health leadership project (hlp)

HLP Annual Report, Fiscal Year 2019, May – September 2019 1

Health Leadership Project (HLP) Annual Progress Report

May 2 – September 30, 2019

Fiscal Year 2019

Submitted to USAID: November 9, 2019 Agreement Number: 7205119CA00004 Submitted by: Management Sciences for Health Project Director: Dr. Georges Dubuche Email: [email protected]


TABLE OF CONTENTS

PROJECT ACTIVITY SUMMARY FORM 3

ACRONYMS 4

EXECUTIVE SUMMARY 5

I. PROJECT MANAGEMENT 6

II. CURRENT PROJECT ACTIVITIES 8

III. KEY PROJECT ACTIVITIES FOR THE NEXT QUARTER 15

LIST OF TABLES

Table 1: Management priorities addressed during this reporting period 6 Table 2: Management priorities for the next reporting period 8

Caption for cover page photo: The CFET team during the organizational capacity assessment using the OSCAR tool

This document was produced for review by the United States Agency for International Development. It was prepared by Management Sciences for Health for the USAID Haiti Health Leadership Program, Agreement No. 72052118RFA00005.


PROJECT ACTIVITY SUMMARY FORM Project Name: Health Leadership Project (HLP)

Project Objectives: HLP supports two objectives: 1. Build GOH Capacity to Lead and Finance the Health Sector 2. Improve GOH Planning and Oversight of the Health Workforce

Implementing Partners: Prime: Management Sciences for Health Sub-awardees: Group Croissance (GC) and Centre de Formation et d’Encadrement Technique (CFET)Agreement: 7205119CA00004

Life of Project (start and end dates): May 2, 2019 – May 1, 2024

Reporting Period (start and end dates): May 2 – September 30, 2019

Total Estimated Contract/Agreement Amount: $7,503,387.29 (including cost share)

Obligations to Date: $3,804,661.61

May 2 – September 30, 2019 Expenses: $689,367.86

Accrued Expenditures for the Reporting Period: $4,662.79

Total Project Expenditures as of September 30, 2019: $694,030.65

Obligated Funds Remaining: $3,110,630.96

Estimated Expenditures for Next Quarter: $340,000.00

Report Submitted by: Dr Georges Dubuche, HLP Project Director

Report Submission Date: November 9, 2019


ACRONYMS

ASCP Agent de Santé Communautaire Polyvalent CFET Centre de Formation et d’Encadrement Technique DAB Direction d’Administration et du Budget DPSPE Direction de Promotion de la Santé et de la Protection de l’Environnement DRH Direction des Ressources Humaines GC Group Croissance GFF Global Financing Facility GOH Government of Haiti MSH Management Sciences for Health MSPP Ministère de la Santé Publique et de la Population NUPAS Non-US organization Pre-Award Surveys OMRH Office du Management et des Ressources Humaines OSCAR Organizational Synthesis of Capacity Assessments for Award Readiness PES Paquet Essentiel de Services PMP Performance Monitoring Plan PY Project Year Q Quarter UAS Unité d’Arrondissement Sanitaire UEP Unité d’Etudes et de Programmation USAID United States Agency for International Development


EXECUTIVE SUMMARY

The USAID-funded Health Leadership Program (HLP), is a five-year program (May 2, 2019 – May 1, 2024) with the goal of strengthening the Government of Haiti (GOH) as steward of the health sector, increasingly in control of its own financial and human resources, over a coordinated system that is less reliant on external partners for equitable delivery of quality health services. HLP’s two objectives are to: ⮚ Objective 1: Build GOH Capacity to Lead and Finance the Health Sector ⮚ Objective 2: Improve GOH Planning and Oversight of the Health Workforce HLP is implemented by Management Sciences for Health (MSH) and Local Solution Partners Group Croissance (GC) and the Centre de Formation et d’Encadrement Technique (CFET). In years 1 and 2, MSH is USAID’s prime implementing partner and will be accountable for achieving the targets and deliverables for each of HLP’s objectives in collaboration with GC and CFET. MSH will also work closely with GC and CFET to strengthen their organizational capacity to ensure that they meet USAID’s technical and financial standards to receive direct funding from USAID in years 3-5. In year 3, when one or both local solutions partners become primary recipients, they will become accountable for achieving HLP’s objectives and targets for years 3 -5. At this time, MSH will be accountable for providing ongoing organizational and technical capacity building support to these organizations. This report describes HLP activities from May 2 – September 30, 2019.


