The Global Fund Board endorsed the Monitoring and Evaluation Framework for the new 2023-2028 Strategy
Author:
Samuel Muniu
Article Type:Article Number: 4
The Board approved Key Performance Indicators for measuring the progress in implementing the Global Fund’ s new strategy
ABSTRACT At its 48th meeting held on 15–17 November 2022 in Geneva, the Global Fund Board endorsed the Monitoring and Evaluation Framework that the Secretariat will use to measure progress over the next Strategy period. It also approved the Key Performance Indicators and the topics for the Multi-Year Evaluation Calendar that are part of the Monitoring and Evaluation Framework.
A well-functioning monitoring and evaluation system is essential to facilitate performance management, continuous learning, and improved decision-making, as well as enhancing accountability. On 17 November 2022, the Global Fund endorsed the components of the Global Fund’s Monitoring and Evaluation (M&E) Framework for its 2023-2028 Strategy. The Board also approved Key Performance Indicators (KPIs) and topics for the Multi-Year Evaluation Calendar. By doing so, the Board endorsed the organization’s framework for measurement over the next Strategy period. It also linked the M&E Framework to the design of the new grants in 2023.
The Board discussed and approved a decision point which was approved unanimously and can be found at the end of the article.
The four interlinked M&E Framework components
The Global Fund’s M&E Framework is divided into four interlinked components:
- Strategic monitoring
- Strategic and thematic evaluation
- Secretariat monitoring
- Program monitoring
Strategic monitoring refers to the routine data collation, aggregation, and analysis involved in generating key insights related to high-level Strategy performance through Board-approved KPIs. They are divided into three categories: impact, strategy, and financial KPIs.
Strategic and thematic evaluation are the periodic independent assessments conducted to assess progress in achieving program outcomes. They support improvements in the performance of Global Fund investments and the business model for implementing the Strategy. They also provide independent assurance on the extent of program progress. The new Independent Evaluation Panel (IEP) is responsible for the strategic and thematic evaluation
Secretariat monitoring refers to data generated from daily Secretariat operations and its subsequent analysis. The data are generated from monitoring program implementation and from the Global Fund’s internal data systems.
Program monitoring includes the routine periodic data collected by countries through their existing routine national monitoring systems and reported to the Global Fund. Countries report to the Global Fund through performance and monitoring frameworks. Performance Frameworks (PF) are developed for each grant and describe intended grant achievements, how performance should be measured, and the targets to be reached. Monitoring Frameworks are used for the Global Fund’s three catalytic investments categories: matching funds (MFs) to catalyze increased programming in specific priority areas, multi-country grants supporting initiatives that cover multiple countries or regions, and Strategic Initiatives (SIs) to support programs that cannot be funded through country grants. The Monitoring Framework for MFs and multi-country grants is integrated and guided by the PFs. For the SIs, the Monitoring Framework is tailored to the specific measurement needs of the investment priorities.
KPIs for the 2023-2028 Global Fund Strategy
The Board approved the 48 KPIs proposed by the Strategy and Audit and Finance Committees (SC and AFC) . These are divided into three categories: Impact, Strategy Outcome KPIs and Financial.
Impact KPIs
Impact KPIs measure the Global Fund partnership’s progress in attaining high-level aggregate health outcomes of ending HIV, TB, and malaria (HTM). The SC will oversee the selection of the metrics and technical partners’ reports will be the source of data for KPI reporting. There are two KPIs in this category:
- KPI I1: Mortality rate –measures the reduction in deaths attributed to HIV, TB, malaria (HTM)
- KPI I2: Incidence rate –measures the reduction in new cases of HTM infections.
Strategy KPIs
These measure the extent to which the Global Fund meets The Strategy’s goals and objectives. The SC will oversee these KPIs, to be developed through the Measurement Consultation process. The Secretariat, program reports and technical partners’ reports are the data sources for reporting on these KPIs.
These KPIs are categorized based on the Strategy’s objectives. There are seven KPIs for ending AIDS, six for TB, and five for malaria as summarized below.
