resulting in improved uptake of and adherence to treatment and preventions programs

Measure

# of priority countries with comprehensive programs aimed at

reducing human rights barriers to services in operation

Aim of indicator Limitations & mitigation measures With a focus on 15-20 priority countries this
Aim of indicator
Limitations & mitigation measures
With a focus on 15-20 priority countries this indicator will
measure the extent to which comprehensive programs to
tackle human rights barriers to access are established
The programs will be designed around the “7 key interventions
to reduce stigma and discrimination and increase access to
justice” of UNAIDS
will have to be established in countries
Where available, established WHO indicators for assessing
enabling environments will be used to track progress in
operationalizing the interventions
The aim is that these programs will contribute to a meaningful
reduction in human rights barriers to services and that
increased access will lead to increased impact. This will be
measured through in-depth evaluations as baseline in 2016, at
mid-term in 2019 and at the end of the strategy period in 2022
from partners for this work – WHO, UNAIDS, OSF, Ford

Human rights interventions to reduce barriers to service are well defined for HIV, but more work is needed for TB & Malaria (Malaria will be conducted as a second phase in 2017)

Specific indicators to track progress beyond those proposed by WHO

need to be defined and tracking systems to collect the relevant data

The in-depth evaluations will use mixed-method assessment of human rights barriers and interventions that reduce barriers. This is a relatively new idea with respect to health programs, but a solid and program-relevant assessment method could set a useful precedent for such assessments for policy-makers and program practitioners

The Global Fund has a key niche as the major funder of interventions aimed at removing legal barriers to access. There is strong backing

49

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

KPI 9

Human rights: a) Reduce human rights barriers to services

Indicator dimensions

Mobilize Increased

Resources

Dimension Comment The global fund has a key niche role as the major funder of
Dimension
Comment
The global fund has a key niche role as the major funder of interventions aimed at
Accountability
Contribution
removing legal barriers to access, but partner support remains key
Not yet
Data availability
Considerable work will be required to build the necessary tracking systems
available
The country dialogue and Concept note development stages will be key, as will be
Actionable & reliable
using the time before then to start building capacity and partnerships. After these
results
stages of the funding process, building human rights programs into grant design
will become increasingly difficult
Portfolio
Coverage
segment
Countries will be selected across different epidemic, burden, conducive
environment and barrier contexts
Projection available
Frequency of reporting
?
tbc

50

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 9

Human rights: b) key populations and human rights in middle income countries

Strategic Vision

Increase programing for key populations and human rights in middle income countries

Measure

Percentage of country allocation invested in programs targeting key populations and human rights barriers to access in middle income countries, for:

i)

Generalised epidemics

ii)

Concentrated epidemics

Aim of indicator

To ensure a successful transition, comprehensive

programs for key populations and human rights will have to be established in middle income countries before they reach this stage

This objective could be operationalized by enhancing the focus of stipulations in funding policy that a set

percentage of the allocation for countries be invested

in programs targeting key populations and human rights barriers to access

Limitations & mitigation measures

These plans would have to be integrated in to funding, eligibility and domestic investment policies

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 9

Human rights: b) key populations and human rights in middle income countries

Indicator dimensions

Dimension

Comment

Accountability

Attribution

 

Data availability

Structured

 

Actionable & reliable

A KPI will not be required if funding policy is sufficiently specific and rigorously

results

enforced

 

Portfolio

 

Coverage

segment

Middle income countries

Projection available

?

A projection should be possible when new grants, subject to these stipulations, come into force

Frequency of reporting

Quarterly

 
4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 9

Human rights: c) key populations and human rights in transition countries

Strategic Vision

Upper middle income countries in transition take over programing for key populations and human rights

Measure

Percentage of funding for programs targeting key populations and human rights barriers to access from domestic (public & private) sources

Aim of indicator

To measure the extent to which, i n upper middle income countries transitioning out of Global Fund support, governments recognize that support to

services for key populations is essential and

increasingly take over responsibility for and funding of these services

This would allowing remaining external funding to be used to support initiatives that support effective transition

Limitations & mitigation measures

These plans would have to be integrated into funding, eligibility and domestic investment policies

Initiatives that support effective transition will be defined in early 2016 and tracked at the operational level

Criteria would be required to define countries ‘in transition’ e.g. transition expected within 10 years

In some countries, even sustained efforts are unlikely going to lead to governments to take over funding of services for key populations and human rights programs

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

KPI 9

Human rights: c) key populations and human rights in transition countries

Indicator dimensions

Dimension

Comment

Accountability

Contribution

 

Data availability

?

Tracking may be possible through UNAIDS sources and through counterpart financing and willingness to pay mechanisms

Actionable & reliable

 

results

If suitable policy levers to enforce compliance can be introduced

 

Portfolio

 

Coverage

segment

Cohort of countries to be defined. HIV and TB programs only

Projection available

Formal projections are unlikely to prove accurate, but risk of non-compliance could be tracked on a more qualitative basis

Frequency of reporting

Annually

There will be a lag of 24-30 months after the start of the replenishment period

4
4

Strategic Targets

Maximize Impact Against HIV, TB and malaria

Build Resilient & Sustainable Systems for Health

Promote and Protect Human Rights & Gender Equality

Op-KPI

Promote and Protect Human Rights & Gender Equality

Mobilize Increased

Resources

Examples of more attributable Operational KPIs that aim to monitor whether:

Interventions to tackle gender and age disparities and human rights barriers to access are being rolled out in prioritized countries

Examples of potential Operational KPIs

Percentage of females at higher risk, in target districts of priority countries, who completed a standardized HIV prevention intervention during the reporting period

Absorptive capacity for interventions targeting:

i. removing human rights barriers to access

ii. women & girls

(grant expenditure / grant agreement budget)

Aim

A measure of service coverage for districts where the

Global Fund is a significant funder of interventions

targeting women & girls

An early warning of potential underperformance on

human rights and women & girls will be underspending

in grants on these services

Note the planned in-depth country-level evaluations of human right barriers to access proposed for 2016, 2019 & 2022 will provide an additional source of information to understand the performance of the Global Fund in this area