I. PROJECT MANAGEMENT

Table 1: Management priorities addressed during this reporting period Management priorities addressed during this period

Status of accomplishment in the reporting period

Comments

Management and Staffing

Ongoing HLP completed the recruitment of project staff except for the Sub-award and Compliance Manager. A candidate was selected for this position; however, she was unable to accept the offer due to ongoing security concerns in the country. As such, HLP relaunched the recruitment process and will aim to onboard a selected candidate in November 2019. Staff and partners participated in an orientation to the project and completed several onboarding trainings in the areas of Standards of Technical Excellence, financial management, and procurement, among others.

Project year (PY) 1 implementation plan, narrative, and budget

Ongoing HLP submitted the first draft of the PY1 implementation plan, narrative and budget to USAID on May 31, 2019. Based on comments and feedback from USAID, the HLP team met on several occasions with the Ministère de la Santé Publique et de la Population (MSPP) to present the HLP project and to review proposed activities and revise the plan based on country needs and priorities. On August 13, HLP held the first meeting with the Director General of the MSPP to formally present the HLP project and request follow up meetings with the Central Directorates and their staff. On August 16, HLP presented the HLP project and its objectives during a second meeting convened by the Director General with all Directorates and their respective units. Following these initial introductions, HLP met on two occasions with the MSPP (August 20 and 23) to discuss and review the PY1 implementation plan in order to better align it with the MSPP’s vision and priorities. HLP maintained communication with the MSPP during ongoing periods of insecurity and political unrest via phone and email to complete revisions and obtain MSPP validation


of the year 1 work plan. The HLP team finalized all year 1 deliverables (implementation plan, narrative, and budget) which were submitted for approval on October 31, 2019.

MEL plan Ongoing On July 31, 2019, HLP submitted the MEL Plan to USAID. Based on comments and feedback from USAID, the HLP team has revised the plan in alignment with the new version of the work plan. The MEL plan was resubmitted to USAID on October 26, 2019. HLP will begin reporting results in the PMP in the next quarter once the PMP has been approved.

Gender and Social Inclusion Strategy

Completed The project submitted the Gender and Social Inclusion Strategy to USAID on May 31, 2019.

Engagement with local solutions partners

Completed MSH finalized and signed the official sub awards with GC and CFET in FY19Q4 and conducted an orientation session with the partners on the requirements and regulations in the sub awards.

Branding and Marking Plan

Completed HLP submitted the Branding and Marking Plan to USAID in May 2019. The document was approved by USAID on May 31, 2019.

PEPFAR COP19 narrative and HRH Inventory tool

Completed HLP submitted the PEPFAR COP19 narrative to USAID on June 25, 2019. HLP also held working sessions with the USAID/PEPFAR team on July 24, 2019, to prepare the HRH Inventory tool.

Purchase of office supplies and equipment

Ongoing During the reporting period, HLP received equipment, office supplies, and two vehicles from Chemonics. In FY20Q1, HLP plans to purchase any remaining office supplies needed to complete office set up.


Table 2: Management priorities for the next quarter Management priorities for the next reporting period

Resources needed

Comments

Complete all required reports, including quarterly accrual and progress reports

Staff time This is an ongoing requirement enabling HLP and USAID to monitor progress.

Finalize office layout, purchase of office equipment and supplies

Staff time HLP will finalize office set up and the purchase of equipment for the project year 1 in the next quarter that will include office supplies, additional office furniture, and one satellite phone which is particularly important during this period of insecurity.

II. CURRENT PROJECT ACTIVITIES

The majority of HLP activities during the fiscal year were focused on managerial and operational startup activities. HLP collaborated closely with USAID to plan for initial technical discussions with the MSPP and the official presentation of HLP to MSPP central directorates and partners. Objective 1 1.1 Sustainable financing for health increased In year 1, HLP developed the 2018-2019 MSPP Budget Analysis, including source data, data analysis, chart/graph production, and report writing. This analysis will help the MSSP to effectively monitor domestic resources allocated to health in the national budget and to highlight the efforts needed to increase and manage domestic resources for health. As a result of this plan, the MSPP is able to track the following indicators:

● % of national budget allocated to health; ● % of the MSPP budget expended; ● % of the MSPP budget allocated to Human Resources for Health; ● % of domestic resources allocated to health; ● % of health investment budget.

