MOZAMBIQUE FORSSAS HEALTH AND SOCIAL WELFARE SYSTEMS STRENGTHENING

QUARTERLY TECHNICAL PERFORMANCE REPORT: Fiscal Year 15, Quarter Three

April 1 – June 30, 2015

Cooperative Agreement No. AID-656-A-12-00002

July 31, 2015

This publication was produced for review by the United States Agency for International Development. It was prepared by Deloitte Consulting LLP.

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MOZAMBIQUE FORSSAS HEALTH AND SOCIAL WELFARE SYSTEMS STRENGTHENING QUARTERLY TECHNICAL PERFORMANCE REPORT: FY15 Quarter Three April 1 – June 30, 2015 Prepared for: USAID/Mozambique Prepared by:

Cooperative Agreement No. AID-656-A-12-00002 July 31, 2015 The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

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Acronyms AOP Annual Operational Plan APE* Community Health Worker (Agente Polivalente Elementar) CMAM* Central Medical Store (Central de Medicamentos e Artigos Médicos) DAF* Directorate of Administration and Finance (Direcção de Administração e Finanças) D&G Democracy & Governance DPC* Directorate of Planning and Cooperation (Direcção de Planificação e Cooperação)

DPGCAS* Provincial Directorates of Gender, Children, and Social Welfare (Direcção Provincial da Género, Criança e Acção Social)

DPS National Directorate of Public Health (Direcção Provincial da Saúde) DRH Directorate of Human Resources (Direcção Recursos Humanos)

FORSSAS* Health and Social Welfare Systems Strengthening (Fortalecimento dos Sistemas de Saúde e Acção Social)

(HSDP) Health Services Delivery Project HSWSS Health and Social Welfare Systems Strengthening ICSM* Health Sciences Institute of Maputo (Instituto de Ciências de Saúde de Maputo)

IFAPA* Public Administration and Governmental Training Institute (Instituto de Formação em Administração Pública e Autárquica)

INS* National Institute of Health (Instituto Nacional de Saúde) IR Intermediate Result M&E Monitoring & Evaluation MEF Ministry of Economics and Finance (Ministério da Economia e Finanças)

MGCAS* Ministry of Gender, Children, and Social Action (Ministério do Género, Criança e Acção Social)

MISAU* Ministry of Health (Ministério de Saúde) MPD Ministry of Planning and Development (Ministério da Planificação e Desenvolvimento) MTEF Medium-Term Expenditure Framework NHA National Health Account NFM New Funding Mechanism PELF* Pharmaceutical Logistics Strategic Plan (Plano Estratégico da Logística Farmacêutica) PES Annual Economic and Social Plan (Plano Economico e Social) PESS Strategic Plan of the Health Sector (Plano Estratégico do Sector da Saúde)

PIREP* Integrated Program for the Reform of Professional Education (Programa Integrado da Reforma da Educação Profissional)

PMP Performance Monitoring Plan PUDR Progress Update and Disbursement Request SCM Supply Chain Management SIP Procurement Information System (Sistema de Informação de Procura) SIS Health Information System (Sistema de Informação de Saúde) QAD Performance Assessment Framework (Quadro de Avaliação do Desempenho) TFM Transitional Funding Mechanism UFGF Global Fund Management Unit (Unidade de Gestão do Fundo Global) UGEA* Acquisitions Executive Management Unit (Unidade Gestora Executora de Aquisições) USAID United States Agency for International Development *Portuguese acronyms, formal definition provided in italics

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Table of Contents Acronyms ..........................................................................................................................................3

Executive Summary ............................................................................................................................5

1. Introduction ...................................................................................................................................5

2. Progress Highlights by Intermediate Result .....................................................................................7

2.1 Intermediate Result 1: Increased Effectiveness in Health Governance .............................................. 7

2.2 Intermediate Result 2: Improved management of health sector financing ....................................... 9

2.3 Intermediate Result 3: Strengthened management and operations capacity ................................. 10

2.4 Intermediate Result 4: Improved management and retention of health and social welfare staff... 13

3. Plans for Upcoming Quarter (January 1 – March 31, 2015) ............................................................. 15

3.1 Intermediate Result 1: Increased Effectiveness in Health Governance ............................................ 15

3.2 Intermediate Result 2: Improved Management of Health Sector Financing .................................... 16

3.3 Intermediate Result 3: Strengthened Management and Operations Capacity ................................ 16

3.4 Intermediate Result 4: Improved management and retention of health and social welfare staff... 17

4. Project Performance Monitoring (PMP) ........................................................................................ 19

5. Success Stories ............................................................................................................................. 19

Annex 1: Indicator Measurement Matrix .......................................................................................... 22

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Executive Summary The United States Agency for International Development (USAID)-funded Health and Social Welfare Systems Strengthening (HSWSS) or Fortalecimento dos Sistemas de Saúde e Accҫão Social (FORSSAS) project, led by Deloitte Consulting, collaborates across the Ministry of Health (MISAU) and the Ministry of Gender, Children, and Social Action (MGCAS) to strengthen governance and supply chain processes, improve health sector funds management, enhance management and operations capacity, and strengthen the health and social welfare workforce. The project’s approach recognizes that system improvements make a larger impact when implemented across health systems building blocks.

This report covers progress against project objectives during the period of April 1, 2015 through June 30, 2015.

Key quarterly achievements are highlighted below and in the report narrative.

Provincial Financial Procedures Manual workshops completed: As of the end of this reporting period, FORSSAS has completed five (5) week-long provincial workshops in Zambezia, Nampula, Tete, Cabo Delgado and Niassa Provinces. Cumulatively, FORSSAS has now trained 434 health professionals across the central and provincial levels in the country’s standardized finance systems, in conjunction with MISAU. The completion of this training marks the achievement of a major milestone in improving the health sector’s financial management system, as well as achievement of DAF, PES, and PARI strategic goals.

FORSSAS outlines Health Financing Strategy, restructures GTF sub-groups for enhanced focus: During the quarter, a two-day workshop discussed an outline for the health financing strategy; obtained consensus for GTF sub-group roles and membership; and confirmed next steps for strategy-writing. The meeting also gathered comments on the National Health Accounts report to support FORSSAS specialists to finalize the study. The outline represents an important step toward completion of the national health financing strategy, and FORSSAS believes that the new GTF structure will help generate consensus and enthusiasm for the health financing objectives defined in the HFS outline.