Table 1: KPIs for ending AIDS, TB, and malaria
| End AIDS, TB, and malaria | Definition |
| H1: People living with HIV who know their status | Percentage of people living with HIV who know their HIV status |
| H2: Antiretroviral therapy (ART) coverage | Percentage of people living with HIV who are on ART |
| H3: Viral load suppression | Percentage of people living with HIV and on ART who are virologically suppressed |
| H4: Key population (KP) reached with prevention programs | Percentage of KP reached with HIV prevention programs-defined package of services |
| H5: Adolescent girls and young women (AGYW) reached with prevention programs | Percentage of high-risk AGYW reached with HIV prevention programs-defined package of services |
| H6: Elimination of vertical transmission | Percentage of pregnant women living with HIV who received antiretroviral medicine |
| H7: People living with HIV (PLHIV) on ART who initiated TB prevention treatment | Percentage of PLHIV on ART who initiated TB preventive therapy |
| T1: TB cases notified, all forms | Number of patients with all forms of TB notified |
| T2: TB treatment success rate, all forms | Performance for TB Treatment Success Rate (all forms) |
| T3: People with confirmed drug resistant TB (DR-TB) on treatment | Percentage of people with confirmed rifampicin-resistant TB and/or multi-drug resistant TB on treatment |
| T4: DR-TB treatment success rate | Performance for Treatment Success Rate of rifampicin-resistant TB and/or multi-drug resistant TB |
| T5: TB contacts on preventive therapy | Number of people in contact with TB patients who began preventive therapy |
| T6: ART coverage for HIV-positive TB patients | Percentage of HIV-positive registered TB patients on ART |
| M1: Long-lasting insecticidal nets (LLINs) distributed | Number of LLINs distributed through mass campaign and continuous distribution |
| M2: Malaria testing, public facilities | Proportion of suspected malaria cases that receive a parasitological test at public sector health facilities |
| M3: Malaria cases treated, public facilities | Proportion of confirmed malaria cases that received first-line antimalarial treatment at public sector health facilities |
| M4: At least three doses of Intermittent Preventive Treatment of Malaria for Pregnant Women (IPTp3) coverage | Proportion of pregnant women attending antenatal clinics who received three or more doses of intermittent preventive treatment for malaria |
| M5: Children receiving full course of seasonal malaria chemoprevention (SMC) | Percentage of children who received the full number of courses of SMC per transmission season in the targeted areas |
There are 10 KPIs to measure the Global Fund’s efforts to maximize people-centered integrated systems for health to deliver impact, resilience, and sustainability as summarized below.
Table 2: KPIs for maximizing people-centered integrated systems for health to deliver impact, resilience, and sustainability
| Maximizing People-centered Integrated Systems for Health to Deliver Impact, Resilience and Sustainability | Definition |
| S1: Provision of integrated people-centered, high-quality services | Percentage of countries with improvement in scores for provision of integrated, people-centered, high quality service delivery from latest baseline |
| S2: Provision of integrated supportive supervision | Percentage of countries with improvement in scores for provision of integrated supportive supervision at health facilities from latest baseline |
| S3: HTM integrated services offered to pregnant women | Percentage of countries with improvement in scores for provision of HTM integrated services to pregnant women from latest baseline |
| S4: Community systems for service delivery | Percentage of countries with systems in place for community health service delivery |
| S5: Systems readiness for community health workers | Percentage of countries with improvement in scores for system readiness for community health workers from latest baseline |
| S6a: Secure, maintained and interoperable Health Management Information Systems (HMIS) | Percentage of countries with digital HMIS functionality baseline maturity score of 3 or less that increased by at least one maturity level |
| S6b: Data driven decision making | Percentage of countries with data use maturity score of 3 or less that increased by at least one maturity level in terms of leveraging programmatic monitoring for data driven decision making |
| S7: Use of disaggregated data for planning or decision making | Percentage of countries that have documented evidence of using required disaggregated data to inform planning or programmatic decision making for priority populations in HIV, TB and malaria |
| S8: On Shelf Availability | Percentage of health facilities with tracer health products available on the day of visit for HIV, TB & malaria respectively |
| S9: Supply Continuity | Percentage of priority products with the desired number of suppliers that meet Quality Assurance requirements |
| S10: Introduction of new products | Percentage of new products introduced, from an agreed list of new products |
The KPIs for community engagement, equity, gender equality and human rights, resource mobilization, and pandemic preparedness and response are summarized below.