In order to increase sustainable financing for health in Haiti, HLP has committed to providing technical support to the MSPP to finalize the development of the health financing strategy. To do so, the MSPP has requested support from HLP to further diagnose/analyze the current health-financing context in Haiti, with a focus on these main components:

1. The management and use of internal revenue within the public health system; and 2. A situation analysis of public and private health insurance companies (including the

mutuelles de santé).


The diagnosis of health financing will provide a roadmap for advancing national health priorities and include evidence-based strategies to improve all functions of the health financing system. 1.2 Public Financial Management Improved Building on the work of the HFG USAID-funded project, one of the priorities under HLP is to support hospitals in the installation of electronic cash registers to improve the management of hospital revenues and increase domestic resources. In FY19Q4, HLP worked jointly with the Unité d’Etudes et de Programmation (UEP) to develop a terms of reference (ToR) for a workshop for hospitals to share experiences and lessons learned from using electronic cash registers. HLP will provide logistical and technical assistance to the Direction d’Administration et du Budget (DAB) and the UEP to conduct the workshop in November 2019. HLP will assist the DAB and UEP to review documentation, draft an agenda for the workshop, propose a PowerPoint template for hospitals to use in developing their presentations for the workshop, and assist with facilitating the workshop itself. Also during this reporting period, HLP held discussions and work sessions via phone with the MSPP/DAB and the MSPP/UEP to prepare for the evaluation of the Plan Directeur 2012-2022.

During the reporting period, the HLP team also held the following meetings with technical partners and the MSPP:

● July 16, 2019: Met with the WHO to discuss Haiti’s financing strategy; the hospital reform (management of electronic cash register); and national health accounts.

● August 5, 2019: Met with the World Bank to discuss the planned workshop to share experiences and lessons learned from using electronic cash registers. The World Bank has agreed to fund the participation of MSPP participants (through the PASMISSI project) if the workshop is held before December 30, 2019. The World Bank would like to assist with the planning of public financial management activities under HLP.

● August 8, 2019: Met with the Global Financing Facility (GFF) focal point/MSSP to discuss the possible link between the GFF and the health financing strategy in Haiti. The GFF currently works on implementing an investment case for health financing (MCH) in Haiti. The investment case could help provide useful and relevant information for further revisions to the health financing strategy.

Objective 2 At the request of the DRH Director at the MSPP, the HLP Technical Advisor for HRH is working as an embedded advisor at the MSPP to provide direct and ongoing support to the DRH through a learning-by-doing approach. 2.1 GOH health workforce leadership increased HR review HR reviews are conducted periodically to control the quality of the system for managing HR (SIGRH) as well as HR data at the department level. In an effort to ensure the sustainability of this approach, HLP developed a PowerPoint guide on the HR review process to serve as a reference for the DRH when conducting this activity on their own. HLP planned a workshop


with HR managers, DRH, and HR focal points at the department level to present this tool, however due to the security situation, the workshop has been postponed until further notice. Capacity building for community referral hospitals management teams (in Port au Prince) Strengthening the capacity of hospital management teams is an important basis for the effective operationalization of the performance evaluation system (Système d'Évaluation de la Performance (SYSEP). As such, on May 23-24, the MSPP invited the HLP team to participate in a capacity building workshop for three community referral hospitals in Port-au-Prince (Arcachon 32, Défilé de Beudet et Bon Repos) to build their management capacity. During this workshop, HLP assisted the MSPP by leading an orientation for hospital staff on the different methods of performance management, including how to plan and develop work objectives; how to provide effective monitoring and supervision during the implementation period; and how to conduct a final self-assessment exercise followed by an annual performance review. Implementation of the SYSEP Based on the 2018-2022 Strategic Plan for the Development of Human Resources for Health for Haiti, and in accordance with the regulatory framework, the Office du Management et des Ressources Humaines (OMRH) is responsible for planning yearly final staff performance evaluations (Système d'Évaluation de la Performance (SYSEP) from October 1- November 30 (Article 32: 19 September 2014). This includes staff self-assessments, annual performance reviews, and dissemination of this information to the Direction des Ressources Humaines (DRH). In preparation for this evaluation process, the DRH/MSPP planned an orientation workshop for department level managerial teams from health institutions to orient them on the process and to plan objectives for the new fiscal year in an effort to build their capacity to lead in this area. While this workshop, which will be led by the DRH with financial support from the ACOSME project (funded by the Canadian government), was originally planned for September 24-26, 2019, due to ongoing security concerns it has been postponed until further notice. Given the ongoing security concerns, the Haiti HLP Senior Advisor for HRH organized virtual working sessions with the DRH to provide technical support to prepare for the SYSEP orientation workshop:

● September 6: Met over the phone with the DRH team to develop the ToRs and agree on a new date for the workshop with the department team in the North.