Current state analysis of bed net distribution completed as part of Business Case Analysis (BCA) activity: During the quarter, BCA kick-off meetings were organized in Maputo with PMI and MISAU. Interviews were conducted in and around Maputo with mosquito bed net distribution stakeholders, including MISAU, CA, and CMAM and partners such as JSI, PSI, Malaria Consortium, World Vision and UNICEF, to map the current bed net distribution and to understand capacity for future models. The team also completed information-gathering trips spanning the provincial, district, and facility levels. These activities helped complete the current state analysis of bed net distribution, a major component of the BCA.

FORSSAS resumes ongoing support to CMAM M&E Department: The new CMAM M&E Officer joined the project on June 8, 2015. The CMAM M&E Officer identified areas of collaboration between CMAM M&E and MISAU M&E Departments, including the Retroinformação Data Quality Assurance Protocol processes supported by FORSSAS within DIS. The Officer also re-initiated efforts to develop SOPs for CMAM performance indicators, including Performance Indicator Reference Sheets (PIRS) and documentation of the methodology for data collection and analysis.

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1. Introduction FORSSAS is a four-year USAID project awarded to Deloitte Consulting, LLP in July 2012. The purpose of FORSSAS is to provide technical assistance to the Government of the Republic of Mozambique (GRM) to address constraints to the health and social welfare system, in order to ultimately improve health outcomes.

The key result areas for FORSSAS are: 1) effective governance, 2) integrated finance, 3) sustainable operational capacity and 4) strengthened human resources management. Figure 1 below shows the intermediate results (IRs) and the sub-IRs that guide project implementation.

Figure 1: FORSSAS Results Framework

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2. Progress Highlights by Intermediate Result This section provides an overview of the project’s progress across IRs and sub-IRs during the reporting period.

2.1 Intermediate Result 1: Increased Effectiveness in Health Governance Through implementation of activities under IR 1, the project supports MISAU and USAID strategic goals to strengthen capacity within procurement, internal audit, and financial management functions. IR 1 includes financial management and procurement strengthening components for MISAU and the Central Medical Store (CMAM), including activities under the Acquisitions Executive Management Unit (UGEA).

Sub-IR 1.1: Support the Directorate of Administration and Finance’s financial management, procurement and governance capacity

Provincial Financial Procedures Manual workshops completed: Following MISAU adoption and approval of the Manual by Minister of Health in October 2014, the Department of Administration and Finance (DAF) requested that FORSSAS train provincial, district, and health facility staff on the financial management standard operating procedures (SOPs) included in the Manual.

As of the end of this reporting period, FORSSAS has completed five (5) week-long provincial workshops in Zambezia, Nampula, Tete, Cabo Delgado and Niassa Provinces. Cumulatively, FORSSAS has now trained 434 health professionals across the central and provincial levels in the country’s standardized finance systems, in conjunction with MISAU. Three hundred twenty four (324) of these trainees were located at the provincial level. The completion of this training marks the achievement of a major milestone in improving the health sector’s financial management system, as well as achievement of DAF, PES, and PARI strategic goals.

Following the trainings, materials were circulated to DAF and all DPS to encourage wider knowledge-sharing of the content. Additionally, the project debriefed representatives from DAF, MB Consulting, and USAID at two separate sessions, discussing evaluation of the training; analysis of pre- and post-test results; training strengths and weaknesses; and suggestions for future training.

With the trainings now complete, FORSSAS will shift attention toward additional coaching and mentoring required to institutionalize the use of the Financial Manual.

Developing and implementing a performance management system at DAF: Following development of performance indicator reference sheets (PIRS) during the previous quarter, the project continued efforts to build capacity to maintain the collection, analysis and use of those indicators. The team designed and developed an action plan that aims to resolve collection and quality issues associated with DAF data, which currently hinder regular calculation and use of these indicators. DAF leadership maintains interest and enthusiasm for enhanced performance management within the Directorate and is supportive of the guidelines for such activities developed by the project. Strengthening DAF's ability to manage externally-funded projects (particularly Global Fund grants): The FORSSAS Financial Management Advisor to the Global Fund Unit (GFU) continued ongoing support to strengthen financial accounting and reporting within the Unit, including payment report review. DAF is increasingly attentive to following up on Global Fund disbursement requests, demonstrating improved initiative to comply with the Financial Operations Manual and Financial Control Plan and help stabilize financing to the sector. Ongoing operational support to DAF: FORSSAS advisors continued to provide ongoing, ad-hoc support to various areas of DAF at the request of DAF leadership. The main support during this reporting period

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related to DAF control of debtor advances (continued from the previous period); support to e-SISTAFE reporting; and budget execution reporting. DAF also requested support in the preparation of financial reports to be presented to MISAU leadership.

DAF Financial Advisor vacancy nearly filled: Recruitment for the second project Financial Advisor to DAF is ongoing, but in its final stages.

Sub-IR 1.2: Support CMAM in supply chain governance

FORSSAS monitors Department following transition of last advisor: FORSSAS continued meetings with SCMS, USAID, and CMAM to monitor the transition of FORSSAS advisors out of the Internal Audit Department of CMAM. High staff turnover persists in the Department; three out of four Department staff left CMAM over the past several months. In response, CMAM will solicit additional training for new staff. CMAM will secure funding for and organizing these trainings.

Sub-IR 1.3: Support CMAM in financial management

CMAM’s financial accounting module continued: During the quarter, FORSSAS staff trained CMAM on procedures to close an account in Primavera; this training will be repeated in order to ensure that all staff are completely comfortable with the procedures. The development of customized Primavera reports also began during the period; ultimately, up to 15 custom reports will be developed and CMAM staff will be trained to use them. The creation and use of these reports will be a step toward greater data and information use for financial decision-making at CMAM. One of the new reports summarizes bank reconciliation status, facilitating Department alignment with recommended financial management practices. The Lead of CMAM’s Finance Sector is assuming increased engagement in this process to accelerate progress. FORSSAS advisors also supported CMAM’s response to the March 2015 Tribunal Administrativo audit report.

Sub-IR 1.4: Strengthen democracy and governance (D&G)

Democracy and Governance (D&G) component for Buzi and Caia Districts discontinued: In February, FORSSAS received a termination of convenience notification from USAID related to all D&G activities. These activities are permanently discontinued under the contract and will not be resumed.