Table 3: KPIs for measuring community engagement, equity, gender equality and human rights, resource mobilization, and pandemic preparedness and response
| KPI | Definition |
| Maximizing Engagement and Leadership of Most Affected Communities to Leave No One Behind | |
| C1: Community engagement across Global Fund grant cycle | Satisfaction of communities with engagement across the grant cycle consistently above minimum acceptable level |
| Maximizing Health Equity, Gender Equality and Human Rights | |
| E1: Scale up of programs to address Human Rights-related barriers | Percentage of countries with increases in scale of programs to reduce Human Rights-related barriers for HTM |
| E2a: Reaching marginalized sub-populations | Percentage of countries with at least half of the custom equity indicators performing at minimum acceptable level |
| E2b: Reducing inequities in HTM | Percentage of countries with at least half of the custom equity indicators showing a faster progression compared to the standard indicator |
| E3a: Advancing gender equality –engagement in grant cycle | Satisfaction of women and gender-diverse communities with engagement in grant cycle consistently above minimum acceptable level |
| E3b: Performance of gender-specific indicators | Percentage of countries with at least half of the gender indicators performing at minimum acceptable level |
| Mobilizing Increased Resources | |
| R1a: Realization of domestic co-financing commitments | Percentage realization of domestic co-financing commitments to health across the whole portfolio |
| R1b: Mitigation actions for countries at risk of not meeting co-financing commitments | Percentage of milestones achieved for implementation of mitigating actions by countries at risk of not meeting co-financing commitments |
| R2: Timeliness and quality of external audit process performed by SAIs | Percentage of countries meeting criteria of timeliness and quality for audit deliverables |
| R3: Announced pledges | Announced pledges as ratio of Replenishment target |
| Contribute to Pandemic Preparedness and Response | |
| P1: Laboratory testing modalities | Percentage of countries with improved or sustained high performance in laboratory testing capacity modalities |
| P2: Early warning surveillance function | Percentage of countries with improved or sustained high performance in early warning surveillance function |
| P3: Human resources for implementation of International Health Regulations (IHR) | Percentage of countries with improved or sustained high performance in human resources for implementation of IHR |
Financial KPIs
Financial KPIs track the Global Fund’s financial indicators. The AFC oversees their metrics and the Secretariat and program reports provide the data sources. These KPIs are:
- KPI F1: Pledge conversion –measuring the pledge conversation rate
- KPI F2: Corporate asset utilization –the utilization of corporate assets across approved uses of funds
- KPI F3: Allocation utilization –the portion of allocated grant funds that are disbursed or forecast to be disbursed
- KPI F4: In-country absorption – the portion of grant budgets reported by country programs as spent on services delivered
Constituencies’ feedback and Board discussion
Constituencies provided their written feedback on the new framework. Some indicated that the new framework should emphasize national and grant outcomes in terms of disease control. While some appreciated how difficult it is to measure grant sustainability, they also wanted this to be monitored by KPIs. In addition, others requested the Secretariat to ensure that co-financing commitments are realistic and can be monitored. Some constituencies supported the new KPIs for measuring resilient and sustainable systems for health (RSSH) grant performance and further recommended that measurements be developed to capture how disease/system integration, quality of care, and health system strengthening contribute to HTM outcomes.
While applauding the effort that has gone into creating a robust M&E Framework, some constituencies requested more details on the plans to adjust the KPI targets considering the replenishment outcome. Others highlighted country-level data quality and availability challenges and requested the Secretariat to describe how it would ensure the generation of high-quality data. Others wondered how the Secretariat will synthesize the large amount of data generated by the M&E framework and if this can be done in time to enable timely decision making.
In the meeting itself, all speakers were unanimous in their support of the participatory approach and consultations, and the extensive work that had gone into the development of the framework.
Some members were concerned that countries are not overburdened with data collection given multiple partner requests for data. This extra burden on countries would, they felt, result in hastily-collected poor quality data.
Finally, stakeholders noted that the Global Fund should pay greater attention to learning as we often learn very little from what we measure, but the lessons learned are often as important as what is being measured.
Decision-point: Topics for Multi-Year Evaluation Calendar 2023-2028 approved by the Board
The Board approved 20 topics for the Multi-Year Evaluation Calendar for 2023-2028. These are the end-term Strategic Review for 2017-2022, resource allocation model, country steered review, the COVID-19 Response Mechanism, the 2023-2025 funding request/ grant-making cycle, gender, community engagement, community systems strengthening, HIV, TB, Malaria, and RSSH. The others are the quality Services, sustainability, human rights, data systems, innovations, mid-term Strategic Review for 2023-2028, the private sector, pandemic preparedness, data-driven equitable response, and partnerships.
| Decision Point: GF/48/DPXX: 2023-2028 M&E Framework, KPI Framework and Multi-Year Evaluation Calendar
The Board acknowledges and appreciates the extensive work across the partnership to incorporate past lessons into development of an improved holistic approach to Monitoring and Evaluation (M&E) for the new Strategy. The Board notes the recommendations of the Strategy Committee (SC) and Audit and Finance Committee (AFC), as set forth in GF/B48/04 and:
Budgetary implications: Budget for the Independent Evaluation Function is included in the 2023 OPEX and will be requested annually in line with approved workplans. No specific budgetary implication for the implementation of the KPI Framework |
The Board Document GF/B48/04, Global Fund Monitoring & Evaluation (M&E) Framework including KPIs and the Multi-Year Evaluation Calendar should be available shortly at https://www.theglobalfund.org/en/board/meetings/48