● September 9-13: Met virtually with the DRH team to develop a PowerPoint presentation on the conceptual and operational framework for the orientation workshop, as well as to develop participant kits containing evaluation forms, guides for filling out the forms, the SYSEP operational guide, and tools to compile assessment results for transmission to DRH.

SYSEP/RBF connection concept note The connection between the SYSEP and results-based financing (RBF) mechanisms aims to establish a link between individual performance and institutional performance and assess each employee’s contributions to the results in order to adjust payment of subsidies accordingly. The DRH, UEP and Vaccine Program have decided to pilot a performance evaluation tool for RBF (SYSEP/RBF). In order to do so, the following steps are required:

● Development of a conceptual framework that defines the operating mechanism


● Development of the tools to conduct the activity ● Orientation sessions for stakeholders on the approach

As such, in year 1, HLP provided technical assistance to the DRH to develop a draft concept note to pilot the SYSEP/RBF tool. As a next step, HLP will provide support to validate the concept note and begin to develop the needed tools: the RBF purchasing governance indicators table, the Directorates Business Plan, the Memorandum of Understanding between the Contracting Directorates and the MSPP/UC, the data evaluation grid and the pricing grid for the payment of subsidies. Addressing absenteeism of health workers The need to implement a sustainable solution to the problem of absenteeism of health workers in Haiti has been identified as a key priority by the MSPP. Absenteeism in the health sector is highly problematic in that it leads to delays in treatment of patients and ultimately prevents populations, especially those most vulnerable (including pregnant women and children) from accessing services and receiving care from health professionals. To address this problem, the DRH has decided to conduct unannounced attendance checks in health facilities. In year 1, HLP provided technical assistance to the DRH to develop a rapid unannounced check form to collect the necessary information during these visits and to inform decision making processes. 2.2 Distribution of health workforce improved Retention plan The retention of health staff in rural and under resourced areas is one of the greatest HRH challenges in Haiti. The situational analysis presented in the 2018-2022 Strategic Plan for the Development of Human Resources for Health shows that 88% of health professionals currently work in urban areas (with 80% of medical specialists working directly in Port au Prince). To address this issue, under HFG, the MSPP developed a health staff retention plan for the rural and under resourced areas however, it was noted that while the plan focuses greatly on the needs of the rural areas, it failed to take into account the need for medical specialists. As such, in Year 1, HLP planned a knowledge exchange workshop with local NGOs in Haiti (that currently mobilize 40% of health professionals to rural areas) to share approaches and strategies that they have found to be successful in improving staff retention. The aim of this workshop was also to complete and validate the retention plan, ensuring that it meets the needs of health workers in rural areas. Due to ongoing security concerns in the country, however, the workshop could not be conducted as planned and has been postponed until further notice. ASCP mapping In year 1, HLP provided support to La Direction de Promotion de la Santé et de la Protection de l’Environnement (DPSPE) to conduct a quality assessment of Agent de Santé Communautaire Polyvalent (ASCP) mapping data collected by the health departments. On August 13, 2019, HLP participated in a workshop organized by the La Direction de Promotion de la Santé et de la Protection de l’Environnement (DPSPE)/MSPP to validate the results of the ASCP mapping exercise. As HLP was not yet awarded at the time this activity was being planned (December 2018), USAID provided funding to the NGO Zanmi La Santé to finance the organization of this workshop. The ASCP mapping exercise is an important activity that aims