Sub-IR 1.5: Support CMAM in procurement capacity

FORSSAS continues to make progress toward implementation of Procurement Department improvement recommendations: Continued FORSSAS engagement helped to empower CMAM Planning Department staff to collect and import quality data into the Procurement Information System (SIP). The new Systems Development Consultant will work to continue progress toward finalizing and implementing the SIP beginning in July 2015.

In support of a revised organizational structure, project staff created a learning approach and draft plan, and reviewed this approach with the Procurement Department Director. A skills assessment questionnaire was developed and presented. The skills assessment, which will inform implementation of new departmental roles and the associated learning plan, will be completed in August.

Sub-IR 1.6: Support UGEA

Ongoing operational support to UGEA: At request of MB Consulting that provided the UGEA advisor as part of the sub-contract with FORSSAS, the support of this UGEA advisor was terminated in May 29, about one month earlier than planned. FORSSAS worked with the UGEA Director to ensure that all activities were completed prior to the end of this support. Upon completion of the Advisor’s activities, UGEA expressed their satisfaction with the support provided by FORSSAS.

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Sub-IR 1.7: Support CMAM in organizational planning, coordination and business process improvement

FORSSAS support to this workstream is now complete.

2.2 Intermediate Result 2: Improved management of health sector financing FORSSAS is supporting MISAU to improve management of health sector financing. Project activities help improve rational allocation of resources, budgeting, planning and management of funds. Current work stream activities relate to resource tracking, resource planning and innovative financing.

Sub-IR 2.1: Develop and execute national health financing strategy

FORSSAS outlines Health Financing Strategy, helps restructure GTF sub-groups for enhanced focus: During April through June 2015, FORSSAS continued supporting DPC with the coordination of the health financing taskforce (GTF). The FORSSAS team has reinforced the GTF with specialized technical assistance by subcontracting Santiago Goicoechea from Monitor Deloitte Mozambique. Following Santiago’s arrival, a two-day workshop was held June 9-10, with an aim to discuss the outline for the health financing strategy; obtain consensus for GTF sub-group roles and membership; and confirm next steps for strategy-writing. The meeting also gathered comments on the National Health Accounts report to support FORSSAS specialists to finalize the study.

The FORSSAS team jointly worked with the specialist from ThinkWell to prepare the outline for the health financing strategy, and define the structure of the document into four Parts/Chapters:

• Part I – Situational Analysis (the document already prepared by FORSSAS/Deloitte will be used to feed this chapter)

• Part II – Principles and Objectives of the Financing Strategy • Part III – Strategies for Financing the Health Sector covering three objectives:

o Objective 1- Increase Revenues o Objective 2 – Improved Efficiency of Resources Allocations o Objective 3- Strategic Purchasing of Health Services (all the three objectives will be fed

with the results of the studies and analysis – some of them concluded and other in elaboration phase).

• Part IV will contain the implementation plan of the strategy and M&E.

During the workshop, GTF members came to a consensus to divide the GTF into the following four GTF sub-groups:

Sub-Group 1: Minimum packages for health services

• Key question addressed: How can the GRM provide quality health services at low cost to the population?

• Studies proposed for the sub-group: Basic Package Models services (being developed by WHO)

Sub-Group 2: Increased resources for health

• Key question addressed: What are the resources that can be used to close the financing gap of the PES?

• Studies proposed for the sub-group: Study Case of Investment for Health (WB); and Innovative Mechanisms for Health Financing (WHO)

Sub-Group 3: Efficiency in Resource Allocation

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• Key question addressed: What are the allocation mechanisms for the different levels (central, provincial and district) and how do we improve efficiency? What mechanisms can be adopted to improve the use of funds?

• Studies proposed: Planning and Resource Allocation (point of contact still TBD)

Sub-group 4: Resources aggregation and provider payment mechanisms

• Key question addressed: Understanding the context: what mechanisms already exist in the country? How do they function? What are the results in terms of efficiency and increased resources? How can it be integrated in the health system?

• Studies proposed: Health Insurance Landscape and options for risk sharing (FORSSAS/Deloitte); Catastrophic Expenditures (WHO); PBF Mechanisms (EGPAF)

FORSSAS and Thinkwell believe that the new GTF structure will help generate consensus and enthusiasm for the health financing objectives defined in the HFS outline. The GTF believes that this structure will allow for the elaboration and editing of future strategy chapters. The FORSSAS and ThinkWell teams have already started writing the first chapter of the strategy and health partners are making efforts to help drive the health financing process.

Since the sub-groups chaired by MISAU and co-chaired by WHO have not met to discuss the identified HFS topics (as instructed by DPC during the above mentioned workshop), WHO convened a partner meeting and proposed greater involvement at the political level (Minister and Heads of Cooperation). To realize this recommendation, the group will start by sending a letter to the Minister. The group awaits the letter from WHO.

Sub-IR 2.2: Support and institutionalize National Health Accounts and other resource tracking and utilization activities

FORSSAS receives stakeholder comments on NHA: FORSSAS received a first round of comments on the NHA report from the Ministry and partners during the GTF workshop on June 9-10. DPC will document these comments (expected in July) in order for FORSSAS to finalize the report. Following this step, the final report will be submitted to MISAU and WHO for validation.

Sub-IR 2.3: Support for resource planning

FORSSAS supports MTEF workshop: During this period, FORSSAS provided support to DPC to prepare materials and presentations for the MTEF workshop held from April 22nd to 24th, for the National Planning Meeting held from May 4-5 and for the Conselho Nacional Coordenador do Sector Saúde (CCSS) held from May 6-8.

The MTEF workshop was directed at provincial key staff working in the Planning and Monitoring, Finance, and Human Resources Departments who are involved in the elaboration of MTEF. The objectives were to strengthen staff capacity in planning techniques; use costing indexes and formulas for the three year (2016-2018) projections of resources and budgeting to specific tables (e.g. current operational expenses, revenues, human resources and investments); and disseminate the government methodology for the MTEF 2016-2018. FORSSAS participated actively with the DPC team to present the material and provided guidance to the working groups to help them prepare the MTEF by province. The forum agreed that MTEF reached their training objectives, and participants recommended that DPC continue with these kinds of initiatives.

The National Planning Meeting included participation from MISAU central level staff (e.g National Directors, Head of Departments and Programs), all health provincial directorate representatives (e.g. Directors, Chief Medical Doctors, heads of Planning and Monitoring Departments and Finance and

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Administrative Departments), and select health partners (e.g. USAID, FORSSAS, WHO, WB, UNICEF, Health Partner’s Focal Point). The event:

1) Shared results from the Social Economic Plan (PES) 2014, 2) Shared final version of PES 2015 (approved in April 2015), 3) Informed participants of the planning methodology and health sector priority areas for 2016,

and 4) Shared the PESS indicators and Quinquenal Government Plan (PQG) for 2015-2019, along with

indicators and instructions for the 2016 planning exercise.