to answer three key questions: who are the ASCPs in Haiti, where are they located, and who is funding them? During the planning stages, HLP provided technical support to the Service de Santé Communautaire to analyze the data and develop a PowerPoint presentation that included the methodological framework of the exercise, the results, as well as proposed recommendations, including the need to provide comprehensive training to all ASCPs (given that 20% are currently only ‘vertically trained’ in one specific thematic area), as well as the need to develop a clear and effective transition plan for the 60% of ASCPs still currently being funded by donors. As a next step, HLP will provide support to the Service de Santé Communautaire to prepare the final report of the ASCP mapping exercise, which will serve as a basis for developing the community health strategy, in collaboration with UNICEF. Transition plan (PEPFAR) The transition of HRH to the MSPP is essential for ensuring adequate distribution of the health workforce. To prepare for the development of the transition plan to assist the MSPP to progressively transition funding for health professionals (doctors, nurses, midwives, laboratory technician, etc.) to the government and away from donors, HLP had planned a working session with the HSD project for September 18, 2019, to develop a data collection tool to assist with the mapping of HIV health workers currently paid by HSD (with funding from USAID and PEPFAR) in the different health departments. This excel tool will include information on the type of health providers (i.e. doctor, nurse, midwife, lab technician, CHW etc.) as well as their official titles in order to develop an HIV health workers inventory. This information will help to standardize titles/functions within the MSPP moving forward. Unfortunately due to the ongoing insecurity, this working session did not take place and will be rescheduled. Task sharing (PEPFAR) A priority under HLP will be to develop a task-sharing plan. As such, In October 2019, the HLP Senior Advisor for HRH held virtual knowledge exchange sessions with MSH’s HIV technical advisor, who will support the task sharing activity and the MSH Tanzania team to learn about their experience developing a task-sharing plan. Discussions centered around how the HLP team can best support the MSPP in incorporating lessons learned to implement a task sharing plan in Haiti, which has now developed national HIV/AIDS guidelines (as well as a supervision guide); data collection tools; and training modules for health professionals who received continued trainings. As a result of this meeting, the Senior Advisor for HRH was able to gather important information on approaches and strategies for Task Sharing that can be adapted to the context in Haiti. Other achievements Build local solutions capacity to become direct recipients of USAID funding In FY19Q3, the HLP team developed the Organizational Synthesis of Capacity Assessments for Award Readiness (OSCAR), an innovative tool that incorporates elements from both the NUPAS and OCA assessments to comprehensively assess the institutional capacity of an organization and readiness to receive USG funding over time. The OSCAR tool provides a rating (from 1 to 4) across three essential sustainability factors: institutional, programmatic, and financial. The tool is used to assess seven domains and subdomains corresponding to the OCA and NUPAS sub-sections:

1. Governance and Legal Structure


2. Financial Management and Internal Control Systems 3. Administration and Procurement Systems 4. Human Resource Systems 5. Program Management 6. Project Performance Management 7. Organizational Management and Sustainability

On August 13, 2019, HLP conducted a joint Organizational Synthesis of Capacity Assessments for Award Readiness (OSCAR) stakeholder alignment meeting with GC and CFET. Six (6) representatives (3 men and 3 women) from GC and CFET (2 from GC and 4 from CFET including the directors of these organizations) participated in the meeting. The objective of the alignment meeting was to introduce OSCAR to partners to ensure a common understanding of the tool. Under HLP, partners will use this tool to identify and assess gaps and weaknesses across the seven managerial domains of their respective organizations to help them and HLP evaluate their institutional, financial, and programmatic sustainability and capacity to receive and absorb direct funding from USAID. During the first two years of the project, HLP will provide technical support to GC and CFET to conduct regular OSCAR evaluations that will enable them to self-monitor and track their improvements across the OSCAR domains (and make adjustments where necessary) in order to meet the requirements to receive direct funding. GC and CFET validated the technical approach, noting that OSCAR is a user friendly tool and is well presented compared to other organizational development tools. They appreciate the fact that OSCAR is set up in a way to provide pertinent information, such as the means of verification, and that it uses dashboards that help to easily present and understand data, including each organization's stage of development. On August 26-29, 2019, CFET conducted its first organizational capacity assessment using the OSCAR tool with support from HLP. CFET achieved a global score of two out of four, which means that while CFET has a basic capacity to receive and manage direct funding from USAID, the organization would, at this stage, unlikely meet Non-US organization Pre-Award Surveys (NUPAS) requirements without first strengthening key areas of institutional, programmatic and financial capacity. Results from the assessment also highlighted that among the sustainability factors CFET’s strengths are in its financial capacity where they scored a three out of four (compared to scores of two and one in institutional and programmatic sustainability). On September 10-11, GC conducted their organizational capacity assessment using the OSCAR tool with the support of HLP. GC, like CFET, also received a score of two out of four, which also means that they will need to strengthen all three sustainability factors (financial, institutional and programmatic) in order to be able to pass the NUPAS evaluation. In terms of the sustainability factors, GC is also strongest in their financial capacity, scoring a three out of four (compared to two for institutional and programmatic sustainability). The results of this assessment will constitute the baseline score of each organization’s capacity to receive direct USAID funding. The sustainability scores of each partner are presented in Figure 1 and 2 below.


Figure 1: Sustainability scores for GC from OSCAR Tool Figure 2: Sustainability scores for CFET from OSCAR Tool

Based on the results of the OSCAR assessment, both CFET and GC developed a five-month action plan to address weaknesses identified in some of the priority domains. HLP will work closely with both organizations to monitor and support the implementation of each organization’s action plan. HLP assistance will include conducting trainings and providing direct coaching/mentoring support to help partners develop and implement missing managerial tools identified during their assessment (ie. branding and marking plans and sub award monitoring plans). This coaching period will enable both partners to better prepare themselves for their second OSCAR evaluation and improve in the areas identified as weakest during the first assessment. Integration of cross cutting issues

Cross cutting issue

Progress made

Local capacity development

Local partner staff embedded in HLP, working alongside MSH and MSPP staff to develop the technical capacity to lead results after year 2 CG and CFET lead self-assessments of readiness to receive USG funding using OSCAR

Gender HLP Gender and Social Inclusion Strategy submitted to USAID, including proposed approaches for gender inclusion in all project activities Gender considerations integrated into MEL plan and project indicators

Environmental compliance

Approved Regulation 216 environmental documentation by USAID

Sustainability approach and goals

MSPP ownership of HLP objectives/activities: Implemented a Project Monitoring Committee composed of key representatives from the different MSPP departments (UEP, DAB, UADS, DRH, DOSS)


HLP conducted a joint revision of the Year 1 implementation plan with the MSPP to ensure adherence to MSPP objectives and priorities Strengthen the organizational and technical capacity of the two partner organizations, GC and CFET: One staff member from each partner organization has been embedded in HLP, working alongside MSH staff to develop the technical capacity to lead results after year 2 Both organizations have conducted the first organizational capacity assessment using the MSH-developed OSCAR tool. Based on results, partners have developed 5-month action plans to strengthen key areas of institutional, programmatic and financial capacity identified as weakest during the assessment.

III. KEY PROJECT ACTIVITIES FOR THE NEXT QUARTER

HLP will conduct the following activities in FY20Q1/PY1Q3 (October 1 - December 30, 2019). Additional activities will be confirmed following further discussions with the MSPP and USAID on the PY1 work plan. Objective 1: Build GOH Capacity to Lead and Finance the Health Sector

● Provide technical assistance to the DAB to conduct a rapid assessment of the public finance management capacity of directorates and hospitals at the department level;

● Provide technical and logistical support to the DAB to conduct a workshop for hospitals to share experiences and lessons learned in using electronic cash registers;

● Provide technical assistance to the MSPP to further analyze/diagnose the health-financing context in Haiti. Technical support will include assisting the MSSP to develop ToRs and tools to conduct the following two studies:

o The management and use of internal revenue within the public health system; o A situation analysis of public and private health insurance companies (including

the mutuelles de santé).

Objective 2: Improve GOH Planning and Oversight of the Health Workforce ● Provide coaching and mentoring support to MSPP/DRH teams to organize periodic reviews

of the human resource management activities, initiated under the HFG project. ● Provide technical support to the DRH to implement the SYSEP, which includes developing

evaluation tools, coaching supervisors on the process, and providing tools to collect and analyze data for decision-making. HLP’s Senior Advisor for HRH will provide supervision support to the MSPP managerial teams and serve as an ‘embedded advisor’ at the MSSP during this time to assist with operational tasks, as requested by the DRH.

● Provide technical support to the DRH to develop a performance evaluation tool for results based financing (RBF) and to implement a pilot of the SYSEP/RBF tool at the central directorate level, in collaboration with the MSPP Contracting Unit and the OMRH. The objective of this activity is to establish a link between individual performance and institutional performance, and based on results, adjust payment of subsidies. Next quarter,


HLP will assist the DRH to meet with the Unite de Contractualisation (responsible for RBF in eight departments) in order to help gather knowledge and lessons learned from their RBF experience which the DRH can use to develop a concept note for the new SYSEP/RBF approach that they will be implementing;

● Provide mentoring and coaching support to the DRH to develop standard organizational charts by level of the management and care pyramid to provide a more clear understanding of reporting lines and roles and responsibilities;

● Provide support to the DPSPE/MSPP Service de Santé Communautaire to develop the ASCP mapping activity report including results and recommendations. HLP, in collaboration with CFET, will provide technical support to the DPSPE/MSPP to become familiar with how to process data (cleaning up and analyzing the data, developing graphs, etc.) and to develop clear and achievable recommendations. The aim is for the Service de Santé Communautaire team to become comfortable with developing these kinds of reports.