During the event, DPC presented the current state of the health financing strategy process, and the preliminary results of the 2012 National Health Account report prepared by FORSSAS. Provinces were encouraged by DPC to identify a technician at DPS to be responsible for NHA data collecting for future reports.

Also during the period, FORSSAS provided support in the elaboration of MISAU PES 2016 and budgeting, working with the National Directorates of MISAU and providing guidance according to new government methodology and programmatic structure. Support was also provided to Maputo Province and Cabo Delgado to harmonize the PES 2016 and align it with health sector and PQG priorities and indicators. A visit to Niassa province is planned for July 2015.

2.4 Bed Net Business Case Analysis (BCA)

BCA activities complete current state analysis of bed net distribution: Currently, USAID PMI and their implementing partners support MISAU to distribute insecticide-treated mosquito nets for routine antenatal patients. As such, USAID PMI asked Deloitte to conduct a business case analysis (BCA) on the future distribution model for bed net distribution that can be sustainable for MISAU moving forward. During the quarter, BCA kick-off meetings were organized in Maputo with PMI and MISAU to validate the scope of the BCA. In fact, the aim was to conduct an analysis of the various options for bed net distribution, which currently involves multiple partners.

Interviews were conducted in and around Maputo with mosquito bed net distribution stakeholders, including MISAU, CA, and CMAM and partners such as JSI, PSI, Malaria Consortium, World Vision and UNICEF, to map the current bed net distribution and to understand capacity for future models.

Different trips to and around Maputo Province were organized to follow the distribution of bed nets from the regional warehouse to the health facility level. Visits included Maputo Province DPS, Namaacha District and Marracuene District.

Travel to Niassa and Nampula Provinces for field visits were accomplished per MOH recommendations to understand the current bed net distribution run by Niassa DPS and JSI in Nampula. This travel included visits from the provincial warehouse level down to multiple health facilities.

Finally, follow-up meetings with partners and MISAU were organized to obtain clarification on a few outstanding questions and discuss findings from field visits in Niassa and Nampula Provinces that the Ministry had requested.

2.3 Intermediate Result 3: Strengthened management and operations capacity FORSSAS is strengthening MISAU’s management and operations capacity by supporting its Global Fund Unit, Department of Projects and Department of M&E to improve planning and performance management processes.

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Sub-IR 3.1: Improve capacity in Department of Projects and the Global Fund Unit to meet donors’ requirements FORSSAS continues support to Global Fund grant monitoring: During the period, FORSSAS provided support to the Global Fund Unit (GFU) to monitor the performance of Round 9 Phase II HIV and Malaria Grants; interim NFM Tuberculosis Grant; and Round 8 Health Systems Strengthening Grant. FORSSAS staff is supporting the GFU to prepare the data for PUDRs to be submitted in August 15, 2015 and to monitor the implementation of the activities and special conditions of the three grants.

FORSSAS oversees implementation of data quality improvements: In addition, FORSSAS continued to provide support to DPC in their daily data quality operations by monitoring the Global Fund’s action plan and overseeing the implementation of data quality recommendations from the GF and XIV Annual Joint Evaluation (ACA XIV).

FORSSAS continues support to World Bank Unit Health Services Delivery Project: Also during the quarter, FORSSAS continues to support the World Bank Unit in helping the Department of Nutrition to develop the monitoring and evaluation plan for their Health Services Delivery Project (HSDP) activities.

Sub-IR 3.2: Strengthen Department of M&E at MISAU FORSSAS supports institutionalization of additional QAD 2015-2019 indicators: FORSSAS assisted DPC in the preparation of the QAD 2015-2019 validation workshop. The workshop will be held in August.

FORSSAS technical staff supported the M&A Department with the procedures to help institutionalize new indicators, added to the QAD at the request of global partners. Institutionalize procedures included definition of the indicators and documentation in the QAD matrix; collection of respective provincial targets for 2015-2017; and preparation of respective technical notes.

Continued improvement of data quality tools: FORSSAS technical staff supported the DIS Department staff with the revision of their feedback tool to strengthen data quality and comply with the inclusion of new indicators and disaggregation of existing indicators (e.g. by age group). FORSSAS enhanced DIS’ data analysis and monthly reporting by changing the reporting structure to improve visual presentation of analysis and results. These revised monthly reports were then sent to the Provinces.

FORSSAS supports DIS to produce Annual Statistical Reports: Project staff supported DIS to revise, finalize, and produce the 2010-2014 Annual Statistical Report and 11 related Provincial Annual Statistic Brochures. The central and provincial levels depend on these reports to support evidence-based decision-making.

FORSSAS continues to support health information system implementation: FORSSAS extended support to implementation, including system installation and staff training in one district of Maputo Province (Manhica) and in Nampula Province. Ultimately, SISMA will be expanded to more than 150 sites across the country.

To strengthen DHIS2 capacity, FORSSAS staff supported DPC to develop scopes of work and terms of reference for contracting a consultant to manage the migration process of SIS-H and SIS-ROH to the DHIS2 platform.

In collaboration with DPC and WHO, FORSSAS technical staff continued to support the training program on Planning, M&E and SIS for the central level health sector. This involved preparation of materials and a revision of manuals. The first training date for the three courses is still pending MOH approval.

FORSSAS is providing technical assistance to DPC to complete an inventory of health infrastructure, equipment and human resources. FORSSAS is providing guidance during the preparation of the inventory, helping to validate essential documents, questionnaires and the methodology for data

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collection. This inventory is a precondition for improving evidence-based planning and financial allocation for integrated development of health infrastructure and human resources.

FORSSAS provides technical assistance to DPS M&E Units: FORSSAS advisors, along with MISAU and partner representatives, provided technical assistance through participation in Gaza Province planning exercises and supervision visits. This activity supported harmonization of the 2016 PES and State Budget.

Sub-IR 3.3: Support CMAM to establish an M&E unit and effectively manage performance

FORSSAS resumes ongoing support to CMAM M&E Department: The new CMAM M&E Officer joined the project on June 8, 2015. Meetings were organized with CMAM leadership, CMAM departments, SCMS and USAID to avoid duplication of M&E support efforts; to better understand the roles and responsibilities of each sector; and to confirm activities for the remainder of project year three.

The CMAM M&E Officer identified areas of collaboration between CMAM M&E and MISAU M&E Departments, including exploring adoption of the Retroinformacao Data Quality Assurance Protocol processes supported by FORSSAS within DIS. The M&E Officer is also currently providing very limited support to the CMAM Finance team to develop a tool to track contract payments, which will ultimately help foster a culture of performance management within CMAM Finance and help to monitor health expenditure.

The Officer re-initiated efforts to develop SOPs for CMAM performance indicators, including Performance Indicator Reference Sheets (PIRS) and documentation of the methodology for data collection and analysis.

2.4 Intermediate Result 4: Improved management and retention of health and social welfare staff Accessible and qualified human resources are critical to sustain gains in strengthening the national and social welfare systems. IR4 activities support better health outcomes through increased availability of qualified health and social welfare workers at all levels of the system. These work streams are directly linked to national policies and strategies including MISAU’s National Plan for Health Human Resources Development (2008-2015) and the Human Resource Strategy for MGCAS.

Sub-IR 4.1: Integrate and coordinate Community Health Worker (APE) Program

During the quarter, FORSSAS continued to work with MISAU to define a revised terms of reference for the APE vacancy. FORSSAS hopes to fill this position during FY15 project quarter four.

Sub-IR 4.2: Strengthen and support sustainability of educational programs with MGCAS

First semester of 2015 completed in Maputo: Nineteen (19) Level 5 Early Childhood Educator (EI) graduates completed courses in Maputo during the quarter. The group is composed of graduates from all the provinces of the country that completed the Level 3 and 4 courses implemented by ICS Maputo.

Continued development of the Early Childhood Educator and Social Welfare curriculum guidelines: The local EI Technical Working Group continued to work on finalizing the guidelines for the CV level 5 EI package. The Social Welfare Technical Working Group is still engaged in developing the guidelines for CV level 3 and 4 packages. Final guidelines for these packages are expected in fall 2015. Approval for these curriculums is pending.

Supporting sustainability of MGCAS courses: The project continues to work with MGCAS to incorporate a targeted budget to support sustainable Ministry contribution to the courses. As reported on the last quarter, MGCAS currently anticipates budgeting approximately $30,000 USD for the continuance of

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these courses. During the present quarter, the project conducted field visits, in conjunction with MGCAS, to Beira and Lichinga to monitor decentralization of TAS courses in these two host provinces, including working sessions with different partners involved on the process.

Course evaluation scope developed: In order to evaluate the outcomes of these courses, FORSSAS staff worked with MGCAS to finalize a Terms of Reference for the evaluation of Maputo, Beira, and Lichinga 2012-2014 course graduates. An RFP was released to request external support to complete the evaluation, which is planned for early fall 2015. The evaluation will collect and analyze data on graduate knowledge, skills, and performance.

Sub-IR 4.3: Increased capacity of DPGCAS

First semester of decentralized TAS Level 5 courses wraps up in Sofala and Niassa: Two Level 5 social welfare courses wrapped up in Sofala and Niassa provinces during the quarter. These courses were supported by the new curriculum developed by FORSSAS consultants. Sixty-three (63) students are enrolled in this semester of these courses and are expected to graduate in December.

Building capacity of Ministry staff at the provincial level: During the quarter, the IFAPAs completed M&E reports with DPGCAS Beira and DPGCAS Lichinga that analyzed outcomes of the provincial courses. These reports were completed with FORSSAS support. The reports demonstrated the positive return on investment realized as a result of the courses, highlighting a positive impact on staff skills, performance, and motivation. The reports are helping to compel DPGCAS beneficiaries, including leadership, to advocate for continued budget allocation toward these courses.

Sub IR 4.4: Strengthen and support MISAU Human Resources Integrated Planning Process

The FORSSAS Advisor is currently on maternity leave. She will resume support to DRH upon her return in September. Prior to her leave, the Advisor continued to support DPC in the implementation of two new tools for budget planning and monitoring (originally developed for and implemented in DRH) that allow for analysis across not only budget codes/line items but also PES activities. She also created a user guide for the budget planning tool as well as for the budget monitoring tool. In addition, FORSSAS provided significant support to DRH in the continued implementation and institutionalization of the budget planning tool for the PES 2015 and PES 2016; the monitoring tool has been in use since 2014.

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3. Plans for Upcoming Quarter (July 1 – September 30, 2015) This section provides an overview of the project’s plans for next quarter in various IRs and sub-IRs.

3.1 Intermediate Result 1: Increased Effectiveness in Health Governance Sub-IR 1.1: Support DAF in financial management, procurement and governance capacity • Hire and onboard second Financial Advisor position to address outstanding vacancy • Support DAF to calculate and interpret indicator results and suggest actions for continuous process

improvement • Prepare and provide post-training coaching for SOP implementation through hands-on mentorship

and in-service instruction for priority areas. DPS of Manica was chosen with support from DAF leadership to be used as the pilot Province to provide post-training coaching. A tool for appraisal and evaluation of Financial SOP implementation will be developed and tested in DPS Manica. In-service trainings will be used at central level while wall-mounted job aids will be distributed to cost centers.

• Plan leadership and management training for senior MISAU leadership, focusing on priority financial areas

• Provide ongoing operational support to DAF, including financial statements preparation, fiduciary risk monitoring appraisals, and support to implementation of in-house financial software

Sub-IR 1.2: Support CMAM in supply chain governance • As prioritized by CMAM, support finalization of IA Work with the creator (currently with SCMS) of

the existing Internal Auditing System for provinces and central hospitals to understand the system • Create and test the Internal Auditing System for visits at central warehouses • Develop technical and user manual for Internal Auditing System • Provide training on Internal Auditing System Sub-IR 1.3: Support CMAM in financial management • Support implementation of CMAM’s financial accounting module Primavera for 2015 and bank

reconciliation monthly reports • Support development of Primavera customized financial reports • Continue to adapt CMAM Financial SOPs • Support the use of e-SISTAFE to prepare monthly financial statements • Continue efforts to institutionalize performance indicators in CMAM Finance sector Sub-IR 1.4: Strengthen democracy and governance • In February 2015, FORSSAS received a termination of convenience notification from USAID related

to all D&G activities; these activities are permanently discontinued under the contract and will not be resumed