Build local solutions capacity to become direct recipients of USAID funding

● Provide support to monitor each partner’s five-month action plan based on OSCAR results; ● Coach and provide technical support to local solutions partners to strengthen their

organizational capacity in identified areas that require strengthening. Upcoming activities include developing organizational branding and marketing plans with each partner (with their logos and taglines); developing and rolling out policies to manage sub-awardees; and strengthening their understanding around cost share.

CHALLENGES AND LESSONS LEARNED Limited technical capacity of local partners on the project The technical capacity and expertise of the two local solutions partners, GC and CFET is not yet at the level needed to conduct the health finance and HRH activities in two years’ time. As such, select staff from both partner organizations have been embedded at the HLP office, and will be working closely and alongside MSH and MSSP staff in order to develop their technical capacity to lead results after two years in the areas of health governance and human resources for health. Political insecurity has negatively impacted the implementation of planned HLP activities The ongoing political instability and security concerns in Haiti that erupted in late August and into September have significantly impacted the progress of many of HLP’s planned activities. For instance, the OSCAR evaluation for GC had to be postponed from early September until later in the month, and the workshop had to be conducted in two days instead of four due to security concerns. Furthermore, technical discussions with key stakeholders including Unite d’Arrondissement Sanitaire (UAS) on the Paquet Essentiel de Service (PES), as well as discussions regarding HLP governance activities have been delayed. The shortage of fuel has also limited staff’s ability to travel and access the office on a regular basis, thus also delaying many of the team’s planned activities and meetings. The HLP team is currently sending weekly updates to USAID on the security situation and the impact of HLP activities, which are included in Annex 1. HLP implemented several strategies in an effort to mitigate the security challenges and enable staff to continue their work and conduct activities as planned under HLP, to the extent possible. HLP closely monitored the security situation through regular security meetings/briefings with the MSH


Security Advisor and home office team; routine communication with USAID, the MSPP, NGO network in Haiti, and other stakeholders; and local television and radio news to stay up-to-date and informed daily on the situation. HLP also receives daily security updates from the MSH Security Advisor, ‘Ange Gardien,’ OSAC, and the United States Embassy that is disseminated to all staff. On days when violent protests are announced, staff are contacted and asked to work from home. If for any reason a staff member is already in the office, they are advised to either take shelter or return home as quickly as possible (if the route is safe enough for them to get home) and to communicate with the team once they are safely home. With regards to the security measures at the HLP office, HLP added a heavy metal door for further protection at the entrance and arrangements have been made with ‘Ange Gardien, S.A,’ MSH’s security company, to increase the number of security guards at the office on an ad-hoc basis as needed, as well as for airport pick-ups. To ensure staff safety and wellbeing at all times, the Haiti MSH office has developed a phone tree in order to be able to easily contact every staff member and assess their personal situation on days when there are violent protests. In addition, HLP developed a team WhatsApp group to be able to contact staff simultaneously and share messages and news updates in real-time. HLP is also in the process of procuring an Iridium 9555 Satellite Phone as a precaution in order to be able to remain in contact with MSH home office and others if the networks are disabled. HLP encouraged staff to work remotely when possible to continue planning for activities with the MSPP and partners. Staff were given cards to access the internet remotely when it was not possible to come into the office. Lessons Learned from Program to Date

Lesson learned Program Application

Embedding a technical advisor is effective for implementing a ‘learning by doing’ approach

The HLP Technical Advisor for HRH will be embedded in the MSPP to provide a direct support to conduct a review of the key documents and the SYSEP (Performance Evaluation System).

A multidisciplinary approach is effective in strengthening the capacity of local partners

The different leads on the HLP project provided their technical expertise and input on how to best assess/evaluate GC and CFET, and develop actions plans to address weaknesses and strengthen their capacity in these areas

Security updates to USAID: In the FY19 Q4 a separate PDF security updates section has already been sent to USAID covering the period up to September 30th, 2019. A separate section will not be repeated as the end of this Annual Report. However, HLP will continue to submit weekly updates on security assessment to USAID until the situation returns to normal.

health leadership project (hlp)

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