Sub-IR 1.5: Support CMAM in procurement capacity • Create interface between SSI (Sistema de Seguimento de Importação) and SIP (Sistema de

Informação de Procura) • Work with SCMS to create interface between SIP and the Central Tool • Provide training on SIP

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• Begin development of SIP standard reports • Conduct interviews for skills assessment and perform skills gap analysis • Develop procurement training materials and initiate one-on-one trainings Sub-IR 1.6: Support UGEA • Technical support to UGEA was completed on May 29, 2015

3.2 Intermediate Result 2: Improved Management of Health Sector Financing Sub-IR 2.1: Develop and execute national health financing strategy • Continue to support the coordination of the GTF and related sub-groups • Support development of first chapter of health financing strategy • Support the GTF sub-groups to analyze studies and summarize conclusions and evidence in order to

feed the next chapters of the strategy

Sub-IR 2.2: Support and institutionalize National Health Accounts and other resource tracking and utilization activities • Review and respond to formal MISAU comments on NHA in order to finalize the report and submit

for approval Sub-IR 2.3: Support for resource planning • Support DPC to finalize the PES 2016 and submit to MEF by the end of July • Continue providing support to MISAU focal points and cost centers to use the PES budget

monitoring tool to complete PES 2016 budgeting • Support DPC to prepare the next (PES) planning cycle and new guidelines for 2017 2.4 Bed Net Business Case Analysis (BCA) • Finalize business case analysis report on mosquito bed net distribution model, including

recommendation(s) • Present final business case analysis report on mosquito bed net distribution model to key Ministry

and donor stakeholders

3.3 Intermediate Result 3: Strengthened Management and Operations Capacity Sub-IR 3.1: Improve capacity in Department of Projects and the Global Fund Unit to meet donors’ requirements • Support the Global Fund Unit (GFU) in monitoring the performance of the New Funding Model

(NFM) for HIV, Malaria and TB, and in the Round 8 – Health Systems Strengthening Grant • Support the GFU to prepare and submit the January – June 2015 progress report for the Round 9

Phase II HIV and Malaria, Round 7 Interim NFM TB, and the Round 8 – Health Systems Strengthening grants

• Continue supporting DPC in monitoring the Global Fund (and other donor/audits) recommendations related to data quality

• Continue supporting DPC to manage and implement special grant conditions • Continue supporting the World Bank Unit to monitor the progress of the Health Services Delivery

Project (HSDP) activities

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Sub-IR 3.2: Strengthen Department of M&E at MISAU • Assist DPC to carry out the QAD 2015-1019 validation workshop • Support M&A staff to improve data collection for implementing indicators (PES, PARI, PQG) and

projects (UFG and UBM), as well as to elaborate monthly PES and PARI balance reports and quarterly QAD 2015-2019 reports

• Support DIS staff to improve their feedback tools to strengthen data quality, data analysis and monthly reporting, and guarantee data validation through meetings held within the respective programs

• Support the training program on Planning, M&E and SIS for the health sector (central level) in collaboration with DPC and WHO

• Continue supporting DIS in training and implementing the SISMA • Support DPS M&E Unit strengthening and technical assistance through planning exercises and

supportive supervision (in Inhambane Province) • Continue supporting DPC and DTIC in implementing the document management software • Continue supporting MISAU during the migration of SIS-H and SIS-ROH to DHIS2 platform • Continue supporting DCP to complete the inventory of infrastructure, equipment and human

resources Sub-IR 3.3: Support CMAM to establish an M&E Unit and effectively manage performance • Finalize the SOPs for CMAM performance indicators • Begin to develop the SOP for the M&E department • Complete a revision of current indicators—eliminating, updating, and adding if necessary—in

coordination with conversations with CMAM departments and SCMS • Begin to develop a dashboard for the departments to support timely, evidence-based operations

decisions • Continue to identify opportunities for collaboration between MISAU and CMAM M&E Departments

3.4 Intermediate Result 4: Improved management and retention of health and social welfare staff Sub-IR 4.1: Integrate and coordinate APE Program • Complete recruitment for a local APE Advisor focused on logistics • After hiring, onboard local advisor and resume support to the APE Program Sub-IR 4.2: Strengthen and support sustainability of educational programs with MGCAS • Continue to provide operational and technical support for the Childhood Educator course in

Maputo • Continue to develop the Level 3 and 4 guidelines for curriculum package for Social Welfare course • Continue to develop the Level 5 guidelines for curriculum package for Early Childhood Educator

course • Kick-off evaluation for 2012-2014 courses implemented in Maputo, Beira and Lichinga • Support MGCAS in lobbying and advocacy efforts to fund its competency-based curriculum and

related certification processes, especially with PIREP/COREP Sub-IR 4.3: Increased capacity of DPGCAS • Continue to provide operational and technical support for the regional social welfare courses in

Lichinga and Beira

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• Support the DPGCAS in Niassa and Sofala to implement activities within their capacity development action plans to address prioritized gaps

• Follow up and support the targeted DPGCAS and the training institutions on planning for implementation, logistics and management of the 2015 level 5 TAS courses activities and resources

• In partnership with MGCAS and IFAPA (Lichinga and Beira), develop the training plan for the short-term courses for staff capacity building of the selected DPGCAS (Tete, Zambézia and Cabo Delgado)

• Support MGCAS to strengthen its institutional liaison/partnerships with MISAU; special attention will be paid to MGCAS-DRH and DF (Training Department) in response to a formal request from MISAU to incorporate the future training activities of MGCAS for the next incoming years

• Support MGCAS and DPGCAS to increase institutional liaison/partnerships with DPS and targeted training institutions (health training institutions and IFAPA and or other Universities) from Maputo, Beira and Lichinga

• Supporting Niassa and Sofala DPGCAS to strengthen its institutional staff, partnership and courses knowledge, encouraging and conducting exchange of experience visits between Lichinga focal points and Sofala focal points involved in the provincial TAS courses process.

Sub IR 4.4: Strengthen and support MISAU Human Resources Integrated Planning Process • Direct support of DRH activities to be on hold while adviser is on maternity leave May-August 2015

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4. Project Performance Monitoring (PMP) The project’s M&E component is linked with the capacity building of local counterparts to collect, report, analyze and use indicator data to measure progresses against national objectives and targets. FORSSAS leverages existing technical advisors within the Ministries to capitalize on opportunities to assist counterparts with data management and use.

In alignment with national systems, the project uses the national system for its M&E data, where possible. While there are advantages to this approach in terms of long-term sustainability and country ownership, there are also disadvantages. Data is not always available in time for reporting to USAID and the quality of data is impacted by system weaknesses.

Over the past quarter, the following project indicators experienced notable improvement or achievement:

• The outcome indicator percent of health expenditure execution compared to original approved health budget shows an improvement compared to the same period of the previous year (21% in January – March 2014 and 33% in January – March 2015). This indicator has experienced steady improvement over the life of the FORSSAS project.

• The output indicator simultaneous NHA production and institutionalization (ranked on a scale) experienced an improvement due to recent progress of the NHA development and review process.

The following indicators experienced notable decline: • The indicator on completeness and timeliness of data submitted through the Modulo Basico

(number and percentage of districts submitting timely, complete and accurate Modulo Basico reports) showed a decrease since the period January – March 2015 (from 73% in September – December 2014, to 59% in January – March 2015 to 56% in April – June 2015) due to a specific indicator (consulta de crianças de 1 – 4 anos) that was not reported by some provinces. The project expects an improvement of data completeness for the next quarter.

• The output indicator percent of payments that arrive to RCPC with complete documentation experienced a decrease compared to the same period of the previous year (Expenditures: 83% and Investments: 93% in April – June 2014; Expenditures: 47% and Investments: 27% in April – June 2015) FORSSAS will investigate the causes for thes decrease in the coming quarter.

5. Success Stories 5.1 DPGCAS Niassa advocacy and student testimonials demonstrate value of provincial social welfare courses Prior to the delivery of standard social welfare courses supported by the FORSSAS project, many of the current students worked in the health or sectors but did so without any specialized training. Others may have served administrative or operational roles in the health or other sectors, as opposed to technical roles. These individuals did not receive advanced professional training, let alone social welfare-specific training.

As a result of the Level 3-5 social welfare courses, students have been able to advance their careers, resulting in increased salary, increased responsibility, and increased professional potential. In fact, some Level 5 social welfare graduates from 2014 have even been promoted due to their completion of the course. These individuals were promoted from administrative to management roles in their districts, demonstrating the potential for career advancement due to the course and the credibility placed by

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provincial administrations on the training that the courses provide. Student testimonials demonstrate the value of provincial social welfare courses in advancing social welfare careers:

• “Before the TAS Level 5 course, I fulfilled an ordinary administrative role at SDSGCAS Chiure. After graduating, I have been appointed as the head of the division of Gender, Child, Social Action in my district.”

• “The social welfare training was so valuable for me and the province, because we had lack of personnel trained in the social welfare field. … Because of our testimony, other colleagues have been motivated to apply for the course.”

• “Before the TAS level 5 course, I was an ordinary administrative personnel. After graduating, I was promoted by the Provincial Director of DPGCAS Nampula to be a General Director. … I was the only one promoted in DPGCAS Nampula, thanks to my TAS Level 5 course graduation.”

Further, this type of professional development program helps to incentivizes workers to return to work in their home districts, as well as to remain in the health sector due to availability of additional professional opportunities. Pre- and in-service training of students is not the only requirement for career improvement. Sustainable workforce development also requires the recognition on behalf of administrative and legislative provincial stakeholders that these courses add value; these stakeholders are required to approve fulfillment of social welfare vacancies prior to graduates assuming these roles. FORSSAS is starting to see increased advocacy by provincial stakeholders for this type of workforce development. For example, the DPGCAS Director in Niassa supported this process by advocating directly for the fulfillment of vacancies with Level 5 course graduates, including advocating to the provincial governments including the provincial Permanent Secretary (PS). Increased advocacy on behalf of provincial MGCAS leadership demonstrates initiative required to fill vacancies, as well as accountability for professional development of their health workforce. The evaluation to be completed by FORSSAS of 2012-2014 will help to support this type of advocacy across provinces. Additionally, participating provinces such as the Nampula DPGCAS are beginning to discuss the value of decentralizing courses to every province, as opposed to only sending students to neighboring provinces. This type of wide scale decentralization of courses can help realize cost efficiencies in workforce development. 5.2 FORSSAS trains 434 health professionals in standardized finance systems in conjunction with MISAU Over the past several years, Mozambique has paid an increasing amount of attention to financial management and governance systems in the health sector. Standardization of financial management processes, decentralization of budget authority, and roll-out of its national financial management information system, e-SISTAFE, are key GRM priorities. These country priorities align with the current objectives for efficiency and sustainability defined in PEPFAR’s current strategy to achieve an AIDS-free generation. MISAU, together with FORSSAS, developed and documented budgeting and execution procedures for all levels of the public health system. FORSSAS supported the Ministry to author the first financial operations manuals for the central and provincial levels in over a decade. FORSSAS trained 110 central-level and an additional 324 provincial-, district-, and facility-level health professionals from all 11 provinces, the latter in partnership with the Danish

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Agency for International Development (DANIDA). The training courses were the first financial management courses to be led by the Ministry in recent history. Standardization and decentralization activities supported by FORSSAS sought the following principal objectives:

• Improve health outcomes through greater efficiency in the flow of funding to decentralized levels of the system, including service delivery points

• Encourage greater involvement and ownership of planning, budgeting and financial governance by health program teams

• Standardize budgeting, programming, and financial execution, including uniform financial statements and proper management of financial archives across the country

• Increase compliance with national laws and regulations and donor requirements • Build capacity to track and govern donor funding, which inspires confidence in local systems and increases

likelihood of greater sums of and diversity in funding for health • Provide health sector leadership with tools for managing financial operations performance

The manuals and training cover a wide range of topics including planning and budgeting, internal controls, use of national accounting systems and regulations, audit preparation, and performance metrics. Customized courses were developed for health program finance teams, building their capacity to plan, budget, and monitor financing for their programs and understand the procedures for employing financial procedures more efficiently and effectively. Training finance teams not only introduces a greater level of adherence to established procedures and greater confidence in the financial control systems, but also pushes budget ownership and control closer to the health programs and health facilities, allowing them to spend funding where it will have greater impact on the services they provide.

Participants from Niassa take part in one of the first financial management courses to be led by the Ministry in recent history

“I’m leaving this course with the knowledge to help the institution I serve to achieve its

mission.”

-Maputo City Health Directorate participant

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Annex 1: Indicator Measurement Matrix

Indicator Operational Definition

Data Source Reporting Frequency

Baseline (Date)

Current Value (FY15 Q3)

Comments

1

Payment processing lead time (days) (Disaggregated by DAF vs. CMAM Finance and by type of invoice: routine goods and services, construction and equipment)

= Invoice payment date - Date of invoice receipt

Accounting Division(s) Files and Payment Vouchers

Quarterly

12.7 days (Operational

expenditures) 19.7 days

(Investments and capital purchases)

Expenditures: 24.4%

Investments: 13.2%

Indicator will be revised in the updated PMP given challenges with data collection.

2

Percent of payments that arrive to RCPC with complete documentation, (RCPC measures DAF performance; CMAM performance will be measured by percentage of complete processes)

=(Total number of paid vouchers received by the RCPC with incomplete supporting documentation/ Total number of paid vouchers received by the RCPC)

RCPC Accounting System/CMAM Process Documentation

Quarterly Data not yet

received

Expenditures: 47%

Investments: 27%

Indicator will be revised in the updated PMP given challenges with data collection.

3 Completion percentage of planned audit activities (CMAM Internal Audit)

= (Total number of activities completed/Total number of activities planned)*100

IA Annual Plan Semi-annually

91% (20/22) (2013)

N/A FORSSAS support to supporting activities is now complete

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Indicator

Operational Definition

Data Source Reporting Frequency

Baseline (Date)

Current Value (FY15 Q3)

Comments

4

Cycle time from tender to contract award (Days) (Disaggregated by public tenders versus direct tenders)

Public Tender = (Date of award confirmation notification) – (Date of request approval to launch public) Direct Tender = (Date of award confirmation notification) - (Date of request approval for contracting using exceptional regime)

Procurement Information Management System (PIMS) (beginning November 1, 2013)

Annually

Public Tender: 225 days (Oct ’12- Jan ‘13)

Direct Award:

47 days for (Oct ’12- Jan

‘13)

N/A Annual indicator

5 Revised Regulamento Internal delivered and approved (Ranked on a scale)

Scale1 FORSSAS SCM Advisor

Quarterly 1 (Oct ‘13) 3 FORSSAS support to supporting activities is now complete

6 % of Health expenditure execution compared to original approved health budget

N=total health expenditure D=total health budget

Annual Health Budget and DAF execution report

Annual 87%

(Jan – Dec 2012)

33% (Jan – Mar 15)

Partial year results reported

1 0 = Regulamento Internal does not exist and is not under development; 1 = Regulamento Internal is under development but not yet approved; 2 = Regulamento Internal is approved by CMAM and Minister of Health; 3 = Regulamento Internal is approved by CMAM and implementation is initiated; 4 = Implementation of approved Regulamento Internal is complete

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Indicator

Operational Definition

Data Source Reporting Frequency

Baseline (Date)

Current Value (FY15 Q3)

Comments

7

Health Financing Strategy Implementation Plan Documented/Implemented (Ranked on a scale)

Scale2

Project Quarterly Reports

Quarterly 0 (Dec ’12) 1

8 Simultaneous NHA production and institutionalization (Ranked on a scale)

Scale3

NHA reports; NHA institutionalization plan

Annual 2 (Dec ’12) N/A Annual indicator

9a # and % of GF special conditions met (and approved by LFA) in the area of Finance

N=# of conditions met (in relative area) D= # of conditions (in relative area) for the reporting period established in the Global Fund Grant Agreement(s)

Global Fund Condition Tracker, Global Fund Management Letters

Semi-annual

50% (2/4) (Jan-Sep ’12)

No PUDRs submitted during the

period

9b # and % of GF special conditions met (and approved by LFA) in the area of M&E

54% (7/13) (Jan-Sep ’12)

9c

# and % of GF special conditions met (and approved by LFA) in the area of Procurement

50% (6/12) (Jan-Sep ’12)

2 0 = HFSIP does not exists and is not under development; 1 = HFSIP is under development but not yet approved; 2 = HFSIP is approved, but implementation has not begun; 3 = HFSIP is approved, implementation has begun, but is not completely effective; 4 = HFSIP is approved, implementation has been completed and repeatable, data outputs are used for decision making

3 1 = NHA team not been established and no institutional home for NHA; 2 = NHA team and institutional home for NHA have been identified; data collection has not commenced; 3= Data sources and key stakeholders for the NHA process have been identified; discussions have been commenced with the statistics bureau about collection of private sector data; 4 = NHA Steering Committee has been organized to support the NHA exercise and drive the demand for data; 5= NHA institutionalization plan has been drafted

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Indicator

Operational Definition

Data Source Reporting Frequency

Baseline (Date)

Current Value (FY15 Q3)

Comments

10 # and % Global Fund PUDRs submitted on time

N=Number of PUDRs submitted to the Global Fund 45 days after the end of the reporting period D= total PUDRs submitted to the Global Fund in the reporting period

Date of submission for each PUDR

Quarterly 3 (33%) (Sep 11- Sep 12)

No PUDRs submitted during the

period

11

# and Percentage of districts submitting timely, complete and accurate Modulo Basico reports

N= Number of district reporting at least 80% of the required monthly summary sheets on time D= Total number of districts

HMIS Quarterly 31%

(Jan-Sep2012) 56%

12

Number of social workers and early childhood educators graduated from pre-service training program, disaggregated by sex and cadre

Number of social workers graduated (one year course) and number of early childhood educators successfully completed each level of the course

Local training institute reports

Quarterly 0

(Dec 2012) 176

This is a cumulative figure. Between 2011- and 2014, 151 social action technicians and 25 early childhood educators have graduated from competency-based courses supported by the new curriculum.

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Indicator

Operational Definition

Data Source Reporting Frequency

Baseline (Date)

Current Value (FY15 Q3)

Comments

13

Percent of provinces that submit timely monthly reports to the APEs program at central level

Percent of provinces that submit monthly summary sheet for M&E data up to the central level according to the deadline established

APEs monthly data form provincial/district summary

Quarterly 60% (Oct-Dec 2012)

Data not available

Data collection of this indicator will resume when FORSSAS support to the APE Program resumes

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Government (MISAU, MGCAS, etc.) has incorporated professional medium-level courses of social workers and child educators into their annual plan and budget (Ranked on a scale)

Scale4 Project reports and

PES Annual

0 (Dec 2012)

N/A Annual indicator

4 0 = No courses budgeted in the annual plan; 1 = Policy dialogue started; 2 = Agreement exists between MGCAS and other ministries, but no budget is available; 3 = Plan approved and Budget available (state budget and external sources); 4 = The plan is implemented